الفهرس 
Review of literature (Embryology)Only 14 pages are availabe for public view
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Abstract
Adhesive intestinal obstruction can be managed conservatively provided that there are no obvious signs of intestinal strangulation (clinically and radiologically). We recommend the use of oral gastrografin on admission together with a trial of conservative treatment for up to 48 hours, hoping for spontaneous resolution of obstruction. Our results indicate that gastrografin follow-through test is highly useful for differentiating incomplete from complete small bowel obstruction (gastrografin appear in the colon or not). So, it can identify early the cases that are more likely to respond to conservative management. Also, early oral intake can be initiated in patients whose contrast medium reaches the colon within 24 hours of ingestion, regardless of the presence of signs and symptoms of intestinal obstruction. On the other hand, it can predict the need for surgery. In addition, gastrografin increased the success of conservative treatment, reduced the need for surgery and shortened the length of hospital stay. Interestingly, there was no evidence that the use of gastrografin would increase the risk of strangulation. The maximum diameter of small bowel loops (measured after 24 hours) can be used as a predictive factor for the success of conservative treatment, need for surgery, time of resolution of obstruction and length of hospital stay. The six-point score can be used to distinguish between simple and strangulated SBO. It is most useful when values are either low (0 or 1) or high (5–6). On the other hand, intermediate values of 2, 3 or 4 require more careful interpretation. This severity score, if validated, does not replace but may supplement individual clinical judgement. Laparoscopic adhesiolysis better to be done in cases fulfilling certain criteria, specially the absence of marked abdominal distension. Also, better to be done by highly experienced laparoscopic surgeon. Conversion to open surgery should not be considered as failure of the procedure.