03) and the mean hospital stay was significantly longer among pat

03) and the mean hospital stay was significantly longer among patients in the control group than among those in the intervention group (4.2 vs 1.0 days, p < 0.001) without differences in complication and recurrence rates. Citarinostat nmr Hyperbaric Oxygen therapy may be useful in management of adhesive intestinal obstruction associated with abdominal surgery, even in patients who fail to respond to other conservative

treatments. HBO therapy may be a preferred option for treatment of patients for whom surgery should be avoided [74]. Further matter of debate are how long should NOM be and when it should be discontinued? Usually NOM, in Emricasan purchase absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours of adhesive SBO (Level of Evidence 2b GoR C) After 3 days without resolution, WSCA study or surgery is recommended (Level of Evidence 2b GoR C) If ileus persists more than 3 days and the drainage volume on day 3 is > 500 ml, surgery for ASBO is recommended (Level of Evidence 2b GoR C) With closely monitoring and in the absence of signs suggestive of complications, an observation period even longer than 10 days before proceeding to surgical intervention appears

to be safe [75]. However at any time, if onset of PRKD3 fever and leukocytosis greater than 15 000/mm3 (predictors of intestinal complications) are observed, then NOM should be discontinued and surgery is recommended. In the experience from the retrospective series of Cox et al. [76], out of 123 patients initially Androgen Receptor inhibition managed with conservative treatment, 31 of 38 patients requiring surgical intervention for SBO, had so more than 48 h duration after admission and the difference between cases resolving within

48 h and those requiring surgery after 48 h was significant (p< 0.001). Therefore most cases of ASBO that will resolve, seem to do so within 48 h of admission. Fleshner et al. in their RCT comparing conservative management of ASBO with NGT or LT, reported that, between the 21 patients ultimately requiring operation, the mean period between admission and operation was 60 hours in the NGT group versus 65 hours in the LT group [77]. In a series of 35 patients with ASBO, a long intestinal tube was endoscopically placed and the decompression was successful in up to 90% of the cases [78]. Therefore the authors recommend for patients with ASBO, a trial with long tube decompression for 48 to 72 hours. For those who fail a trial with the long tube, laparotomy with enterolysis or bowel resection is indicated.

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