In a series of 53 patients with ASBO and treated with long intestinal tube decompression, laparotomy is appropriate after non-response for 7 and 3 days for complete and partial SBO, respectively [79].

From further experiences, if ileus persists more than 3 days and the drainage volume on day WH-4-023 3 is > 500 ml, surgery for ASBO is recommended [80]. The EAST practice Autophagy Compound Library datasheet management guidelines for SBO recommend that patients without resolution of the SBO by day 3-5 of non-operative management should undergo water soluble study or surgery [81]. Finally when deciding between operative or non operative management it would be beneficial to assess the risk of ASBO recurrence after NOM and which factors can predict recurrence of ASBO after NOM The patients non responders Selleck PCI-34051 to

the long-tube and conservative treatment within 72 hours have a considerable risk of recurrent ASBO (Level of Evidence 2b GoR C) Risk factors for recurrences are age <40 years and matted adhesion (Level of Evidence 1b GoR A) Gastrografin use does not affect the recurrences rates or recurrences needing surgery when compared to traditionally conservatively treated patients (Level of Evidence 1b GoR A) Out of 32,583 patients with an index admission for SBO in 1997 from an US population study [82], 24% had surgery during the index admission and regardless of treatment during the index admission, 81% of surviving patients STK38 had no additional SBO readmissions over the subsequent 5 years. A prospective multicenter study including 286 patients operated on for an adhesive postoperative SBO and followed up for a median time of 41 months. The cumulative incidence of overall recurrence was 15.9%, and for surgically managed recurrence 5.8%. After multivariate analysis, the risk factors

for the overall recurrences were age <40 years (hazard ratio HR, 2.97), adhesion or matted adhesion (HR, 3.79) and, for the surgically managed: adhesions or matted adhesions (HR, 3.64), and postoperative surgical complications (HR, 5.63) [83]. Non-operative treatment for adhesions in stable patients results in a shorter hospital stay and similar recurrence and reoperation rates, but a reduced interval to reobstruction when compared with operative treatment [84]. In details patients treated without operation had a 34 per cent readmission rate, compared with 32 per cent for those treated surgically (P not significant), a shorter time to readmission (median 0.7 versus 2.0 years; P < 0.05), no difference in reoperation rate (14 versus 11 per cent; P not significant) and fewer inpatient days over all admissions (4 versus 12 days; P < 0.0001). In retrospective series of 79 patients with ASBO, out of 23 patients who recovered from ASBO following conservative treatment after 3 days with long intestinal tubes, 16 patients showed recurrent ASBO and half underwent surgery within 3 years [85].