INTRODUCTION: Small bowel obstruction (SBO) in pregnancy is rare and is most commonly caused by adhesions from previous abdominal surgery. Previous literature reviews have emphasised the need for prompt laparotomy in all cases of SBO because of the significant risks of fetal loss and maternal mortality. We undertook a review of the contemporary literature to determine the optimum management strategy for SBO in pregnancy. METHODS: The MEDLINE® and PubMed databases were searched for cases of SBO in pregnancy between 1992 and 2014. Two cases from our own institution were also reviewed. RESULTS: Forty-six cases of SBO in pregnancy were identified, with adhesions being the most common aetiology (50%). The overall risk of fetal loss was 17% and the maternal mortality rate was 2%. In cases of adhesional SBO, 91% of cases were managed surgically, with 14% fetal loss. Two cases (9%) were managed conservatively with no complications. Magnetic resonance imaging (MRI) was used to diagnose SBO in 11% of cases. CONCLUSIONS: Based on our experience and the contemporary literature, we recommend that urgent MRI of the abdomen should be undertaken to diagnose the aetiology of SBO in pregnancy. In cases of adhesional SBO, conservative treatment may be safely commenced, with a low threshold for laparotomy. In other causes, such as volvulus or internal hernia, laparotomy remains the treatment of choice.
INTRODUCTION:Small bowel obstruction (SBO) in pregnancy is rare and is most commonly caused by adhesions from previous abdominal surgery. Previous literature reviews have emphasised the need for prompt laparotomy in all cases of SBO because of the significant risks of fetal loss and maternal mortality. We undertook a review of the contemporary literature to determine the optimum management strategy for SBO in pregnancy. METHODS: The MEDLINE® and PubMed databases were searched for cases of SBO in pregnancy between 1992 and 2014. Two cases from our own institution were also reviewed. RESULTS: Forty-six cases of SBO in pregnancy were identified, with adhesions being the most common aetiology (50%). The overall risk of fetal loss was 17% and the maternal mortality rate was 2%. In cases of adhesional SBO, 91% of cases were managed surgically, with 14% fetal loss. Two cases (9%) were managed conservatively with no complications. Magnetic resonance imaging (MRI) was used to diagnose SBO in 11% of cases. CONCLUSIONS: Based on our experience and the contemporary literature, we recommend that urgent MRI of the abdomen should be undertaken to diagnose the aetiology of SBO in pregnancy. In cases of adhesional SBO, conservative treatment may be safely commenced, with a low threshold for laparotomy. In other causes, such as volvulus or internal hernia, laparotomy remains the treatment of choice.
Authors: Emanuel Kanal; A James Barkovich; Charlotte Bell; James P Borgstede; William G Bradley; Jerry W Froelich; J Rod Gimbel; John W Gosbee; Ellisa Kuhni-Kaminski; Paul A Larson; James W Lester; John Nyenhuis; Daniel Joe Schaefer; Elizabeth A Sebek; Jeffrey Weinreb; Bruce L Wilkoff; Terry O Woods; Leonard Lucey; Dina Hernandez Journal: J Magn Reson Imaging Date: 2013-01-23 Impact factor: 4.813
Authors: Richard P G Ten Broek; Pepijn Krielen; Salomone Di Saverio; Federico Coccolini; Walter L Biffl; Luca Ansaloni; George C Velmahos; Massimo Sartelli; Gustavo P Fraga; Michael D Kelly; Frederick A Moore; Andrew B Peitzman; Ari Leppaniemi; Ernest E Moore; Johannes Jeekel; Yoram Kluger; Michael Sugrue; Zsolt J Balogh; Cino Bendinelli; Ian Civil; Raul Coimbra; Mark De Moya; Paula Ferrada; Kenji Inaba; Rao Ivatury; Rifat Latifi; Jeffry L Kashuk; Andrew W Kirkpatrick; Ron Maier; Sandro Rizoli; Boris Sakakushev; Thomas Scalea; Kjetil Søreide; Dieter Weber; Imtiaz Wani; Fikri M Abu-Zidan; Nicola De'Angelis; Frank Piscioneri; Joseph M Galante; Fausto Catena; Harry van Goor Journal: World J Emerg Surg Date: 2018-06-19 Impact factor: 5.469