Review

. 2018 Jun 19:13:24.

doi: 10.1186/s13017-018-0185-2. eCollection 2018.

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Richard P G Ten Broek^#^{1

2}, Pepijn Krielen^#¹, Salomone Di Saverio³, Federico Coccolini⁴, Walter L Biffl⁵, Luca Ansaloni⁴, George C Velmahos⁶, Massimo Sartelli⁷, Gustavo P Fraga⁸, Michael D Kelly⁹, Frederick A Moore¹⁰, Andrew B Peitzman¹¹, Ari Leppaniemi¹², Ernest E Moore¹³, Johannes Jeekel¹⁴, Yoram Kluger¹⁵, Michael Sugrue¹⁶, Zsolt J Balogh¹⁷, Cino Bendinelli¹⁸, Ian Civil¹⁹, Raul Coimbra²⁰, Mark De Moya²¹, Paula Ferrada²², Kenji Inaba²³, Rao Ivatury²², Rifat Latifi²⁴, Jeffry L Kashuk²⁵, Andrew W Kirkpatrick²⁶, Ron Maier²⁷, Sandro Rizoli²⁸, Boris Sakakushev²⁹, Thomas Scalea³⁰, Kjetil Søreide^{31

32}, Dieter Weber³³, Imtiaz Wani³⁴, Fikri M Abu-Zidan³⁵, Nicola De'Angelis³⁶, Frank Piscioneri³⁷, Joseph M Galante³⁸, Fausto Catena³⁹, Harry van Goor¹

Affiliations

¹ 1Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
² 39Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
³ 2Addenbrooke's Hospital, Cambridge, UK.
⁴ 3General Emergency and Trauma Surgery, Bufalini hospital, Cesena, Italy.
⁵ 4Acute Care Surgery, The Queen's Medical Center, Honolulu, Hawaii USA.
⁶ 5Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA.
⁷ Department of Surgery, Macerata Hospital, Macerata, Italy.
⁸ Faculdade de Ciências Médicas (FCM), Unicamp Campinas, São Paulo, Brazil.
⁹ Albury Hospital, Albury, NSW Australia.
¹⁰ 9University of Florida, Gainesville, USA.
¹¹ 10Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA.
¹² Second Department of Surgery, Meilahti Hospital, Helsinki, Finland.
¹³ 12Trauma Surgery, Denver Health, Denver, CO USA.
¹⁴ 13Erasmus MC, Rotterdam, The Netherlands.
¹⁵ Division of General Surgery Rambam Health Care Campus Haifa, Haifa, Israel.
¹⁶ General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland.
¹⁷ 16Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia.
¹⁸ John Hunter Hospital, New Lambton Heights, New Zealand.
¹⁹ 18Department of Vascular and Trauma Surgery, Auckland City Hospital, Auckland, New Zealand.
²⁰ 19Department of Surgery, UC San Diego Health System, San Diego, USA.
²¹ Trauma, Acute Care Surgery Medical College of Wisconsin/Froedtert Trauma Center Milwaukee, Milwaukee, Wisconsin USA.
²² 21Virginia Commonwealth University, Richmond, VA USA.
²³ 22Division of Trauma & Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA USA.
²⁴ 23Department of General Surgery, Westchester Medical Center, Westchester, NY USA.
²⁵ 24Department of General Surgery, Assuta Medical Centers, Tel Aviv, Israel.
²⁶ 25Department of Surgery, Foothills Medical Centre, Calgary, Canada.
²⁷ Department of Surgery, Harborview Medical Centre, Seattle, USA.
²⁸ 27Trauma & Acute Care Service, St Michael's Hospital, Toronto, ON Canada.
²⁹ 28Department of General Surgery, University of Medicine Plovdiv, Plovdiv, Bulgaria.
³⁰ 29R Adams Crowley Shock Trauma Center, University of Maryland, Baltimore, USA.
³¹ 30Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
³² 31Department of Clinical Medicine, University of Bergen, Bergen, Norway.
³³ 32Department of General Surgery, Royal Perth Hospital, The University of Western Australia and The University of Newcastle, Perth, Australia.
³⁴ 33Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India.
³⁵ 34Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
³⁶ 35Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France.
³⁷ 36Canberra Hospital, Canberra, Australia.
³⁸ 37Trauma and Acute Care Surgery and Surgical Critical Care Trauma, Department of Surgery, University of California, Davis, USA.
³⁹ Emergency and Trauma Surgery, Parma Maggiore hospital, Parma, Italy.

^# Contributed equally.

PMID: 29946347
PMCID: PMC6006983
DOI: 10.1186/s13017-018-0185-2

Review

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Richard P G Ten Broek et al. World J Emerg Surg. 2018.

. 2018 Jun 19:13:24.

doi: 10.1186/s13017-018-0185-2. eCollection 2018.

Authors

Affiliations

¹ 1Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
² 39Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
³ 2Addenbrooke's Hospital, Cambridge, UK.
⁴ 3General Emergency and Trauma Surgery, Bufalini hospital, Cesena, Italy.
⁵ 4Acute Care Surgery, The Queen's Medical Center, Honolulu, Hawaii USA.
⁶ 5Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA.
⁷ Department of Surgery, Macerata Hospital, Macerata, Italy.
⁸ Faculdade de Ciências Médicas (FCM), Unicamp Campinas, São Paulo, Brazil.
⁹ Albury Hospital, Albury, NSW Australia.
¹⁰ 9University of Florida, Gainesville, USA.
¹¹ 10Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA.
¹² Second Department of Surgery, Meilahti Hospital, Helsinki, Finland.
¹³ 12Trauma Surgery, Denver Health, Denver, CO USA.
¹⁴ 13Erasmus MC, Rotterdam, The Netherlands.
¹⁵ Division of General Surgery Rambam Health Care Campus Haifa, Haifa, Israel.
¹⁶ General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland.
¹⁷ 16Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia.
¹⁸ John Hunter Hospital, New Lambton Heights, New Zealand.
¹⁹ 18Department of Vascular and Trauma Surgery, Auckland City Hospital, Auckland, New Zealand.
²⁰ 19Department of Surgery, UC San Diego Health System, San Diego, USA.
²¹ Trauma, Acute Care Surgery Medical College of Wisconsin/Froedtert Trauma Center Milwaukee, Milwaukee, Wisconsin USA.
²² 21Virginia Commonwealth University, Richmond, VA USA.
²³ 22Division of Trauma & Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA USA.
²⁴ 23Department of General Surgery, Westchester Medical Center, Westchester, NY USA.
²⁵ 24Department of General Surgery, Assuta Medical Centers, Tel Aviv, Israel.
²⁶ 25Department of Surgery, Foothills Medical Centre, Calgary, Canada.
²⁷ Department of Surgery, Harborview Medical Centre, Seattle, USA.
²⁸ 27Trauma & Acute Care Service, St Michael's Hospital, Toronto, ON Canada.
²⁹ 28Department of General Surgery, University of Medicine Plovdiv, Plovdiv, Bulgaria.
³⁰ 29R Adams Crowley Shock Trauma Center, University of Maryland, Baltimore, USA.
³¹ 30Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
³² 31Department of Clinical Medicine, University of Bergen, Bergen, Norway.
³³ 32Department of General Surgery, Royal Perth Hospital, The University of Western Australia and The University of Newcastle, Perth, Australia.
³⁴ 33Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India.
³⁵ 34Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
³⁶ 35Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France.
³⁷ 36Canberra Hospital, Canberra, Australia.
³⁸ 37Trauma and Acute Care Surgery and Surgical Critical Care Trauma, Department of Surgery, University of California, Davis, USA.
³⁹ Emergency and Trauma Surgery, Parma Maggiore hospital, Parma, Italy.

^# Contributed equally.

PMID: 29946347
PMCID: PMC6006983
DOI: 10.1186/s13017-018-0185-2

Abstract

Background: Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups.

Methods: The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion.

Recommendations: Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO.Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention.

Discussion: This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.

Keywords: Adhesions; Laparoscopy; Laparotomy; Small bowel obstruction; Surgery.

PubMed Disclaimer

Conflict of interest statement

Not applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Peritoneal adhesion index. Reproduced with permission from [35]

**Fig. 2**
Algorithm to diagnosis and treatment of ASBO

See this image and copyright information in PMC

References

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Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Affiliations

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Authors

Affiliations

Abstract

Conflict of interest statement

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References

Publication types

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LinkOut - more resources

Full Text Sources

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Medical