Small Bowel Diseases

Obstruction, Internal Hernia, and Malrotation

The fellow should be able to:

• Demonstrate an understanding of the evaluation and etiology of small bowel obstruction
• Describe the treatment of the patient with adhesive small bowel disease
• Understand the role of intraluminal contrast in the prognosis and treatment of SBO
• Describe the evaluation and treatment of the patient with an SBO but no prior abdominal surgery
• Describe the management of the patient with intussusception on imaging
• Describe the treatment for an adult patient with volvulus associated with malrotation
• Describe the management of a patient with incidentally identified malrotation
• Describe the management of malignant SBO 

Resources

• Topic Summary
• Additional Resources:
  • EAST Practice Management guidelines: Maung, Adrian A., MD; Johnson, Dirk C., MD; et al., Journal of Trauma and Acute Care Surgery. 2012 Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline
  • AAST anatomic severity grading system for adhesive SBO: Hernandez, Matthew C, MD; Haddad, Nadeem N., MD; et al., Journal of Trauma and Acute Care Surgery. 2018.  The American Association for the Surgery of Trauma Severity Grade is valid and generalizable in adhesive small bowel obstruction
  • Gastrograffin use in Adhesive disease: Klingbeil K et al. The effect of hyperosmolar water-soluble contrast for the management of adhesive small bowel obstruction: A systematic review and meta-analysis. Annals of Surgery.
  • Quach, Giang, DO; Zielinski, Martin D., MD; Journal of Trauma and Acute Care Surgery. 2023. Surgical management of small bowel obstruction – what you need to know
  • Collom, Morgan L., DO; Duane, Therese M., MD; et al., Journal of Trauma and Acute Care Surgery. 2018. Deconstructing dogma: nonoperative management of small bowel obstruction in the virgin abdomen
  • Lewis M, et al. Small Bowel Obstruction in the Virgin Abdomen. J Gastrointest Surg. 2023.
  • Strajina V, et al. Small bowel obstruction in a virgin abdomen. Am J Surg. 2019.

Small Bowel Diverticulitis and Meckel’s Diverticulum

The fellow should be able to:

• Demonstrate an understanding of the evaluation and etiology of small bowel diverticulitis
• Demonstrate an understanding of the management of Meckel’s diverticulitis
• Describe the differences in treatment of the bleeding vs inflamed Meckel’s
• Discuss the options for incidentally identified Meckel’s
• Discuss the treatment options for perforated small bowel diverticulitis

Resources

• Topic Summary
• Overview Article: