RARE AND UNUSUAL CAUSES OF ACUTE SMALL BOWEL OBSTRUCTION: DIAGNOSTIC AND SURGICAL ASPECTS
DOI:
https://doi.org/10.32782/health-2026.1.4Keywords:
acute obstruction of the small intestine, atypical and rare forms, biliary ileus, small-small intestinal intussusception, pinched hernia of Spiegel's line, foreign body of the abdominal cavityAbstract
Acute small bowel obstruction (ASBO) remains a significant challenge in modern surgery due to its high risk of complications, diagnostic errors, and mortality, necessitating continuous refinement of diagnostic and therapeutic algorithms. The aim of this study was to investigate atypical and rare clinical manifestations of ASBO, identify underlying causes, and develop pathogenetically justified diagnostic and therapeutic approaches at various stages of patient care. The study analyzed 221 clinical cases of ASBO, among which 206 cases (93.21%) were caused by intra-abdominal adhesions, 7 cases (3.17%) by incarcerated anterior abdominal wall hernias, 2 cases (0.9%) by internal hernia incarceration, 3 cases (1.36%) by obstruction of the distal small intestine by large gallstones, 2 cases (0.9%) by small bowel intussusception, 1 case (0.45%) by a foreign body with intestinal necrosis, and 1 case (0.45%) by Spigelian hernia. Analysis demonstrated that atypical forms of ASBO are associated with non-specific clinical presentations, a high rate of misdiagnoses (up to 39.82% at the pre-hospital stage), and complicate the selection of optimal surgical strategies. The use of modern laboratory and instrumental methods, including ultrasonography and computed tomography, enhances diagnostic accuracy and timely surgical intervention. Different clinical scenarios, including biliary ileus, intussusception, incarcerated hernias, and foreign body obstruction, highlight the necessity for individualized surgical approaches considering the location of pathology, bowel condition, and comorbidities. Special attention is given to the prevention of postoperative complications, early recognition of rare etiological factors, and adherence to surgical safety standards. The results indicate that a comprehensive management approach – incorporating early diagnosis, pathogenetically guided surgery, and postoperative monitoring – reduces mortality and improves clinical outcomes. These findings can inform the development of clinical protocols, surgical education, and quality improvement in the care of patients with acute small bowel obstruction.
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