BACKGROUND: Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout. METHODS: The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater. Four main topic areas included nosology, diagnosis, management and treatment. RESULTS: A bowel obstruction was defined as an obstacle to the progression of intestinal contents and fluids generally beginning with a sudden onset. The panel identified four major criteria of diagnosis including absence of flatus, presence of >3.5 cm ileal levels or >6 cm colon dilatation and abdominal distension. Panel also recommended a surgical admission, a multidisciplinary approach, and a gastrografin swallow for patients presenting occlusions. Criteria for immediate surgery included: presence of strangulated hernia, a >10 cm cecal dilatation, signs of vascular pedicles obstructions and persistence of metabolic acidosis. Moreover, rules for non-operative management (to be conducted for maximum 72 hours) included a naso-gastric drainage placement and clinical and laboratory controls each 12 hours. Non-operative treatment should be suspended if any suspects of intra-abdominal complications, high level of lactates, leukocytosis (>18.000/mm3 or Neutrophils >85%) or a doubling of creatinine level comparing admission. Conversely, consensus was not reached regarding the exact timing of CT scan and the appropriateness of colonic stenting. CONCLUSIONS: This consensus is in line with current international strategies and guidelines, and it could be a useful tool in the safe basic daily management of these common and peculiar diseases

Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi consensus study of SICUT (Società Italiana di Chirurgia d’Urgenza e del Trauma) / Costa, G; Ruscelli, P; Balducci, Genoveffa; Buccoliero, F; Lorenzon, Laura; Frezza, Barbara; Chirletti, Piero; Stagnitti, Franco; Miniello, S; Stella, F.; The, Obow; Mingoli, Andrea. - In: ANNALI ITALIANI DI CHIRURGIA. - ISSN 0003-469X. - STAMPA. - 87:(2016), pp. 105-117.

Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi consensus study of SICUT (Società Italiana di Chirurgia d’Urgenza e del Trauma)

BALDUCCI, Genoveffa;LORENZON, LAURA;FREZZA, BARBARA;CHIRLETTI, Piero;STAGNITTI, Franco;MINGOLI, Andrea
2016

Abstract

BACKGROUND: Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout. METHODS: The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater. Four main topic areas included nosology, diagnosis, management and treatment. RESULTS: A bowel obstruction was defined as an obstacle to the progression of intestinal contents and fluids generally beginning with a sudden onset. The panel identified four major criteria of diagnosis including absence of flatus, presence of >3.5 cm ileal levels or >6 cm colon dilatation and abdominal distension. Panel also recommended a surgical admission, a multidisciplinary approach, and a gastrografin swallow for patients presenting occlusions. Criteria for immediate surgery included: presence of strangulated hernia, a >10 cm cecal dilatation, signs of vascular pedicles obstructions and persistence of metabolic acidosis. Moreover, rules for non-operative management (to be conducted for maximum 72 hours) included a naso-gastric drainage placement and clinical and laboratory controls each 12 hours. Non-operative treatment should be suspended if any suspects of intra-abdominal complications, high level of lactates, leukocytosis (>18.000/mm3 or Neutrophils >85%) or a doubling of creatinine level comparing admission. Conversely, consensus was not reached regarding the exact timing of CT scan and the appropriateness of colonic stenting. CONCLUSIONS: This consensus is in line with current international strategies and guidelines, and it could be a useful tool in the safe basic daily management of these common and peculiar diseases
2016
Delphi study, Intestinal obstruction, Large bowel obstruction, Pseudo-obstruction, Small bowel
01 Pubblicazione su rivista::01a Articolo in rivista
Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi consensus study of SICUT (Società Italiana di Chirurgia d’Urgenza e del Trauma) / Costa, G; Ruscelli, P; Balducci, Genoveffa; Buccoliero, F; Lorenzon, Laura; Frezza, Barbara; Chirletti, Piero; Stagnitti, Franco; Miniello, S; Stella, F.; The, Obow; Mingoli, Andrea. - In: ANNALI ITALIANI DI CHIRURGIA. - ISSN 0003-469X. - STAMPA. - 87:(2016), pp. 105-117.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/982094
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