Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi Consensus study of SICUT (Società Italiana di Chirurgia d’Urgenza e del Trauma)
Gianluca Costa 1, Paolo Ruscelli 2, Genoveffa Balducci 1, Francesco Buccoliero 3, Laura Lorenzon 1, Barbara Frezza 1, Piero Chirletti 4, Franco Stagnitti 5, Stefano Miniello 6, Francesco Stella 7, and the OBOW - SICUT Collaborative Study Group 8
1 Emergency Surgery Unit, Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy
2 Emergency Surgery Unit, Torrette Hospital, Faculty of Medicine and Surgery, Polytechnic University of Marche, Ancona, Italy
3 Emergency Surgery Unit, M. Bufalini Hospital, AUSL Cesena, Italy
4 Department of Surgical Sciences, Umberto I Hospital, Faculty of Medicine and Odontology, University of Rome “La Sapienza”, Rome, Italy
5 Department of Sciences and Medical-Surgical Biotechnology, Polo Pontino Terracina, Faculty of Pharmacy and Medicine, University of Rome “La Sapienza”, Rome, Italy
6 Emergency and Trauma Surgery Section, Department of Applications and Innovative Technologies for Surgery, Faculty of Medicine and Surgery, University of Bari, Italy
7 Management and Control System Unit, Director of Hospital Medical Data Archiving System, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome “La Sapienza”
8 OBOW-SICUT Collaborative Study Group (see Appendix 1)
Ann. Ital. Chir. 2016, 87(2), 105–117
Published: 1 Mar 2016
Abstract
BACKGROUND: Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout. METHODS: The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater. Four main topic areas included nosology, diagnosis, management and treatment. RESULTS: A bowel obstruction was defined as an obstacle to the progression of intestinal contents and fluids generally beginning with a sudden onset. The panel identified four major criteria of diagnosis including absence of flatus, presence of >3.5 cm ileal levels or >6 cm colon dilatation and abdominal distension. Panel also recommended a surgical admission, a multidisciplinary approach, and a gastrografin swallow for patients presenting occlusions. Criteria for immediate surgery included: presence of strangulated hernia, a >10 cm cecal dilatation, signs of vascular pedicles obstructions and persistence of metabolic acidosis. Moreover, rules for non-operative management (to be conducted for maximum 72 hours) included a naso-gastric drainage placement and clinical and laboratory controls each 12 hours. Non-operative treatment should be suspended if any suspects of intra-abdominal complications, high level of lactates, leukocytosis (>18.000/mm3 or Neutrophils >85%) or a doubling of creatinine level comparing admission. Conversely, consensus was not reached regarding the exact timing of CT scan and the appropriateness of colonic stenting. CONCLUSIONS: This consensus is in line with current international strategies and guidelines, and it could be a useful tool in the safe basic daily management of these common and peculiar diseases.
