Frykberg E R, Phillips J W
Department of Surgery, University of Florida, University Hospital, Jacksonville 32209.
South Med J. 1989 Feb;82(2):169-73. doi: 10.1097/00007611-198902000-00006.
To analyze factors related to etiology, diagnosis, and outcome, we reviewed the records of 26 patients in whom a clinical picture of small bowel obstruction developed within one month after abdominal surgery. The initial operation was an emergency procedure in 20 cases and an exploratory laparotomy after trauma in 11. The colon was the organ most commonly operated upon initially, being involved in ten procedures (38%), all of which were emergencies. The clinical diagnosis of bowel obstruction was made within ten days postoperatively in most cases. Surgical reexploration was required in 15 patients (58%), whereas the obstructive symptoms resolved with nasogastric suction in 11. Two patients, both of whom survived, required resection of strangulated bowel; in both a treatment delay of at least 72 hours was documented. There were two deaths (8%), neither of which was directly related to the bowel obstruction. Diagnosis of this clinical entity requires a high index of suspicion, especially after emergency procedures that involve the colon. Optimal survival is achieved by prompt recognition and early intervention when a mechanical bowel obstruction is suspected in the early postoperative period.
为分析与病因、诊断及预后相关的因素，我们回顾了26例患者的病历，这些患者在腹部手术后1个月内出现了小肠梗阻的临床表现。最初的手术中，20例为急诊手术，11例为创伤后探查性剖腹术。结肠是最初最常接受手术的器官，有10例手术涉及结肠（38%），所有这些都是急诊手术。大多数病例在术后10天内做出了肠梗阻的临床诊断。15例患者（58%）需要再次手术探查，而11例患者通过鼻胃管吸引后梗阻症状得到缓解。两名患者均存活，需要切除绞窄肠段；两人均记录有至少72小时的治疗延迟。有两例死亡（8%），均与肠梗阻无直接关系。对这一临床实体的诊断需要高度的怀疑指数，尤其是在涉及结肠的急诊手术后。当术后早期怀疑有机械性肠梗阻时，通过及时识别和早期干预可实现最佳生存。
