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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, however 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.
Adhesive small bowel obstruction (ASBO) is among the most common causes of emergency surgical admissions and operations following abdominal surgery, accounting for 16% and 20% of such cases, respectively. Conservative management is indicated for suspected partial obstruction, whereas suspected complete obstruction necessitates surgical intervention. However, distinguishing between partial and complete SBO is frequently challenging due to the often subtle or absent signs of strangulation, which commonly leads to an initial trial of conservative treatment. The risk of ASBO following abdominal surgery depends on both the procedure type and individual patient risk factors. A systematic review has reported that the incidence of ASBO after abdominal surgery ranges from 5% to 15%, with some studies observing even higher rates after specific procedures, particularly colorectal surgery. Procedures such as colectomy and surgeries involving the lower abdomen or pelvis are associated with an increased risk of postoperative adhesion formation, leading to obstruction. The highest rates are generally observed after open surgery compared to laparoscopic approaches, which result in fewer adhesions [1]. In the absence of strangulation, conservative management is typically attempted. Reported success rates for conservative treatment range from 65% to 80%. The likelihood of successful conservative management is influenced by factors such as the absence of strangulation or ischemia, early diagnosis, and the presence of partial rather than complete obstruction. Mortality rates increase with delayed surgical intervention, especially when conservative treatment fails or signs of bowel ischemia or necrosis develop. Elderly patients are at particularly high risk; one study reported a 39% mortality rate among patients experiencing ASBO complications, many of whom were managed conservatively. This heightened risk of mortality with delayed surgery underscores the need for prompt and accurate identification of patients unlikely to benefit from nonoperative management [2]. In South Korea, a surgeon was found guilty after a patient experienced complications following delayed surgery for ASBO, illustrating the critical need for standardized protocols to minimize delays and associated complications. The Clinical Practice Guideline Committee of the Korean Society of Acute Care Surgery has conducted systematic reviews to guide both general practitioners and surgeons on nonsurgical management, surgical indications, and appropriate interventions for ASBO. This initiative aims to standardize care and improve outcomes by ensuring that healthcare providers adhere to clear protocols for both conservative and operative management.
Objectives
This narrative review aims to summarize the current evidence on the diagnosis and management of ASBO, with a particular focus on the efficacy of conservative treatment and the indications for surgical intervention. It also seeks to clarify the distinction between ASBO and postoperative ileus, evaluate adjunctive therapies such as water-soluble contrast, antibiotics, and analgesics, and emphasize the importance of imaging and laparoscopic surgery in selected patients. Through this synthesis, the review promotes evidence-based decision-making and the adoption of standardized clinical protocols to optimize patient outcomes.
METHODS
Search strategy
The authors used multiple search engines to identify articles published from 2013 to 2023 on the management of ASBO. Keywords were selected for each section. For instance, a literature search was conducted using MEDLINE, the Cochrane Database, Embase, PubMed, Scopus, EBSCOhost, and the Web of Science to identify studies on laparoscopic surgery for ASBO. The search strategy for laparoscopic surgery included the terms “laparoscopic surgery” or “laparoscopic adhesiolysis,” combined with “small bowel obstruction.” The entire manuscript was reviewed by each author, and revisions continued until consensus was reached. All aspects of the review are based on expert opinion.
CONSERVATIVE MANAGEMENT FOR ASBO
Water-soluble contrast test
The water-soluble contrast (WSC) test may be considered in cases of partial SBO that do not resolve within 48 hours, as it can promote bowel function without significant complications or mortality. If WSC does not reach the colon within 24 hours, this strongly suggests failure of nonoperative management and the need to consider surgical intervention.
The WSC challenge, commonly referred to as the Gastrografin challenge, is both a diagnostic and therapeutic intervention involving the administration of a water-soluble contrast agent. A 100-mL dose of Gastrografin (Bayer) is given via a nasogastric tube or orally, followed by abdominal radiography within 24 hours. If the contrast reaches the large bowel within this period, it indicates resolution of the obstruction. Gastrografin may also confer therapeutic benefits by increasing luminal fluid content, which can help relieve obstruction through osmotic effects. A 2023 review of ASBO reported that the WSC test is helpful for both diagnosis and treatment [3–5]. These therapeutic benefits are consistent with earlier randomized trials, such as the study by Assalia et al. [6], which examined the impact of oral Gastrografin for partial ASBO. The 2012 guidelines from the Eastern Association for the Surgery of Trauma recommend considering WSC for improving bowel function and reducing hospital stay in cases of partial obstruction persisting beyond 48 hours [7]. Multiple randomized trials and meta-analyses further support its diagnostic accuracy and therapeutic value [8–13]. A 2018 review by the World Society of Emergency Surgery demonstrated that failure of Gastrografin to reach the large bowel within 24 hours is an indication that conservative management is unlikely to succeed, thus supporting surgical decision-making [14].
Antibiotics
Antibiotic administration provides no clinical benefit in the nonoperative management of uncomplicated ASBO.
The rationale for using antibiotics in this setting is based on the bacterial translocation hypothesis, a theory supported by older studies but lacking recent validation [15,16]. A recent retrospective study found that antibiotic administration in uncomplicated ASBO did not improve clinical outcomes [17]. Specifically, the use of antibiotics during the first 2 days of hospitalization for nonoperative management of ASBO was associated with longer hospital stays, without significantly affecting the rates of sepsis, septic shock, Clostridium difficile infection, mortality, or total hospitalization costs. Moreover, current ASBO management guidelines do not specifically recommend antibiotics in nonoperative treatment, indicating a limited role in such cases [14]. Recent randomized controlled trials have also shown no added benefit to prolonged antibiotic use for intra-abdominal infections, including ASBO when source control is achieved [18].
Unnecessary antibiotic use increases the risk of antibiotic resistance and healthcare costs, emphasizing the importance of judicious prescribing [19,20]. For patients with ASBO requiring surgery, prophylactic antibiotics should be administered as a single dose within 1 hour prior to incision to prevent surgical site infection, with no routine postoperative dosing in order to minimize resistance and other adverse effects. In contrast, therapeutic antibiotics are indicated in cases of ASBO complicated by perforation or ischemia; in these scenarios, broad-spectrum antibiotics are required to address contamination risks, and prompt surgical source control is essential for optimizing outcomes [21].
Analgesics
There is insufficient evidence supporting the use of analgesics in ASBO.
Studies specifically examining the role of analgesics in the management of ASBO are limited. In patients with ASBO who do not exhibit clinical signs of strangulation or perforation and have no clear indications for surgery, nonoperative management is recommended as the initial approach [14,22,23]. This raises the question of whether routine pain management should be incorporated into nonoperative care. To date, no studies have directly addressed this issue. We view that while pain management can improve patient comfort, it may also potentially delay timely surgical intervention. Currently, no research has evaluated this balance. Furthermore, one study recommended that nonoperative management should not exceed 3 days [24]. A randomized controlled trial evaluating the clinical benefits of analgesics in this context is underway, and new evidence may emerge from its results (ClinicalTrials.gov identifier: NCT05878015).
Antispasmodics
There is insufficient evidence supporting the use of antispasmodics in ASBO.
In adult patients with ASBO, the available evidence does not show improved clinical outcomes with antispasmodic use compared to no medication. Current guidelines, such as the Bologna guidelines for ASBO diagnosis and management, recommend nonoperative strategies including nasogastric decompression and intravenous fluid resuscitation, but do not endorse antispasmodics as a treatment option [14]. Comprehensive reviews of SBO management similarly do not include antispasmodics in their protocols [25]. Thus, there is currently no evidence to support routine use of antispasmodics in adults with ASBO. Moreover, high-quality studies evaluating the effectiveness of antispasmodics for pain relief in ASBO are lacking.
Nutritional therapy
Total parenteral nutrition (TPN) should be initiated in ASBO under the following conditions:
(1) The patient is anticipated to be nothing-by-mouth status for more than 5 to 7 days.
(2) The patient is already malnourished or at high risk of becoming malnourished.
(3) The postoperative gastrointestinal tract is not yet functional, in which case TPN should be administered on a temporary basis.
Current evidence supports initiating TPN in patients with bowel obstruction who are expected to be nothing-by-mouth status for more than 7 days, as this approach helps prevent malnutrition and its associated complications [26–28]. Studies demonstrate that TPN is effective for maintaining nutritional status when oral or enteral routes are not feasible, particularly in cases of severe obstruction. Additionally, early initiation of TPN in patients at high risk for malnutrition can prevent further nutritional decline, which is associated with worse clinical outcomes [29].
In situations where enteral feeding worsens symptoms or leads to complications, TPN is recommended as a safer alternative based on case series and expert consensus. Postoperative TPN is also recommended, especially in patients with delayed gastrointestinal recovery, to ensure adequate nutrition until oral or enteral feeding can be resumed. Regular monitoring and a multidisciplinary approach are crucial to the effective management of TPN. Evidence indicates that closely managed, patient-specific nutritional support leads to improved outcomes.
The nutritional management of patients with bowel obstruction is complex, depending on the obstruction’s severity, location, duration, and the patient's overall nutritional status. The primary goals are to prevent malnutrition, manage symptoms, and support recovery while avoiding exacerbation of the obstruction.
CONSERVATIVE MANAGEMENT FOR POSTOPERATIVE ILEUS
It is essential to clarify the definitions of postoperative ileus (POI), prolonged POI (PPOI), and ASBO, as these terms are frequently confused, even by surgeons. However, POI and ASBO are distinct entities that require different management strategies.
POI is defined as a transient cessation of bowel motility after abdominal surgery. It is generally self-limiting, resolving within 3 to 5 days postoperatively. When POI persists, it is termed PPOI. While the definition of PPOI varies in the literature, recent systematic reviews define it as occurring when patients meet two or more of the following five criteria on or after postoperative day 4: (1) nausea or vomiting in the preceding 12 hours; (2) inability to tolerate a solid or semisolid diet over the last two meals; (3) abdominal distension; (4) absence of flatus and stool for the preceding 24 hours; and (5) radiological evidence of ileus on abdominal x-ray or computed tomography (CT) scan within the previous 24 hours. Conservative management remains the mainstay for both POI and PPOI [30].
Hot pack application
There is no specific evidence that the use of hot packs directly prevents or treats adhesions after surgery. However, several studies suggest that hot pack application may aid gastrointestinal motility recovery in paralytic ileus. A 2023 randomized controlled trial demonstrated that abdominal hot packs promoted gastrointestinal motility recovery after gynecological surgery [31]. Other studies also report that thermotherapy can enhance intestinal motility and speed bowel recovery [32,33]. No study has yet evaluated the clinical outcomes of hot pack application in ASBO.
Abdominal massage
Most research on abdominal massage focuses on its use for constipation. A 2024 systematic review concluded that physical abdominal massage was the most effective method for preventing the initial occurrence of bowel exhaustion, although more high-quality research is needed [34]. One study also found that manual therapy improved symptoms in patients without bowel necrosis or cancer [35]. Abdominal massage may therefore be considered for paralytic ileus; however, its effect on ASBO has not been evaluated.
Active ambulation
Evidence regarding the impact of ambulation on the clinical course of ASBO is limited. However, a faster return of bowel function has been observed in colectomy patients who are encouraged to ambulate early. Prehabilitation before major abdominal surgery has also been associated with fewer pulmonary complications [36,37]. Ambulation is thus recommended for POI, although its role in ASBO has not been investigated.
Chewing gum
Chewing gum acts as a sham feed, promoting intestinal motility through cephalic vagal stimulation. In healthy volunteers, gum chewing is as effective as food at stimulating cephalic-phase gastric secretion and has therefore been used as a modified sham feeding to study physiological responses [38]. Chewing sugarless gum after elective intestinal resection improves clinical outcomes [39,40]. While no studies have specifically addressed gum chewing in ASBO, it may have beneficial effects on bowel motility, and, given its minimal adverse effects, gum chewing can be considered for patients with POI.
Rectal irritation
There is no evidence to suggest that rectal irritation (e.g., rectal massage) has any effect on POI or ASBO.
Prokinetics
ASBO is one potential cause of POI, and is ultimately confirmed during surgical treatment [1]. The pathogenesis of POI remains unclear [2], which directly affects treatment strategies. Generally, recovery of colonic function marks the resolution of POI. Prokinetic agents, designed to enhance gastrointestinal motility, appear to have minimal, if any, effect on reducing the duration of POI.
The literature evaluating these agents is limited by small sample sizes, variable surgical procedures, and the use of insensitive endpoints [3–6]. There are no data supporting the efficacy of metoclopramide in treating POI. Evidence for cisapride is limited and does not show significant benefit. Erythromycin is considered ineffective, as its mechanism of action does not address the underlying issues of POI.
Given these challenges, supportive care remains the primary treatment for POI until its pathogenesis is better understood. Clinicians should therefore focus on symptom management and supportive strategies, rather than relying on pharmacological interventions to shorten the duration of POI.
SURGICAL INDICATIONS FOR ASBO
Leukocytosis, erythrocyte sedimentation rate, or C-reactive protein
Leukocytosis (particularly counts ≥10,000/mL), elevated erythrocyte sedimentation rate, or increased C-reactive protein (CRP) may indicate an inflammatory response suggestive of complications such as bowel ischemia or necrosis.
The Bologna guidelines recommend specific laboratory evaluations for managing ASBO, including a complete blood count, CRP assay, blood lactate measurement, and serum electrolyte and creatinine levels [14]. Previous studies have shown that a leukocyte count ≥10,000/mL may predict intestinal ischemia [41–43]. Laboratory parameters such as white blood cell (WBC) count are important indicators for surgical intervention, particularly in cases of ASBO and intestinal ischemia. Elevated WBC counts are often associated with inflammation or infection, both of which increase the risk of complications requiring surgery.
Patients suspected of having bowel obstruction should be considered for early surgical treatment due to the associated increases in morbidity and mortality. Clinical indicators, such as fever, leukocytosis, tachycardia, persistent pain, metabolic acidosis, peritonitis, and systemic inflammatory response syndrome (SIRS), can accurately identify ischemia in approximately 40% to 50% of cases. When combined with imaging studies, early surgical intervention can be identified in most patients requiring surgery (70% to 96%) [7]. The optimal initial management for complete SBO is still under debate. Some studies report that complete SBO is associated with an increased need for bowel resection (31%), while others show that nonsurgical treatment is still successful in 41% to 73% of complete obstruction cases. Surgical treatment for both partial and complete SBO is associated with lower recurrence rates and longer disease-free intervals compared to nonsurgical management. Factors significantly associated with the need for surgery in SBO include the absence of prior abdominal surgery, presence of air-fluid levels on radiography, no bowel movement within 24 hours of admission, dehydration at admission, and CRP level >10 mg/L [44]. Another study found that patients with elevated CRP were more likely to require intensive care [45]. The meta-analysis further identified CRP as one of five key laboratory variables predictive of SBO resolution without surgery [45]. Patients without clinical or radiological signs of bowel ischemia can safely undergo initial nonsurgical management. For partial SBO, nonsurgical treatment rarely leads to ischemia (3% to 6%), but these patients require close monitoring and serial abdominal and clinical examinations. Nonsurgical management is generally successful in 65% to 80% of patients, especially those with partial SBO or early postoperative SBO, with most improving within 2 to 5 days after treatment initiation. If bowel function does not recover after 5 days, surgery is indicated [46].
Fever or hematochezia
Surgical treatment may be prioritized in patients with ASBO accompanied by fever or hematochezia.
Patients suspected of bowel obstruction with bowel ischemia should undergo early surgical treatment because of the associated increases in morbidity and mortality. Clinical indicators such as fever, leukocytosis, tachycardia, persistent pain, metabolic acidosis, peritonitis, and SIRS accurately identify ischemia in approximately 40% to 50% of cases. When imaging studies are performed, most patients requiring early surgical intervention can be identified (70% to 96%) [7,46]. Discussions regarding the initial treatment of complete SBO are ongoing. While some studies report an increased need for bowel resection in complete SBO (31%), others have shown that nonsurgical treatment remains successful in 41% to 73% of patients with complete obstruction [46]. Surgical treatment for partial and complete SBO results in lower recurrence rates and longer disease-free intervals than nonsurgical management. A meta-analysis also identified 29 potential predictive variables for improving SBO without surgical intervention. Fourteen imaging variables, ten clinical variables, and five laboratory variables were found to be significant among the ten clinical variables [45]. Therefore, the presence of fever suggests prioritizing surgical treatment over nonsurgical management.
Based on current evidence, the presence of hematochezia (bloody stools) in patients with ASBO significantly increases the likelihood of bowel strangulation, which may require prompt surgical intervention. However, available evidence is insufficient to establish this association definitively, and further studies are needed. Nevertheless, careful monitoring for clinical deterioration is essential in cases where hematochezia is present, to determine if surgical intervention becomes necessary [7,46].
Radiology findings
The presence of free air, ischemia, or complete obstruction (closed loop, whirl sign) is an indication for surgery.
Once ASBO is confirmed, imaging findings play a crucial role in determining the timing of surgical intervention. Perforation and peritonitis both require immediate surgery. If imaging reveals signs of ischemia, prompt surgical treatment is needed to prevent intestinal necrosis and perforation. Contrast-enhanced multidetector CT is widely used to identify ASBO and detect coexisting ischemia. CT demonstrates high sensitivity (83%) and specificity (92%) for detecting bowel ischemia compared with operative findings as the reference standard [47,48]. CT findings associated with small bowel ischemia include poor or absent segmental bowel wall enhancement (Fig. 1) [49], delayed hyperenhancement (Fig. 2) [50], bowel wall thickening (Fig. 3) [51], the small bowel feces sign (Fig. 4) [52], and pneumatosis intestinalis (Fig. 5) [53–58]. While none of these findings alone is highly sensitive or specific, combining them increases diagnostic accuracy [52,59]. On imaging, closed-loop obstruction often appears as a distended, fluid-filled, C- or U-shaped bowel segment, with prominent mesenteric vessels converging toward a point of torsion, a CT whirl sign (Fig. 6) [60,61], or incarceration [62]. Other radiological features include a triangular loop, the beak sign (Fig. 7) [63], and two collapsed bowel loops adjacent to the obstruction site (Fig. 8) [64,65]. Closed-loop obstruction can result in serious complications unless perfusion to the affected bowel segment is restored.
Large nasogastric drainage volume
There is insufficient evidence to support using nasogastric drainage volume as an independent indication for surgery in ASBO.
The evacuation of air and fluid from the small intestine has greatly improved clinical outcomes, and gastrointestinal intubation is now standard in ASBO management. Since the late 20th century, research has focused on different tube types, placement sites, and their efficacy in fluid removal from the intestinal lumen. However, randomized controlled trials published in the 1990s found no benefit of long tubes over standard nasogastric tubes. Therefore, nasogastric tubes remain the standard approach, offering decompression of the distended stomach, which enhances patient comfort and limits further distension from swallowed air. Only one study, conducted in patients with ASBO under 20 years of age, suggested that drainage volume may help predict the eventual need for surgical intervention in children initially managed conservatively [66]. Further research is needed to clarify whether nasogastric decompression volume should be considered a surgical indication.
Long-standing partial obstruction
Patients with ASBO need surgery if nonoperative management fails within 3 to 5 days, depending on the clinical circumstances.
If bowel function does not recover after 3 to 5 days of conservative treatment—without clinical deterioration—surgical intervention may be necessary. Multiple studies have shown that operative delays longer than 3 [24] to 5 days [67,68] are associated with increased morbidity, higher mortality, and longer hospital stays [69]. The World Society of Emergency Surgery (Bologna guidelines) advises waiting up to 3 days before considering surgical exploration [14], while the Eastern Association for the Surgery of Trauma guidelines recommend waiting up to 5 days [7]. Notably, for patients who ultimately require surgery, a delay greater than 1 day has been identified as a risk factor for requiring bowel resection [70].
SURGICAL MANAGEMENT FOR ASBO
Laparoscopic surgery has better surgical outcomes than open surgery. However, laparoscopic surgery poses a risk of iatrogenic bowel injury and should be selected very cautiously.
To date, only one well-designed prospective, randomized controlled study exists: Sallinen et al. [71] conducted an international, multicenter, randomized open-label trial showing that laparoscopic adhesiolysis results in quicker recovery. In addition, nine propensity score–matched studies were analyzed due to the high risk of selection bias in observational research. A meta-analysis of these studies indicated that laparoscopic surgery is associated with a lower risk of morbidity (odds ratio [OR], 0.46; 95% CI, 0.30 to 0.69) and shorter hospital stays (mean difference, –3.04 days; 95% CI, –3.94 to –2.14). No significant differences were found for mortality, operative time, or incidence of iatrogenic bowel injury. Operative time tended to be shorter in the laparoscopic group, though this was not statistically significant (mean difference, –15.3 minutes; 95% CI, –32.27 to 1.61). Mortality was slightly lower after laparoscopic surgery (OR, 0.81; 95% CI, 0.21 to 3.15). Iatrogenic bowel injury was marginally more frequent in laparoscopic cases (OR, 1.30; 95% CI, 0.71 to 2.4).
Although laparoscopic surgery offers significant advantages for ASBO, surgeons must carefully select appropriate candidates. Predictors of successful laparoscopic adhesiolysis include: two or fewer prior laparotomies, prior non-midline incision, appendectomy as the index procedure, a single adhesive band as the cause, early laparoscopic intervention within 24 hours of symptom onset, absence of peritonitis on physical exam, and a highly experienced surgeon. Predictors for conversion to open surgery include the presence of the fecal sign, markedly distended bowel loops, and multiple or complex adhesions. Therefore, laparoscopic surgery may be considered as the initial approach in patients with a single adhesive band and favorable predictors, but without factors predictive of conversion.
CONCLUSIONS
ASBO remains a significant clinical challenge requiring careful differentiation from POI to ensure appropriate management. Conservative treatment is effective in most cases, with success rates of 65% to 80%. However, timely surgical intervention is critical in cases of complete obstruction, bowel ischemia, or failure of conservative management, as delayed surgery increases morbidity and mortality. Advances in diagnostic imaging, especially contrast-enhanced CT, have improved identification of high-risk patients needing early surgery. Furthermore, laparoscopic adhesiolysis has demonstrated benefits in selected cases, providing lower morbidity and shorter hospital stays compared to open surgery. Adoption of standardized protocols as recommended by international guidelines is crucial for optimizing patient outcomes. Clinicians should implement structured management strategies, balancing conservative and surgical options while monitoring for clinical deterioration. Future research should refine nonoperative management techniques and develop predictive markers to identify patients requiring surgery. By applying evidence-based practices, healthcare providers can enhance care quality and reduce complications associated with ASBO.
ARTICLE INFORMATION
Author contributions
Conceptualization: all authors; Methodology: all authors; Writing–original draft: all authors; Writing–review & editing: all authors. All authors read and approved the final manuscript.
Conflicts of interest
Dae Sang Lee and Seong Pyo Mun are editorial board members of this journal, but were not involved in the peer review process or decision-making regarding publication of this article. The authors have no other conflicts of interest to declare.
Funding
This work was supported by grants from the Clinical Medicine Research Institute, Chosun University Hospital (Gwangju, Korea) in 2025.
Data availability
Data sharing is not applicable as no new data were created or analyzed in this study.
Fig. 1.
An axial computed tomography image demonstrates a segment of the small bowel wall with reduced enhancement (arrows) in contrast to the adjacent loops that exhibit more normal enhancement (arrowheads). Reprinted from Kaewlai [49], available under the Creative Commons license.
Fig. 2.
Mucosal hyper-enhancement of thick-walled small bowel (arrows) and ascites suggests small bowel ischemia. Reprinted from Dhatt et al. [50], with permission from Elsevier.
Fig. 3.
A computed tomography scan reveals dilated small bowel loops with thickened walls (arrow). Reprinted from Wikipedia [51], available under the Creative Commons license.
Fig. 4.
Small bowel showing the feces sign. There is a narrowed segment (white arrow) and feces-like material within the distended lumen (black arrow). Reprinted from Lazarus et al. [52], with permission from the American Roentgen Ray Society.
Fig. 5.
Coronal reformatted images reveal dilated small bowel loops, with some loops in the pelvis exhibiting rounded cystic air collections in both dependent and nondependent areas, indicative of air within the bowel wall. Reprinted from Sravani [53], available under the Creative Commons license.
Fig. 6.
Multiple dilated small bowel loops are observed, particularly in the left and central abdomen.
Presence of air-fluid levels within the distended bowel segments, suggestive of small bowel obstruction. The whirl sign is noted in the central abdomen (arrow). Reprinted from Dawes [60], available under the Creative Commons license.
Fig. 7.
Closed loop obstruction of the small intestine. (A) Beak sign in the transitional zone (white lines). (B) Distal point of obstruction: zone of transition (arrow) and small intestine flat upstream (star). Reprinted from Mbengue et al. [63], available under an Elsevier user license.
Fig. 8.
(A, B) Multiple dilated small-bowel loops collapsed thickened loops in right iliac fossa (arrowheads and circles). Reprinted from Memon et al. [65], available under the Creative Commons license.
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Evidence-based conservative and surgical management of adhesive small bowel obstruction: a narrative review
Fig. 1. An axial computed tomography image demonstrates a segment of the small bowel wall with reduced enhancement (arrows) in contrast to the adjacent loops that exhibit more normal enhancement (arrowheads). Reprinted from Kaewlai [49], available under the Creative Commons license.
Fig. 2. Mucosal hyper-enhancement of thick-walled small bowel (arrows) and ascites suggests small bowel ischemia. Reprinted from Dhatt et al. [50], with permission from Elsevier.
Fig. 3. A computed tomography scan reveals dilated small bowel loops with thickened walls (arrow). Reprinted from Wikipedia [51], available under the Creative Commons license.
Fig. 4. Small bowel showing the feces sign. There is a narrowed segment (white arrow) and feces-like material within the distended lumen (black arrow). Reprinted from Lazarus et al. [52], with permission from the American Roentgen Ray Society.
Fig. 5. Coronal reformatted images reveal dilated small bowel loops, with some loops in the pelvis exhibiting rounded cystic air collections in both dependent and nondependent areas, indicative of air within the bowel wall. Reprinted from Sravani [53], available under the Creative Commons license.
Fig. 6. Multiple dilated small bowel loops are observed, particularly in the left and central abdomen.
Presence of air-fluid levels within the distended bowel segments, suggestive of small bowel obstruction. The whirl sign is noted in the central abdomen (arrow). Reprinted from Dawes [60], available under the Creative Commons license.
Fig. 7. Closed loop obstruction of the small intestine. (A) Beak sign in the transitional zone (white lines). (B) Distal point of obstruction: zone of transition (arrow) and small intestine flat upstream (star). Reprinted from Mbengue et al. [63], available under an Elsevier user license.
Fig. 8. (A, B) Multiple dilated small-bowel loops collapsed thickened loops in right iliac fossa (arrowheads and circles). Reprinted from Memon et al. [65], available under the Creative Commons license.
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Evidence-based conservative and surgical management of adhesive small bowel obstruction: a narrative review
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