Underappreciated Cause of Bowel Obstruction Should Be Included in Surgical Assessments

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Each year, more than 10 million Americans seek medical attention, often in emergency situations, for symptoms of intestinal blockages. Researchers at the University California, San Diego School of Medicine have identified an abnormal form of small bowel twisting (or volvulus) that may cause these painful obstructions. In contrast to other causes of bowel obstruction that are treated with bowel rest, these require immediate surgical care.

Results of the study were published in the May online edition of The American Journal of Surgery.

Jason Sicklick, MD, surgical oncologist, UC San Diego Health System.

“As the first population-based epidemiological study of small bowel volvulus in adults, our findings provide a robust representation of this infrequent cause of obstruction in American adults,” said Jason Sicklick, MD, assistant professor of surgery and surgical oncologist at UC San Diego Health System. “While relatively uncommon compared to other causes of bowel obstructions, surgeons should be aware of the potential for small bowel volvulus with or without intestinal malrotation in the adult population.”

Intestinal obstructions are often caused by post-surgical adhesions, tumors or hernias. However, in 1 percent of cases, patients may develop intestinal obstruction secondary to a small bowel volvulus (SBV). This condition involves the twisting of a loop of small bowel where vital arteries and veins reside. Initially, physicians may not consider SBV as a potential diagnosis as it is typically observed in newborns.

By being alert to the possibility of SBVs, said lead author Taylor Coe, doctors won’t necessarily have to wait for tell-tale signs of peritonitis, intestinal ischemia or failure of non-operative management, thus improving patient outcomes.

Sicklick and his team performed a retrospective analysis of the United States Nationwide Inpatient Sample spanning from 1998 -2010. More than 65 percent of the time, an operation was the prescribed treatment. Non-surgical approaches to management of SBV were associated with higher mortality.

David Chang, PhD, former director of outcomes research at UC San Diego also contributed to the study.