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)


COD: 01_1242_2548 Categorie: ,

Gianluca Costa, Paolo Ruscelli, Genoveffa Balducci, Francesco Buccoliero, Laura Lorenzon, Barbara Frezza, Piero Chirletti, Franco Stagnitti, Stefano Miniello, Francesco Stella, and the OBOW – SICUT Collaborative Study Group

Ann. Ital. Chir., 2016 87: 105-117

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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.


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