Conservative Management Safe for Adhesive Small Bowel Obstruction in Virgin Abdomen, suggests research

Small bowel obstruction (SBO) is one of the most common reasons for emergency hospitalization for acute abdominal pain. Although the majority of small bowel obstructions are due to postoperative adhesions, small bowel obstruction may also occur in the absence of any previous abdominal surgery, and this is termed virgin abdomen small bowel obstruction (VA-SBO). This is a challenging problem for the emergency surgeon, and the recommended management strategies for VA-SBO were reviewed by the World Society of Emergency Surgery (WSES) in 2021, highlighting the need for improved evidence on the causes and treatment outcomes of small bowel obstruction.

The researchers used a retrospective approach, analysing the population hospitalized for small bowel obstruction between 2015 and 2019. Patients without a previous history of abdominal surgeries were included to study small bowel obstruction in virgin abdomens. Medical records were examined to determine whether the initial management was surgical or conservative. Conservative measures included nasogastric tube insertion, IV fluids, and pain relief medication. Additional data were collected for patients managed conservatively, such as radiological investigations, endoscopy, rehospitalization, and any subsequent surgery performed within two years after the initial admission.

Key findings:

• In the study, which was a retrospective study of 169 patients with small bowel obstruction in individuals who had no prior abdominal surgery, the study excluded abdominal wall hernias from 223 patients out of 1118 diagnosed with SBO.

• Immediate surgical intervention within six hours of admission was undertaken in 46 patients (27.2%; 95% CI, 20.7–34.6).

• Of the 123 patients who underwent conservative management, 32 patients (26.0%; 95% CI, 18.5–34.7) underwent surgical intervention for failure of treatment.

• In the study, conservative management of the 123 patients was successful in 53.8%.

• Of the 123 patients who underwent non-operative management, 75 patients underwent contrast media with follow-through.

• The underlying cause of the small bowel obstruction was unknown in 76 patients (45%).

• Adhesions were the most common underlying cause of SBO, followed by malignancy and intestinal torsion.

• Of the 76 patients who were discharged after successful treatment or negative surgical exploration, 46% were followed up within two years, and only eight patients had recurrent SBO episodes.

The study proves that adhesions remain the most common confirmed cause of small bowel obstruction in patients with a virgin abdomen. In the absence of symptoms necessitating emergency surgical intervention, the use of conservative management techniques such as nasogastric suction, IV fluids, and observation is a safe and valid treatment option. The low rate of recurrence of the obstruction during follow-up further supports the use of non-operative management in patients with small bowel obstruction in the setting of a virgin abdomen.

Reference:

Jaanimäe, L., Lepner, U., Kirsimägi, Ü. et al. Outcomes of small bowel obstruction management in previously unoperated patients with a mid-term follow-up: a retrospective cohort study. BMC Surg (2026). https://doi.org/10.1186/s12893-026-03597-6