Primary Operative Management for Low Adhesive Bowel Obstruction.

Background: Our patients that required surgery for adhesive small bowel obstruction (ASBO) were noticed to have a peculiar association. This link was the type of surgery they had originally; operations in the pelvis or those in which the scars were below the umbilicus. These patients did not improve on conservative management. This study was then undertaken to investigate this trend and to recommend primary surgery for these group of patients, terming them as low adhesive small bowel obstruction for the purpose of the study.
Methods: This is a retrospective descriptive study from April 2003 to February 2010 on patients who were admitted on the service of the gastrointestinal surgery unit of the University College Hospital Ibadan, Nigeria, with a diagnosis of ASBO and had surgery for relief of the condition. Demographic indices like age, sex and type of previous operation were taken into account.
Results: There were 4 male and 17 female patients, a Male to Female ratio of 1: 4. Their Ages ranged from 23-60 years. The global mean age was 40 years. The mean age for males was 31.5 years while for the female patients it was 42 years. Previous surgical operations showed that gynecological operations were in the majority (62%), followed by appendicectomy (24%) and colorectal surgery made up the rest (14%).
Conclusion and Recommendations: We propose primary surgical treatment for low ASBO especially those from gynecological operations and appendicectomy. Conservative management should be reserved as the initial treatment of non-low-level ASBO until other features prove otherwise.