Abstract
Small bowel obstruction is a common clinical condition that accounts for 20 % of all surgical admissions for acute abdomens [1]. Late, misdiagnosis, or even appropriate management of small bowel obstruction has likely been a source of frustration for many practicing general surgeons at some time during their surgical careers. Because of the acute onset of small bowel obstruction the majority of these patients present in the emergency room (ER). Therefore patient evaluation, subsequent operations and management are often performed by the surgeon on call. With the new paradigm shift regarding the management of surgical emergencies, the majority of patients with small bowel obstruction are now being managed by the acute care surgeon. The acute care surgeon is accustomed to dealing with difficult cases, and operating on a patient with small bowel obstruction is often a complicated procedure. There are multiple issues to address when operating on patients with small bowel obstruction including entering hostile abdomens, enterostomies, fistulas, wound infections, short bowel issues, and recurrent obstructions, just to name a few of the problems. The traditional surgical dictum the sun should never rise and set on a complete small bowel obstruction is no longer considered an entirely valid statement. This caveat may be attributed in part to the surgeon's diagnostic ability to differentiate complete obstruction, which could compromise intestine viability, from a partial obstruction, which could be amenable to nonoperative management. Thus in the absence of signs suggesting strangulation, a patient with partial obstruction can be treated and managed effectively using nonoperative modalities. © 2013 Springer Science+Business Media New York. All rights reserved.