Small bowel obstruction after abdominal aortic surgery.

Early postoperative small bowel obstruction (SBO) is a known complication of intestinal surgery, but its frequency, etiology, and morbidity after abdominal aortic procedures have not been reported. To study this complication, the records of 1475 patients who had an abdominal aortic operation for aneurysmal (n = 818) or occlusive (n = 657) disease on a private surgical service from 1963 to 1990 were reviewed. Forty-four patients (2.9%) developed a postoperative SBO. Small bowel obstruction occurred from 4 to 28 (mean 6) days postoperatively. All patients were treated with nasogastric suction. Eighteen of the 44 (41%) required reoperation from 6 to 30 (mean 14.2) days after the initial aortic procedure. All 18 had lysis of adhesions, and two required small bowel resections. There were no bowel infarctions and no late graft infections. Overall mortality was 5 per cent, and morbidity was 16 per cent. Incidence of pancreatitis in the entire series was 0.5 per cent, and incidence of colonic ischemia in the aneurysm group was 0.9 per cent. We conclude that 1) Early postoperative small bowel obstruction is an unusual complication of aortic surgery but is more frequent than other gastrointestinal complications such as intestinal ischemia and pancreatitis; 2) Management principles are similar to those for early postoperative bowel obstruction following other procedures; 3) Reoperation is required in nearly half of patients, particularly when SBO does not resolve within 2 weeks.