Intestinal obstruction caused by solitary bands: aetiology, presentation, diagnosis, management, results.

PURPOSE

Solitary band intestinal obstruction is receiving renewed interest based on the emerging possibility of laparoscopic intervention restricted to this type of small intestinal obstruction. Therefore, pertinent observations focussing on this patient population undergoing conventional "open" surgery could be of interest.

METHOD

Prospectively collected chart data of all patients operated for solitary band obstruction (SBO) from January 1979 until December 1993 were reviewed and the further course followed for 1-15 (median 8) years.

RESULTS

The incidence of SBO was 15.4% of a total of 123 patients operated for late adhesive obstruction. In previously operated patients (approximately 70%) appendectomy and gynecological procedures dominated, whereas in previously nonoperated patients inflammatory entities such as adnexitis or appendicitis were common precursers. In approximately 52%, SBO occurred without prodromal symptoms. Nonstrangulating SBO was characterized by vague clinical symptoms and screening sonography rendered an immediate diagnosis. In approximately 31%, SBO was complicated by strangulation or torsion. Early postoperative morbidity was approximately 28% including 2 cases of early postoperative intestinal obstruction, the further course complicated by 3 episodes of late recurrent obstruction in 2 patients. Approximately 21% developed proven and another approximately 21% suspected recurrent intestinal adhesions.

CONCLUSIONS

1. History and clinical presentation of SBO can be uncharacteristic including previously nonoperated patients with vague symptoms. 2. Sonography is highly sensitive. 3. Postoperative morbidity is mainly associated with enterotomy and omitted resection. 4. The incidence of late recurrent obstruction is substantial but within the range of obstructions following enterolysis and gut repair for obstructing extensive adhesions without intestinal tube splinting.