Adhesive small bowel obstruction (ASBO) is a common postoperative complication and remains a leading cause of emergency surgical admissions. This review synthesizes current evidence regarding the diagnosis, conservative management, and surgical treatment of ASBO, focusing on the role of standardized protocols in optimizing patient outcomes. ASBO most often develops following abdominal or pelvic surgery, especially after open procedures. Conservative management, including nasogastric decompression, water-soluble contrast studies (e.g., Gastrografin), and nutritional support, is effective in 65% to 80% of cases without ischemia or strangulation. However, fever, leukocytosis, persistent pain, or computed tomographic findings (e.g., the whirl sign or bowel wall thickening) necessitate early surgical intervention. Evidence indicates that extending conservative management beyond 3 to 5 days in nonresponders increases both morbidity and mortality. Recent studies do not support routine antibiotic or antispasmodic use in uncomplicated ASBO. Although analgesics and ambulation may provide symptom relief, their impact on surgical timing remains unclear. Laparoscopic adhesiolysis has demonstrated reduced morbidity and shorter hospital stays versus open surgery in appropriately selected patients. Accurate differentiation between ASBO and postoperative ileus is essential for effective treatment. Conservative management remains the first-line approach in cases of partial ASBO, but clinicians must be vigilant for signs of clinical deterioration. Surgical management, including laparoscopic intervention, should be promptly pursued if conservative therapy fails or patients exhibit clinical decline. Implementing evidence-based guidelines and individualized decision-making improves patient safety, reduces complications, and enhances overall outcomes. Ongoing research is needed to refine conservative strategies and identify predictive markers for early surgical intervention.

Purpose
Distinguishing a fever caused by infection from the necessary febrile response in injured patients is difficult, because trauma patients often have concomitant obvious infectious origins. In traumatic brain injury, early fever might be associated with worse clinical outcomes; however, few reports on trauma patients without brain injury are available.

Methods
In this retrospective observational study, consecutive trauma patients without brain injury who were admitted to the surgical intensive care unit during a 3 year period were included. The surgical and clinical outcomes were compared according to body temperature. Locally weighted scatterplot smoothing was used to identify the relationship between body temperature and injury severity.

Results
A total of 111 patients were included. Body temperature increased as the injury severity score increased up to 47.717, above which it decreased. Mortality was high in hypothermic patients (72.7%; p < 0.001); however, few differences were observed between normothermic and hyperthermic patients (3.5% and 2.4%, respectively). The nonsurvivors had lower body temperatures on the 1st and 2nd days after admission (36 ˚C and 36.9 ˚C) compared with the survivors (37.3 ˚C and 37.7 ˚C; p < 0.001 and p = 0.006). In severely injured patients, low levels of inflammatory biomarkers and low body temperature were correlated with mortality.

Conclusions
Fever in trauma patients without brain injury is correlated with injury severity but not with prognosis. Hypothermia on the 1st and 2nd days after admission was significantly correlated with mortality. In severely injured patients, a decreased inflammatory response might play a certain role in promoting a high mortality rate.

Citations

• Fever in the Trauma Bay: A Marker for Greater Risk of Adverse Outcomes
  Samir M. Fakhry, Yan Shen, Gina M. Berg, James R. Dunne, Parker Hu, Darrell L. Hunt, Mark G. McKenney, Nicholas W. Sheets, R. Joseph Sliter, Matthew M. Carrick, Jeneva M. Garland, Alessandro Orlando
  Surgical Infections.2025; 26(4): 255.     CrossRef
• Prognostic factors in patients with gastrointestinal perforation under the acute care surgery model : a retrospective cohort study
  Kiyoung Sung, Sanguk Hwang, Jaeheon Lee, Jinbeom Cho
  BMC Surgery.2024;[Epub]     CrossRef