Outcomes of small bowel obstruction management in previously unoperated patients with a mid-term follow-up: a retrospective cohort study

Small bowel obstruction (SBO) is a widespread cause of emergency admissions for acute abdominal pain. While adhesions from prior surgeries are the most common cause, SBO occurs in patients without previous abdominal operations (virgin abdomen, VA-SBO). In 2021, the World Society of Emergency Surgery (WSES) re-evaluated the recommended management for these cases. This study aimed to investigate the causes and management of SBO in patients without prior abdominal surgeries. A retrospective review was conducted to examine the data of patients hospitalised with SBO between 2015 and 2019. Patients without previous abdominal surgeries were included. Medical charts were reviewed to determine whether surgery or conservative management was initiated. For non-operatively managed cases, follow-up data on radiological or endoscopic evaluations, hospitalisations, or surgeries performed within two years of the index admission were collected. Of 1118 patients diagnosed with SBO, 223 were included in the study. After excluding patients with abdominal wall hernia, 169 patient charts were analysed. 46 patients (27.2%; 95% CI, 20.7–34.6) underwent surgery within six hours of admission. Of the 123 patients initially managed conservatively, surgery was eventually required in 32 cases (26.0%; 95% CI, 18.5–34.7) following treatment failure. Non-operative treatment, including nasogastric tube insertion, intravenous fluid administration and analgesia, was successful in 53.8% of cases. Of the 123 patients initially managed with conservative measures, 75 received contrast media (CM), and its follow-through was initiated. The underlying cause of SBO remained unclear in 76 (45%) patients (SBO resolved by conservative measures or surgery did not determine the cause). Among the identified aetiologies, adhesions were the most common, followed by malignancy and intestinal torsion. Of the 76 patients discharged after successful non-operative management or negative surgical exploration, 46% had further follow-up within two years. Only eight patients experienced recurrent SBO episodes during the follow-up period. Adhesions remain the most commonly confirmed cause of VA-SBO (virgin abdomen small bowel obstruction). In the absence of signs or symptoms requiring urgent surgical intervention, conservative management is a valid and safe approach when patients are closely monitored. The low recurrence rate further supports this strategy. Retrospectively registered at Clinicaltrials.gov (NCT06912581) on 24.03.2025.