Intra-abdominal adhesions are the most common reason for mechanical small bowel obstruction (SBO) and are implicated in infertility and complex abdominal and pelvic pain. Recent studies suggest that 10% of patients who have undergone colectomy will be re-admitted for SBO within 3 years. The annual cost of managing this condition is well over 1 billion dollars.

Hyaluronate/carboxymethyl cellulose (Seprafilm), oxidized regenerated cellulose (Intercede), and other agents are available to attempt to limit postoperative adhesion formation. These agents have been shown to reduce adhesion formation, but have not been proven to decrease the incidence of SBO. Furthermore, there is a possible link to an increased incidence of anastamotic leak. Thus, utilization of these products varies by institution and surgeon. Other techniques that have been shown to decrease postoperative adhesion include a laparoscopic approach, minimization of foreign material (sutures/mesh), and use of powder-free gloves.

Patients usually present with nausea and emesis if theobstruction is complete. If the obstruction is only partial, patientsmay have less severe symptoms and may still be passing flatus.Many patients are profoundly dehydrated and hypokalemic andrequire significant resuscitation and electrolyte repletion.Patients with limited cramping and abdominal distension, andno signs of peritonitis, often benefit from fluid and electrolyterepletion, nasogastric tube decompression and observation. Thisapproach may allow laparotomy to be avoided, but mandatesclose observation for signs of threatened bowel. Patients with arising white blood cell count, fever, peritonitis, and persistent orincreasing pain (possible closed loop obstruction) will likely needsurgical exploration. Obstructed small bowel may becomeischemic or necrotic without classical signs and symptoms; whena non-operative approach is taken, serial evaluations and a highindex of suspicion are necessary.