Feasibility and safety of an algorithm for the management of adhesive small bowel obstruction

This single-center, prospective cohort study assessed the feasibility and safety of a structured management protocol (Ileus Management Algorithm Protocol: I-MAP) for patients with adhesive small bowel obstruction (ASBO). Among 63 patients initially admitted for ASBO, 40 met the inclusion criteria and were managed in line with I-MAP, incorporating nasogastric tube (NGT) output and water-soluble contrast (WSC) administration within a standardized decision-making framework. The study's primary outcome, protocol adherence, was achieved in 87.5% (35/40) of patients, demonstrating the protocol's feasibility. 27/35 patients (77%) had ASBO resolution with conservative management. Eight patients required surgery, mostly due to lack of improvement after 72 hours of conservative management. Complications were minimal, with only two cases of bronchial aspiration. No patient died within 30 days of conservative management. This standardized algorithm using pre-defined NGT output values proved feasible and safe, standardizing care and providing structured guidance in clinical decision-making. Larger trials are necessary to confirm efficacy and explore patient-reported outcomes.