The course of 101 patients with small bowel obstruction due to adhesion seen at Kangnam eneral Hospital from january 1991 to July 1994 was analyzed. The patients were divided into two groups on the basis of the type of treatment: those treated
operatively(N=40) and those treated nonoperatively(N=61). Clinical parameters such as age, sex, symptoms and signs, type of previous operations, interval of time from onset of symptom to hospitalization, interval of time from hospitalization to
operation, previous history of hospitalization due to intestinal obstruction, and morbidity and mortality were compared between two groups, to determine the factors influencing the modality of treatment of adhesive intestinal obstruction.
Among 101 cases, 10 cases(10%%) were treated with emergency operation, 30 cases(30%) with elective delayed operation, and 61 cases(60%) with nonoperative management. There were no difference of distribution of age and sex between two groups. The
symptoms and signs such as continuous abdominal pain, rebound tenderness, fever, and tachycardia occured more frequently in the loperative group than in the conservative group. In the patients who had two or more classic signs of strangulation
the
chance of operation and intestinal resection was higher. The patients with previous history of operation was 90 cases(89%). The rate of operative treatment was higher in cases whose previous operations had been ouch as gynecologic procedures and
intussusception, and was lower in cases whose previous operation had been hepatobiliary procedures. The rate of operative treatment was increased in cases of delayed hospital visit, especially in cases of 48 hours delay. The chance of intestial
resection was higher in cases of delayed decision of operation, especially in cases of 48 hours delay. Thus, it is preferable to consider operative management for the patients who does not relieved symptoms within 2 days of conservative
management.
The
chance of the nonoperative treatment for the patients with previous history of admission due to intestinal obstruction was slightly higher than that for the patients wit no previous history of admission. Morbidity and mortality of operative group
was
40% and 2.5% respectively, and morbidity and mortality of conservative group was 6.6% and 1.64%, respectively.
In conclusion, operative treatment rather than conservative treatmet should be considered in the patients with adhesive intestinal obstruction, if they have two or more signs of strangulation, type of previous opertions such as gynecologic
surgery
and
intussusception, 48 hours delay f hospital visit, no improvement of obstruction after 2 days conservative treatment, and the first attack of obstruction.
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