A review of the management of small bowel obstruction. Members of the Surgical and Clinical Adhesions Research Study (SCAR).

Small bowel obstruction is a significant surgical problem and is commonly caused by postoperative adhesions. Patients suffering from this condition are often difficult to assess and require careful evaluation and management. Articles regarding the diagnosis, evaluation and management of small bowel obstruction have been identified from the Ovid, Embase and Silver Platter electronic databases and then reviewed by the authors. Particular emphasis has been placed on randomised controlled trials or large prospective series. Anecdotal reports or those containing small numbers have been largely excluded, but where they have been included it has been made clear in the text. The management of small bowel obstruction is predominantly the management of obstruction due to postoperative adhesions. The selective use of radiological techniques, such as water soluble contrast and CT studies, often help to characterise the nature of the obstruction and may even help with its resolution. Techniques involving the use of laparoscopy and barrier membranes may reduce morbidity but there is a need to evaluate these strategies further with prospective clinical trials.