New paradigms in the treatment of small bowel obstruction.
urgery in the 21st century has seen the development of a host of exciting echnological and management innovations such as minimally invasive urgery, endovascular treatment in vascular disease, endoscopic proceures that require no incision, and potent and effective new medications hat have altered the natural history of some surgical diseases. One isease that has changed very little in its incidence, natural history, reatment approach, and preventability is small bowel obstruction (SBO) mall bowel obstruction remains a common and difficult problem ncountered by all surgeons who operate in the abdomen. Given its ommon and serious nature, it is surprising that so little progress has been ade in preventing and treating it when it occurs. Nevertheless, over the ast 15 years, some modest progress and advancements have been made n its treatment, which will be the focus of this review. In Wiseman's review of the topic, he noted that Hunter knew about BO in the mid 1700s and described a case associated with adhesions, eritonitis, and infection. In 1842, Bryant reported a fatal case of bowel bstruction caused by adhesions. Both Muller and Malcolm described sing salt solution to "float the intestines" and prevent adhesions in 1886 nd 1889 respectively. By 1932, adhesions accounted for 7% of ntestinal obstructions in the United Kingdom, and by 1934, Moss eported that 27% of intestinal obstructions in the United States were due o adhesions (Table 1)
Current problems in surgery