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Complete Versus Partial Small Bowel Obstruction: an Obsolete Classification?
*Ali Y Mejaddam, *Carolina V Solis, *Ayesha M Imam, *Yuchiao Chang, Hasan B Alam, *David R King, *Peter J Fagenholz, *Marc A de Moya
Massachusetts General Hospital/Harvard Medical School, Boston, MA

OBJECTIVE: The management of complete adhesive small bowel obstruction (C-SBO) has traditionally been supported by the old adage “never let the sun rise or set on a complete SBO”. There may be a trend towards more aggressive non-operative management given the increased use of computed tomography (CT) or simply changes in practice patterns. We conducted a study to evaluate differences in predictors and outcomes of C-SBO versus partial SBO (P-SBO).
DESIGN: Retrospective cohort study.
SETTING: Academic tertiary medical center.
PATIENTS: Patients admitted with adhesive SBO (2008-2011).
MAIN OUTCOME MEASURES: Need for operative lysis of adhesions.
RESULTS: There were 152 patients with adhesive SBO during the study period (62±19 years old, 51% male). 27 (18%) patients had C-SBO and the remaining 125 (82%) were identified as P-SBO. On univariate analysis, none of the study variables were associated with C-SBO except for increased admission to the intensive care unit (p=0.029). The need for surgery was not significantly different between both groups (48% C-SBO vs. 32% P-SBO; p=0.11). Significant predictors of the need for surgery on multivariable analysis were rebound tenderness to palpation (p<0.0001) and high-grade partial obstruction on CT (p=0.0003).
CONCLUSIONS: C-SBO was not associated with an increased need for surgery or worse outcomes compared to P-SBO. High-grade obstruction on CT or signs of peritonitis are associated with the need for operation. The classification of SBO as complete or partial is unnecessary.


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