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This retrospective study analyzed three years of data from a single high-volume London center to identify predictive factors for treatment success or failure. Patients older than 16 with CT-proven adhesive SBO received a protocol using NG decompression and water-soluble contrast, with surgery for no colonic contrast or clinical deterioration, evaluating outcomes and co-morbidities.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/challenges-and-outcomes-of-three-years-of-the-adhesive-intestinal-obstruction-management-protocol/408713/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/challenges-and-outcomes-of-three-years-of-the-adhesive-intestinal-obstruction-management-protocol/408713.png","ImageObject",300,407,{"name":92,"@type":93},"dabgoudw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",15,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What patient group and imaging criteria were included in the study?","Question",{"text":113,"@type":114},"The study included patients older than 16 years with clinical signs of SBO and CT evidence proving adhesive SBO, requiring hospital admission. Patients with other causes of SBO and those without CT evidence of adhesive disease were excluded.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What was the conservative management protocol in uncomplicated cases?",{"text":118,"@type":114},"Uncomplicated cases received NG decompression for at least six hours, followed by oral or NG Gastrografin. Abdominal X-rays were taken at six and 12 hours after Gastrografin intake to assess contrast reaching the colon or rectum.",{"name":120,"@type":111,"acceptedAnswer":121},"When did the protocol recommend switching to surgery?",{"text":122,"@type":114},"Surgery was pursued for patients with no contrast in the large intestine, persistent abdominal pain, and onset abdominal tenderness or peritonitis, indicating failed conservative management or clinical deterioration.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},408713,1790970101,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":36,"preview_page_count":4},3985747860484,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Review began 10/29/2025  \nReview ended 11/18/2025  \nPublished 12/01/2025  \n© Copyright 2025  \nEwedah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98269  \nOpen Access Original Article  \nChallenges and Outcomes of Three Years of the Adhesive Intestinal Obstruction Management Protocol  \nMoataz M. Ewedah 1, Dixon Osilli 1 , Praveen Surya Ravichandran 1 , Tarun Sai Krishna Puli 2, Faris A. Abbadi 1 , Tanya Krasteva 1, Sayed Haschmat Sarwary 1  \n1. Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, GBR 2. Paediatrics and Child Health, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, GBR  \nCorresponding author: Tarun Sai Krishna Puli, [tarunsaikrishnapuli@gmail.com](tarunsaikrishnapuli@gmail.com)  \nAbstract  \nIntroduction: Small bowel obstruction (SBO) is a significant contributor to surgical morbidity, mortality, and healthcare costs, contributing to a significant number of emergency laparotomies. Advancements in diagnostic techniques have improved the accuracy in delineating simple from complicated SBOs. Some adhesive SBOs will ultimately need surgical intervention, mostly when they are complicated cases. Recently, minimally invasive surgeries, enhanced recovery protocols, and multidisciplinary approaches have become more popular in optimising recovery and minimising recurrence risks. On the other hand, most adhesive SBOs can be managed conservatively with bowel rest, nasogastric (NG) decompression, intravenous fluid therapy, and water-soluble oral contrast agents, leading to a significant reduction in operation-related morbidity, hospital stays, and healthcare costs. Current guidelines recommend a trial of conservative management, although not without controversy.  \nAim: This study aimed to explain the predictive factors of success or failure of treatments of adhesive SBOsand statistically report the effect of co-morbidities and expected outcomes of SBO management, based on three-year data from a single high-volume centre in London, UK.  \nMethodology: Our retrospective-descriptive study included patients with clinical signs of SBO, older than 16 years old, and CT proving adhesive SBO, who required hospital admission. We excluded patients with other causes of SBO and those who had no CT evidence of adhesive disease. Data were collected from online hospital records and analysed in Microsoft Excel® (Microsoft Corporation, Redmond, Washington) . Hospital protocol was NG decompression for at least six hours in uncomplicated cases, followed by oral or NGGastrografin, with abdominal X-rays taken at six and 12 hours post-Gastrografin intake to assess contrast in the colon or rectum. Successful cases were then given a trial of oral feeds before discharge. Those with no contrast in the large intestine, persistent abdominal pain, and onset abdominal tenderness or peritonitis were taken to surgery.  \nResults and limitations: Out of 415 patients, 30.4% required surgery either as initial mode of treatment or after failed conservative management, proving the effectivity of therapeutic Gastrografin (69 .6%), followed by 35.2% being 75 or less years old, proving SBO is more prevalent in elderly population with co-morbidities, as 40.5% are ASA Grade 3, prone to post-operative complications. Surprisingly, COPD patients required surgery more often than those who did not have it, as they desaturate due to distension easily. On the other hand, not much statistical difference is seen in the 30-day mortality rate between the operated and conservatively managed groups.  \nConclusion: Our study aligns with the literature to prove that our management protocol is safe. Alongside, the post-operative burden of those undergoing surgery is high ; it is vital to identify complex ","cbCaie1va5bH9aMG","https://ap.wps.com/l/cbCaie1va5bH9aMG","pdf",193668,16,"English","# Abstract\n# Introduction\n## Clinical background and guidelines\n# Methodology\n## Study design and protocol\n# Results and Limitations\n## Surgery rates and prognostic findings\n# Conclusion\n## Safety and risk stratification\n# How to cite this article","[{\"question\":\"What patient group and imaging criteria were included in the study?\",\"answer\":\"The study included patients older than 16 years with clinical signs of SBO and CT evidence proving adhesive SBO, requiring hospital admission. Patients with other causes of SBO and those without CT evidence of adhesive disease were excluded.\"},{\"question\":\"What was the conservative management protocol in uncomplicated cases?\",\"answer\":\"Uncomplicated cases received NG decompression for at least six hours, followed by oral or NG Gastrografin. Abdominal X-rays were taken at six and 12 hours after Gastrografin intake to assess contrast reaching the colon or rectum.\"},{\"question\":\"When did the protocol recommend switching to surgery?\",\"answer\":\"Surgery was pursued for patients with no contrast in the large intestine, persistent abdominal pain, and onset abdominal tenderness or peritonitis, indicating failed conservative management or clinical deterioration.\"}]","Challenges and Outcomes of Three Years of the Adhesive Intestinal Obstruction Management Protocol | PDF",1790580323]