Clinical strategies for the management of intestinal obstruction and pseudo-obstruction

BACKGROUND In: Testinal obstructions/pseudo-obstruction of the smalUlarge bowel are jequent 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. METHODST:h e 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 flzrids generally beginning with a sudden onset. The panel identiJed four major criteria of diagnosis including absence of flatus, presence of > 3.5 cm ileal levels or > G 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. CONCLUSIOTNhSis: consensus is in line with current international strategies and guidelines, and it could be a usefil tool in the safe basic ahily management of these common and peculiar diseases.