905 To Operate or Not to Operate? a Clinical Audit in the Management of Adhesional Small Bowel Obstruction
G Karagiannidis, T Khaliq, M El-Farran, F Youssef- Surgery
Abstract
Aim
To compare our current management of adhesional small bowel obstruction (ASBO) with the National audit for small bowel obstruction 2017 and Bologna guidelines, to produce a flow chart which will indicate:First line management should be with intravenous fluids, analgesia, anti-emetics, and nasogastric tube (NGT).Patients diagnosed with ASBO should first undergo a trial conservative management with a water-soluble contrast.Operative management should be considered after 72 hours of non-resolving SBO.
Method
The medical records of all SBO patients admitted to Ipswich Hospital NHS trust between 1/4/2020 and 1/4/2021 were screened. All patients above 16 years of age and with a clinical diagnosis of ASBO were included in the audit.
Results
43 patients were diagnosed with ASBO.All patients were prescribed IV fluids. 38 (88.4%)and 36 patients (83.7%)received analgesia and anti-emetics respectively.21 patients(72.1%) had a NG tube inserted.24 patients (53.5%) were treated conservatively while 19 patients were taken to theater.37% of the ASBO patients, who were managed conservatively, were given a water-soluble contrast(Gastrograffin),which caused resolution of the obstruction in 20 patients(83.3%),while the rest were taken to theater.The average time to theater was 4 days(96 hours).
Conclusions
Our results are in line with the comparing standards. Our first line management for ASBO could be improved.The use of a water-soluble contrast should be used more regurarly in the conservative management of ASBO. A step-by-step ASBO flow chart could help the admitting surgical team follow the appropriate steps for the better management of ASBO.