This study will compare the results of early surgery after 12 h conservative treatment and 48 h conservative treatment of adhesive small bowel obstruction.
At the admission patients undergo abdomen x-ray, general and biochemical blood test and computer tomography (CT). After exclusion of indications for an emergency operation, patients are given a water-soluble contrast. Conservative treatment is carring out to 12 hours from admission. All patients with resolution of small bowel obstruction in 12 hours will be excluded from the research. Criteria for obstruction release of conservative treatment 1. No pain 2. Appearance of gas in the colon 3. Decrease of bloating 4. Contrast in the colon. After that, if obstruction is not resolved, randomization is performed. First group undergo surgery. Second group undergo conservative treatment with water-soluble contrast evaluation until 48 hours. In the second group surgery is performed if the conservative treatment is not effective. The results of early and late surgery and the results of conservative treatment in groups will be compared.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
200
Method of video laparoscopic operation: * Open access in the left upper quadrant of the anterior abdominal wall, * Installation of trocars, depending on the prevalence of the adhesion process * Assessment of the peritoneal adhesion index * Detection of the asleep gut * Detection of obstacle area * Removing the obstacle without trying to completely eliminate the adhesion process in the abdominal cavity If there is no possibility to eliminate the cause of intestinal obstruction laparoscopically laparotomy is performed.
X-ray of the thoracic (1) and abdomen (2-5 times) with water soluble contrast.
Computer tomography of abdomen with iv contrast
Moscow Clinical Hospital 1
Moscow, Russia
RECRUITINGQuantity of patients with obstruction release after conservative treatment
No of patients with success of conservative treatment
Time frame: in the 2nd group - 48 hours
Readmission rate in conservative treatment and surgery
12 months readmission rate
Time frame: 12 months
30 days mortality
Number of patients who has dead in 30 days after admission
Time frame: 30 days
Complications rate
Number of complications rate in groups
Time frame: 30 days
Quantity of bowel resection
Number of patients who undergo bowel resection in groups
Time frame: 156 hours
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Ultrasound of the abdomen (2 times)
General blood test and biochemical blood test 2 times a day