Small bowel obstruction outcomes according to compliance with the World Society of Emergency Surgery Bologna guidelines - Scorecard - MDSpire

Small bowel obstruction outcomes according to compliance with the World Society of Emergency Surgery Bologna guidelines

  • By

  • Lewis J Kaplan

  • Isidro Martinez-Casas

  • Shahin Mohseni

  • Matteo Cimino

  • Hayato Kurihara

  • Matthew J Lee

  • Gary A Bass

  • SnapSBO Collaborators

  • Agron Dogjani

  • Kastriot Subashi

  • Klevis Doci

  • Joana Spaho

  • Ali Abdulla

  • Sara Ahmed

  • Yusuf AlAnsari

  • Mariam AlKooheji

  • Alaa Marzooq

  • Khaled Nazzal

  • Emir Ahmetašević

  • Zlatan Mehmedović

  • Maja Kovačević

  • Jasminka Mujkanović

  • Peter Svenningsen

  • Marie Peter Møller

  • Gitte Emilje Olsen

  • Abeer Aboalazayem

  • Muhammad Ashrad Awad

  • Mahmoud M A Elfiky

  • Moemen Farouk

  • Mostafa Gad

  • Basma Magdy

  • Peep Talving

  • Edgar Lipping

  • Edgar Lipping

  • Sten Saar

  • Artjom Bahhir

  • Maarja Talviste

  • Vincent Dubuisson

  • Luca Cigagna

  • Luigi Cayre

  • Spyridon Christodoulou

  • Panagiotis Kokoropoulos

  • Ioannis Margaris

  • Maria Papadoliopoulou

  • Theodoros A Sidiropoulos

  • Panteleimon Vassiliu

  • Evangelos Barkolias

  • Pavlos Georgalis

  • Theodosios Kantas

  • Vasiliki Nikolaou

  • Aristeidis Papadopoulos

  • Katerina Tata

  • Stergios Arapoglou

  • Ioannis Gkoutziotis

  • Aikaterini Mpratko

  • Elissavet Symeonidou

  • Stylianos Kykalos

  • Nikolaos Machairas

  • Adam Mylonakis

  • Panagiotis Sakarellos

  • Dimitrios Schizas

  • Michail Vailas

  • Iraklis Anastasiadis

  • Parmenion Patias

  • Koumarelas Konstantinos

  • Mourtarakos Saradis

  • Charles Lee

  • Chloe Spillane

  • Dylan Viani Walsh

  • Nadia Walsh

  • Thomas Noel Walsh

  • Gabriel Orsi

  • Andrew Keane

  • David Kearney

  • Emma de Sousa

  • Michael Sugrue

  • Anne Marie Doyle

  • Robert Fitzsimmons

  • Angus J Lloyd

  • Mohammad Saad Qasim

  • Mashood Ahmed

  • Taylor Jacoby

  • Michael E Kelly

  • Shafagh Khodadi

  • Paul McCormick

  • Éanna J Ryan

  • Mahmoud M Salama

  • Helen Heneghan

  • Cian Davis

  • Odhran K Ryan

  • Sean T Martin

  • Miklosh Bala

  • Michele Altomare

  • Stefano P B Cioffi

  • Andrea Spota

  • Giada Panagini

  • Laura Benuzzi

  • Stefania Cimbanassi

  • Noemi DiFuccia

  • Stefano Manfroni

  • Alan Biloslavo

  • Paola Germani

  • Nicolo de Manzini

  • Manuela Mastronardi

  • Anna Modica

  • Serena Scomersi

  • Gabriele Bellio

  • Luigi Cayre

  • Gaia Altieri

  • Pietro Fransvea

  • Gabriele Sganga

  • Silvia Tedesco

  • Francesca Bunino

  • Sabrina Caspani

  • Daniele DelFabbro

  • Simone Giudici

  • Giulia Mauri

  • Paolo Meneghesso

  • Enrico Ortolano

  • Antonella D'addiego

  • Francesca Di Vittorio

  • Gabriele Bormolini

  • Michele Carlucci

  • Giovanni Pesenti

  • Claudia Tintori

  • Mauro Zago

  • Martina Zambon

  • Simona Meneghini

  • Andrea Mingoli

  • Giulia Duranti

  • Gioia Brachini

  • Pierfrancesco Lapolla

  • Mehdi Hanafi

  • Clara Valdez Cruz

  • Andrea Alfredo Huerta de León

  • Jose García Regalado

  • Pasquale de Jesús Cristiano Nakhal

  • Diego Enrique Rodríguez González

  • Jose Ruiz

  • Salvador Lozada Jimenez

  • Oscar Carlos Delgado

  • Monserrat Reyes Zamorano

  • Anyely Fuertes Muñoz

  • Ademola Adetoyese Adeyeye

  • Ehis Afeikhena

  • Akinola Akinmade

  • Babatunde Mustapha

  • Jaroslav Presl

  • Patrick Rebnegger

  • Bjoern Rudisch

  • Gruenfelder Johanna

  • Rokitte Karin

  • Filipa M CorteReal

  • Jorge A Pereira

  • Joao L Pinheiro

  • Daniela M Pinto

  • Andreia J Santos

  • Andreia M Silva

  • Susana Henriques

  • Joao Melo

  • António Miguel Pereira

  • Antonio Miguel Pereira

  • Ana Margarida Cabral

  • Bruno Dias Couto

  • Barbara Nunes Gama

  • Catarina Santos Rodrigues

  • Mara Nunes

  • Bruno Ribeiro Silva

  • Daniela Tavares

  • Daniela Tavares

  • Toma Mihai

  • Oprea C Valentin

  • Srdjan S Putnik

  • Petar Andjic

  • Marija Djujic

  • Rastislav Filko

  • Vanja Kunkin

  • Andjela Milak

  • Aleksandar Ognjenovic

  • Nebojsa Mitrovic

  • Goran Aleksandric

  • Mihailo Bezmarević

  • Sasa Dragović

  • Milan Jovanović

  • Bosko Milev

  • Miroslav Mitrović

  • Srdjan Petković

  • Valentina Isakovic

  • Nikola Zoran Nikolic

  • Predrag Radic

  • Dragan Luka Vasic

  • Zlatibor M Loncar

  • Dusan D Micic

  • Vladimir R Resanovic

  • Pavle D Vladimir

  • Krstina S Doklestic Vasiljev

  • Ljiljana Velibor Milic

  • Vladica Velibor Cuk

  • Jovan Todor Juloski

  • Radisav Slavoljub Radulovic

  • Dragana Dragan Arbutina

  • Jacobo Trebol

  • Manuel Torres-Jurado

  • Andres J Valera-Montiel

  • Francisco E Blanco-Antona

  • Beatriz de Andrés-Asenjo

  • Maria Ruiz-Soriano

  • Tania Gómez-Sanz

  • Andrea Vázquez-Fernández

  • Juan Beltran de Heredia

  • Cristina Rey-Valcárcel

  • Monica Ballón-Bordon

  • Maria Pérez-Díaz

  • Maria Dolores Sanchez-Rodriguez

  • Jose David Gonzalez-Esteban

  • Celia Alegre Nevado

  • Ricardo Montenegro Romero

  • Andrea Campos-Serra

  • Raquel Gracia-Roman

  • Heura Llaquet-Bayo

  • Anna Muñoz-Campaña

  • Giulia Vitiello

  • Lorena Apodaca Murguiondo

  • Inigo Augusto Ponce

  • Amaia Garcia Dominguez

  • Aintzane Lizarazu Perez

  • Elena Sagarra Cebolla

  • Mónica García Aparicio

  • Paloma Garaulet González

  • Benito Miguel Josa Martínez

  • Miriam Fraile Vasallo

  • Mónica MengualBallester

  • Isabel Andrés Lucas Zamorano

  • Jose Martinez Moreno

  • Manuel Luis Buitrago Ruiz

  • Clara Piñera Morcillo

  • Alberto Díaz García

  • Hanna Hernández Oaknin

  • Maria Pellicer Barreda

  • Jennifer Amparo García Niebla

  • Antonio Pérez Álvarez

  • Diego Cordova

  • Laura Jiménez

  • Fernando Mendoza

  • Cristina Vera

  • Alberto Vilar Tabanera

  • María de los Ángeles Gil-Olarte Márquez

  • José Antonio López-Ruiz

  • Mª Estela Romero-Vargas

  • Julio Reguera-Rosal

  • Alberto García-García

  • Beatriz Marenco de la Cuadra

  • Eduardo Perea del Pozo

  • Virginia Duran Muñoz

  • Felipe Pareja Ciuró

  • Ainoa Benavides dos Santos

  • Ernest Bombuy

  • Anna G-Monferrer

  • Sandra López Gordo

  • José Guerra

  • Vanessa Sojo

  • Begona De Soto

  • Aaron Roman

  • Ana María González-Castillo

  • Elena Manzo

  • Estela Membrilla-Fernandez

  • Amalia Pelegrina-Manzano

  • Simone Cremona

  • Alexander Forero-Torres

  • Santiago Valderrabano

  • Francisco Reinoso Olmedo

  • Fuad Lopez Fernandez

  • Aitor Landaluce-Olavarria

  • Jon Barrutia- Leonardo

  • Alba Garcia-Trancho

  • Melania Gonzalez-De Miguel

  • Izaskun Markinez-Gordobil

  • Maryam Makki

  • Dana Altamimi

  • Sadhika Vinod

  • Olga Rutka

  • John V Taylor

  • M Denton

  • S Gourgiotis

  • R Ravi

  • A J Ribbits

  • Jared Wohlgemut

  • Shehryar Rangana Khan

  • Christopher Leiberman

  • Sabreen P Elbakri

  • Charlie A Edgar

  • Conor Magee

  • Oluwaseun Oyekan

  • Mehwish Ansar

  • Jeremy Wilson

  • Rahel Rashid

  • Deborah Atwell

  • Joshua Cassedy

  • Brianna Gabriel

  • William Hoff

  • Shyam Murali

  • Anna E Garcia Whitlock

  • Carolyn Susman

  • Sarah Barnett

  • Emily Ertmann

  • Camden DeSanctis

  • Pavel Karasek

  • Nathan Klingensmith

  • Dale F Butler

  • Brandon Bruns

  • Ankeeta Mehta

  • Vanessa Nomellini

  • Keyus Patel

  • Anthony Tannous

  • April 18, 2025

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Clinical Scorecard: Outcomes of Small Bowel Obstruction Based on Adherence to the Bologna Guidelines from the World Society of Emergency Surgery

At a Glance

CategoryDetail
ConditionAdhesive Small Bowel Obstruction (SBO)
Key MechanismsMechanical obstruction of the small intestine lumen, commonly due to adhesions from prior surgery
Target PopulationAdults (≥18 years) with radiologically confirmed adhesive SBO
Care SettingEmergency surgical and inpatient hospital settings across diverse healthcare environments

Key Highlights

  • Adherence to the WSES Bologna guidelines for adhesive SBO is associated with shorter hospital length of stay and improved optimal outcomes.
  • Only a minority of patients received full guideline-compliant care (17.2% in successful NOM, 10.1% in NOM-T, 0.4% in direct surgery).
  • Implementation barriers include resource limitations and regional practice variability, impacting guideline adoption and patient outcomes.

Guideline-Based Recommendations

Diagnosis

  • Use radiological confirmation (e.g., CT scan) to diagnose adhesive SBO.
  • Employ water-soluble enteral contrast studies as part of diagnostic evaluation.

Management

  • Non-operative management (NOM) is recommended when ischemia, strangulation, or peritonitis are absent.
  • Timely surgical intervention is advised if NOM fails or if clinical signs of ischemia, strangulation, or peritonitis develop.
  • Postoperative care should follow evidence-informed protocols to reduce complications.

Monitoring & Follow-up

  • Monitor patients closely during NOM for signs of deterioration requiring surgery.
  • Follow patients for at least 60 days post-discharge to capture complications and readmissions.

Risks

  • Delayed surgical intervention may increase morbidity and length of hospital stay.
  • Non-adherence to guidelines may lead to higher complication rates and prolonged recovery.

Patient & Prescribing Data

982 adults with adhesive SBO enrolled in a prospective multicentre observational study

Successful non-operative management occurred in 57.1%, surgery after failed NOM in 22.8%, and direct surgery in 20.1%; guideline adherence correlated with better outcomes and shorter LOS.

Clinical Best Practices

  • Adopt WSES Bologna guidelines comprehensively to improve patient outcomes in adhesive SBO.
  • Implement institutional strategies to overcome resource and practice variability barriers to guideline adherence.
  • Use snapshot audit methodology to monitor real-world guideline compliance and identify areas for quality improvement.

References

Original Source(s)

Small bowel obstruction outcomes according to compliance with the World Society of Emergency Surgery Bologna guidelines

  • by Lewis J Kaplan, Isidro Martinez-Casas, Shahin Mohseni, Matteo Cimino, Hayato Kurihara, Matthew J Lee, Gary A Bass, SnapSBO Collaborators, Agron Dogjani, Kastriot Subashi, Klevis Doci, Joana Spaho, Ali Abdulla, Sara Ahmed, Yusuf AlAnsari, Mariam AlKooheji, Alaa Marzooq, Khaled Nazzal, Emir Ahmetašević, Zlatan Mehmedović, Maja Kovačević, Jasminka Mujkanović, Peter Svenningsen, Marie Peter Møller, Gitte Emilje Olsen, Abeer Aboalazayem, Muhammad Ashrad Awad, Mahmoud M A Elfiky, Moemen Farouk, Mostafa Gad, Basma Magdy, Peep Talving, Edgar Lipping, Edgar Lipping, Sten Saar, Artjom Bahhir, Maarja Talviste, Vincent Dubuisson, Luca Cigagna, Luigi Cayre, Spyridon Christodoulou, Panagiotis Kokoropoulos, Ioannis Margaris, Maria Papadoliopoulou, Theodoros A Sidiropoulos, Panteleimon Vassiliu, Evangelos Barkolias, Pavlos Georgalis, Theodosios Kantas, Vasiliki Nikolaou, Aristeidis Papadopoulos, Katerina Tata, Stergios Arapoglou, Ioannis Gkoutziotis, Aikaterini Mpratko, Elissavet Symeonidou, Stylianos Kykalos, Nikolaos Machairas, Adam Mylonakis, Panagiotis Sakarellos, Dimitrios Schizas, Michail Vailas, Iraklis Anastasiadis, Parmenion Patias, Koumarelas Konstantinos, Mourtarakos Saradis, Charles Lee, Chloe Spillane, Dylan Viani Walsh, Nadia Walsh, Thomas Noel Walsh, Gabriel Orsi, Andrew Keane, David Kearney, Emma de Sousa, Michael Sugrue, Anne Marie Doyle, Robert Fitzsimmons, Angus J Lloyd, Mohammad Saad Qasim, Mashood Ahmed, Taylor Jacoby, Michael E Kelly, Shafagh Khodadi, Paul McCormick, Éanna J Ryan, Mahmoud M Salama, Helen Heneghan, Cian Davis, Odhran K Ryan, Sean T Martin, Miklosh Bala, Michele Altomare, Stefano P B Cioffi, Andrea Spota, Giada Panagini, Laura Benuzzi, Stefania Cimbanassi, Noemi DiFuccia, Stefano Manfroni, Alan Biloslavo, Paola Germani, Nicolo de Manzini, Manuela Mastronardi, Anna Modica, Serena Scomersi, Gabriele Bellio, Luigi Cayre, Gaia Altieri, Pietro Fransvea, Gabriele Sganga, Silvia Tedesco, Francesca Bunino, Sabrina Caspani, Daniele DelFabbro, Simone Giudici, Giulia Mauri, Paolo Meneghesso, Enrico Ortolano, Antonella D'addiego, Francesca Di Vittorio, Gabriele Bormolini, Michele Carlucci, Giovanni Pesenti, Claudia Tintori, Mauro Zago, Martina Zambon, Simona Meneghini, Andrea Mingoli, Giulia Duranti, Gioia Brachini, Pierfrancesco Lapolla, Mehdi Hanafi, Clara Valdez Cruz, Andrea Alfredo Huerta de León, Jose García Regalado, Pasquale de Jesús Cristiano Nakhal, Diego Enrique Rodríguez González, Jose Ruiz, Salvador Lozada Jimenez, Oscar Carlos Delgado, Monserrat Reyes Zamorano, Anyely Fuertes Muñoz, Ademola Adetoyese Adeyeye, Ehis Afeikhena, Akinola Akinmade, Babatunde Mustapha, Jaroslav Presl, Patrick Rebnegger, Bjoern Rudisch, Gruenfelder Johanna, Rokitte Karin, Filipa M CorteReal, Jorge A Pereira, Joao L Pinheiro, Daniela M Pinto, Andreia J Santos, Andreia M Silva, Susana Henriques, Joao Melo, António Miguel Pereira, Antonio Miguel Pereira, Ana Margarida Cabral, Bruno Dias Couto, Barbara Nunes Gama, Catarina Santos Rodrigues, Mara Nunes, Bruno Ribeiro Silva, Daniela Tavares, Daniela Tavares, Toma Mihai, Oprea C Valentin, Srdjan S Putnik, Petar Andjic, Marija Djujic, Rastislav Filko, Vanja Kunkin, Andjela Milak, Aleksandar Ognjenovic, Nebojsa Mitrovic, Goran Aleksandric, Mihailo Bezmarević, Sasa Dragović, Milan Jovanović, Bosko Milev, Miroslav Mitrović, Srdjan Petković, Valentina Isakovic, Nikola Zoran Nikolic, Predrag Radic, Dragan Luka Vasic, Zlatibor M Loncar, Dusan D Micic, Vladimir R Resanovic, Pavle D Vladimir, Krstina S Doklestic Vasiljev, Ljiljana Velibor Milic, Vladica Velibor Cuk, Jovan Todor Juloski, Radisav Slavoljub Radulovic, Dragana Dragan Arbutina, Jacobo Trebol, Manuel Torres-Jurado, Andres J Valera-Montiel, Francisco E Blanco-Antona, Beatriz de Andrés-Asenjo, Maria Ruiz-Soriano, Tania Gómez-Sanz, Andrea Vázquez-Fernández, Juan Beltran de Heredia, Cristina Rey-Valcárcel, Monica Ballón-Bordon, Maria Pérez-Díaz, Maria Dolores Sanchez-Rodriguez, Jose David Gonzalez-Esteban, Celia Alegre Nevado, Ricardo Montenegro Romero, Andrea Campos-Serra, Raquel Gracia-Roman, Heura Llaquet-Bayo, Anna Muñoz-Campaña, Giulia Vitiello, Lorena Apodaca Murguiondo, Inigo Augusto Ponce, Amaia Garcia Dominguez, Aintzane Lizarazu Perez, Elena Sagarra Cebolla, Mónica García Aparicio, Paloma Garaulet González, Benito Miguel Josa Martínez, Miriam Fraile Vasallo, Mónica MengualBallester, Isabel Andrés Lucas Zamorano, Jose Martinez Moreno, Manuel Luis Buitrago Ruiz, Clara Piñera Morcillo, Alberto Díaz García, Hanna Hernández Oaknin, Maria Pellicer Barreda, Jennifer Amparo García Niebla, Antonio Pérez Álvarez, Diego Cordova, Laura Jiménez, Fernando Mendoza, Cristina Vera, Alberto Vilar Tabanera, María de los Ángeles Gil-Olarte Márquez, José Antonio López-Ruiz, Mª Estela Romero-Vargas, Julio Reguera-Rosal, Alberto García-García, Beatriz Marenco de la Cuadra, Eduardo Perea del Pozo, Virginia Duran Muñoz, Felipe Pareja Ciuró, Ainoa Benavides dos Santos, Ernest Bombuy, Anna G-Monferrer, Sandra López Gordo, José Guerra, Vanessa Sojo, Begona De Soto, Aaron Roman, Ana María González-Castillo, Elena Manzo, Estela Membrilla-Fernandez, Amalia Pelegrina-Manzano, Simone Cremona, Alexander Forero-Torres, Santiago Valderrabano, Francisco Reinoso Olmedo, Fuad Lopez Fernandez, Aitor Landaluce-Olavarria, Jon Barrutia- Leonardo, Alba Garcia-Trancho, Melania Gonzalez-De Miguel, Izaskun Markinez-Gordobil, Maryam Makki, Dana Altamimi, Sadhika Vinod, Olga Rutka, John V Taylor, M Denton, S Gourgiotis, R Ravi, A J Ribbits, Jared Wohlgemut, Shehryar Rangana Khan, Christopher Leiberman, Sabreen P Elbakri, Charlie A Edgar, Conor Magee, Oluwaseun Oyekan, Mehwish Ansar, Jeremy Wilson, Rahel Rashid, Deborah Atwell, Joshua Cassedy, Brianna Gabriel, William Hoff, Shyam Murali, Anna E Garcia Whitlock, Carolyn Susman, Sarah Barnett, Emily Ertmann, Camden DeSanctis, Pavel Karasek, Nathan Klingensmith, Dale F Butler, Brandon Bruns, Ankeeta Mehta, Vanessa Nomellini, Keyus Patel, Anthony Tannous

  • April 18, 2025

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