American journal of surgery | 2019
Small bowel obstruction in a virgin abdomen.
Abstract
INTRODUCTION\nSurgical exploration is still considered mandatory in the setting of small bowel obstruction (SBO) and a virgin abdomen by some large centers. The aim of this study is to determine the etiology of SBO in patients without prior abdominal operation.\n\n\nMETHODS\nRetrospective review of the patients treated for SBO and virgin abdomen at the Mayo Clinic between 2006 and 2016 was performed. Follow up data, operative and pathologic findings were examined to determine the etiology of SBO.\n\n\nRESULTS\nSixty patients met inclusion criteria; abdominal exploration was performed in 50 patients (83%) and 10 patients (17%) were managed non-operatively. Exploration was therapeutic in 29 (58%), negative in 20 (40%) and non-therapeutic in one patient (2%). Overall, 8 patients (13%) were diagnosed with a malignancy: right-sided colon cancer (n\u202f=\u202f3), small bowel (SB) neuroendocrine tumor (n\u202f=\u202f2), SB lymphoma (n\u202f=\u202f2) and carcinomatosis peritonei (n\u202f=\u202f1); Upon retrospective review, both SB neuroendocrine tumors and one SB lymphoma were visible on the initial imaging. Leukocytosis (p\u202f=\u202f.03) and no recent weight loss (p\u202f=\u202f.04) were associated with negative exploration.\n\n\nCONCLUSION\nPatients with SBO and virgin abdomen frequently have a benign etiology. Careful imaging review directed at subtle signs of an underlying malignancy is warranted. If non-operative management is chosen, close follow up is essential and it should include a careful personal and family history as well as updated colonoscopy.