when to call for laprotomy in SBO ? - USMLE Forums
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Old 11-10-2012
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GIT when to call for laprotomy in SBO ?

patient presents with small bowel obstruction but passes flatus, TLC raised...NG Tube>suction & IV saline started ....what to do next ? and when to ans. laparotomy in such a q ?
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In the vignette....It gives a mixed picture I think...
Small intestinal obstruction but able to pass flatus -- Suggest not a complete obstruction --- So conservative management can be done...

But its gives TLC raised suggest bacterial overgrowth suggesting developing peritonitis...Hence Emergency surgery is preferred...

But Its said never let the sun rise or set in small bowel obstruction..



The decision to perform surgery for intestinal obstruction can be difficult. Peritonitis, clinical instability, or unexplained leukocytosis or acidosis are concerning for abdominal sepsis, intestinal ischemia, or perforation; these findings mandate immediate surgical exploration.

Patients with an obstruction that resolves after reduction of a hernia should be scheduled for elective hernia repair, whereas immediate surgery is required in patients with an irreducible or strangulated hernia. Stable patients with a history of abdominal malignancy or high suspicion for malignancy should be thoroughly evaluated for optimal surgical planning. Abdominal malignancy can be treated with primary resection and reconstruction or palliative diversion, or placement of venting and feeding tubes

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AS CG has explained so beautifully you do expl. laparotomy in the presence of clinical deterioration, increasing leukocytosis, worsening acidosis, which suggests ischemia>>>perforation>>>peritonitis.
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