New Bologna guidelines for adhesive small bowel obstruction (ASBO)

Published On 2018-07-09 13:31 GMT   |   Update On 2018-07-09 13:31 GMT

Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and in some cases may prove to be fatal. The current guideline which appears in the World Journal of Emergency Surgery is a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The new guideline presents recommendations that can be used by surgeons who treat patients with ASBO.


Although adhesive small bowel obstruction is a common condition, the prevention and treatment are often characterized by surgeons’ personal preferences rather than standardized evidence-based protocols. There is a large amount of conflicting and low-quality evidence in publications regarding treatment of adhesive small bowel obstruction.


Therefore, the World Society of Emergency Surgery (WSES) working group on ASBO has developed evidence-based guidelines to support clinical decision making in the diagnosis and management of ASBO


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Key Recommendations:

  • Laparoscopic surgery reduces adhesion formation and might reduce subsequent incidence of ASBO.

  • Hyaluronate carboxymethylcellulose reduces adhesion formation and the risk of subsequent reoperations of adhesive SBO. The use of this barrier seems cost-effective in open colorectal surgery.

  • In the absence of signs that require emergent surgical exploration (i.e., peritonitis, strangulation, or bowel ischemia), non-operative management is the treatment strategy of choice.

  • A trial of non-operative management can be continued safely for 72 h.

  • Initial evaluation should be complemented with the assessment of nutritional status and laboratory tests evaluating at least blood count, lactate, electrolytes, and BUN/Creat

  • Plain X-rays have only limited value in the workup of patients with small bowel obstruction and are not recommended.

  • Optimal diagnostic workup should include a CT scan in the assessment and water-soluble oral contrast. In the absence of the need to perform immediate surgery, a follow-up abdominal X-ray should be made after 24 h. If the contrast has reached the colon, this is indicative of the resolution of the bowel obstruction.

  • Long trilumen Naso-intestinal tubes are more efficacious than nasogastric tubes in non-operative management but require endoscopic placement.

  • Adhesion barriers reduce the risk of recurrence for ASBO following operative treatment.

  • Younger patients, and pediatric patients, in particular, have a higher lifetime risk of developing adhesion-related complications and might, therefore, benefit most from adhesion prevention.

  • Patients with diabetes might require more early operative intervention.


For more reference log on to https://doi.org/10.1186/s13017-018-0185-2


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Article Source : With inputs from World Journal of Emergency Surgery

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