What are the small bowel obstructions to operate and how to do it?

Small bowel obstruction is one of the main surgical emergencies. CT scan is today the best exam to detect occlusions requiring an urgent surgical procedure. It also specify the cause of the obstruction. Post-operative adhesions are the first etiology and justify 3.5%-5% of laparotomies in Western Countries. Recently, small bowel obstructions due to adhesions could be treated by a laparoscopic procedure. The authors report a series of 35 patients presenting an acute small bowel obstruction treated by laparoscopy. The laparoscopic procedure was successful in 70% of cases when occlusion was due to acute adhesions. Compared with open procedure, coelioscopy had an immediate benefit on intestinal mobility re-establishment and hospital stay. The morbidity was 4.5% with no mortality. CT has to be part of pre-operative check-up in front of a small bowel obstruction in order to propose a laparoscopic procedure when postoperative adhesions are suspected.