Management of Complex Small Bowel Obstructions of Various Etiologies: A Case Series and Literature Review

A small bowel obstruction (SBO) involves partial or complete blockage of the small intestine. Complete high-grade or closed-loop obstructions constitute acute surgical emergencies necessitating urgent intervention to prevent severe complications. Several probable etiologies of SBO have been identified, including malignancy, stool impaction, and inflammatory bowel disease; however, post-surgical adhesion is the most prevalent cause in the developed world. A SBO can be diagnosed clinically after a physical examination, but imaging is needed for surgical assessment and management. Misdiagnosis and inadequate management of SBO can cause several complications, such as intestinal necrosis and perforation. Therefore, when required, rapid diagnosis and surgical intervention are critical to avoiding mortality. Computer tomography (CT) and small bowel follow-through (SBFT) are widely utilized imaging modalities for confirmatory diagnosis of SBO. This case series features three patients who had exploratory laparotomies following extensive clinical evaluations and a radiologically confirmed diagnosis of SBO. All three cases involved numerous surgeries. The patients presented with severe abdominal discomfort and received surgical intervention after a CT scan confirmed the diagnosis and conservative therapy failed. In this case, all patients had different presentations but responded adequately to the same treatment modalities with no postoperative complications.