Current management of small-bowel obstruction.

In conclusion, most of the recent advances in the management of small bowel obstruction consist of developments in the imaging modalities available to assist in the diagnosis itself, particularly with regard to the distinction between partial and complete obstruction. Unfortunately, little progress has been made to enable physicians to detect early, reversible strangulation, and therefore the surgical management of small-bowel obstruction has changed very little over the past 10 years. Because of the inability to detect reversible ischemia, there is a substantial risk of progression to irreversible ischemia (and an inherent rise in morbidity and mortality) when surgery is delayed for an extended period of time, especially in the setting of suspected complete obstruction. However, almost all patients do benefit from an initial 12 to 24 hours of resuscitation and decompression in cases of complete obstruction; resuscitation and decompression can usually be extended for a longer period of time in those patients with partial obstruction who exhibit no signs of progression (Fig 6). It is encouraging, however, that some advances have been made in understanding the pathophysiology and prevention of adhesion formation. Research efforts in the future should continue to focus on these issues as well as on the development of methods to better recognize early signs of strangulation.