Gerenciamento da obstrução do intestino delgado em adultos

Abstract

Introduction: Small bowel obstruction (SBO) occurs when the normal flow of intestinal intraluminal contents is interrupted. Treatment of intestinal obstruction depends on the etiology, severity and location of the obstruction. The goals of initial management are to alleviate discomfort and restore normal fluid volume, acid-base balance, and electrolytes. Intestinal involvement (ischemia, necrosis, or perforation) and a surgically correctable cause of SBO (e.g., incarcerated hernia) require initial surgical exploration; other patients may be candidates for a trial of nonsurgical management. Although 60 to 85% of adhesion-related SBOs resolve without surgery, it is difficult to predict a priori which patients will fail nonsurgical treatment. Objective: to discuss the management of small bowel obstruction in adults. Methodology: Literature review from Scielo, PubMed and VHL databases, from March to May 2024, with descriptors: “obstruction", "small intestine", "adults" AND "management". Included articles from 2019-2024 (total 71), excluding other criteria and choosing 05 full articles. Results And Discussion: Patients diagnosed with acute BOS should be admitted to the hospital and evaluated by a surgeon. Initial treatment includes volume resuscitation, correction of metabolic abnormalities, fasting, and gastrointestinal decompression (with a nasogastric tube) for those with significant abdominal distension, nausea, or vomiting. For most uncomplicated patients, prophylactic antibiotics are not indicated. However, patients with suspected intestinal compromise (i.e., ischemia, necrosis, or perforation) undergoing surgical exploration are candidates.   Those with clinical (fever, persistent tachycardia, focal or generalized peritonitis) or radiological signs of intestinal involvement require immediate surgical exploration. By convention, timely surgery is also usually offered to patients with BOS caused by one of the surgically correctable causes other than adhesions. When there is no indication for surgery, fasting (with or without nasogastric decompression), serial abdominal examinations and laboratory and/or imaging studies are maintained, as indicated by clinical parameters. The ideal duration of nonsurgical management is uncertain and largely depends on the patient's clinical status and situation. For the majority of clinically stable patients with BOS, we suggest that nonsurgical treatment not be extended beyond three to five days, given the increased morbidity and mortality associated with this approach. However, there are some clinical scenarios in which prolongation of nonoperative treatment may be appropriate. As an example, those with early postoperative SBO may be managed for a longer period (e.g., up to six weeks) in the absence of clinical deterioration. Conclusion: Most patients with small bowel obstruction (SBO) but not indicated for immediate surgery can safely undergo an initial trial of non-surgical management. Nonsurgical treatment resolves symptoms in many patients with BOS, but success rates depend on the etiology.