A common case with common problems: laparoscopic treatment of small bowel obstruction (SBO)

Abstract

Background: Laparoscopic approach to patients with suspected small bowel obstruction (SBO) is not yet widely accepted nor clearly standardized; due to the absence of randomized trials, many questions still remain matter of debate.

Methods: By describing a single typical case of acute intestinal occlusive syndrome in a 82 years old woman, in which a SBO was suspected on the basis of previous surgical history and CT scan imaging, every single step of therapy is discussed, including the decision to perform explorative laparoscopy, the first trocar placement, the decision to continue by laparoscopy or to convert in laparotomy, and finally the small bowel resection and re-anastomosis.

Results: The decision to approach a suspected SBO by laparoscopy should be taken on the basis of a number of features which would predict the success rate, such as mild abdominal distention, proximal obstruction, partial obstruction, small bowel diameter less than 4 cm, previous appendenctomy, anticipated single band adhesion. In these cases laparoscopic approach may improve post-operative outcomes in terms of reduced postoperative ileus, hospitalization and wound infection rate.

Conclusions: In selected, not unusual cases of SBO, a laparoscopic approach is feasible and effective. A growing Literature, mainly based upon retrospective series, is available.

Key words: Conversion, Laparoscopy, Mortality, Small bowel obstruction, Surgery.