Cotton, Michael

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LETTERS TO THE EDITORAdhesive Bowel Obstruction: Letter to the EditorMichael CottonPublished online: 5 February 2010 Socie´te´ Internationale de Chirurgie 2010Dear Sir,I read with interest the article by Butt et al. [1] regardingthe rare but possible relevance of de novo adhesional bowelobstruction, i.e., cases of small bowel occlusion arisingwithout previous abdominal surgery. In a study performedin Bulawayo, Zimbabwe [2], the pattern of small bowelobstruction changed with cases caused by postoperativeadhesions becoming much more frequent than those due toinguinal hernia. However, a significant number of cases ofsmall bowel obstruction in young women was found to bedue to previous pelvic sepsis (PID) treated conservativelywith antibiotics. This remains a considerable problem inresource-poor countries. An important impression was thatde novo small bowel obstruction in men warranted earlyexploration because significant pathology was found inalmost all cases. This message remains important in thosecircumstances where access to sophisticated scanningmethods is unavailable.Of course, it goes without saying that even more carefulinspection of the abdomen is necessary in today’s patientwho may have had laparoscopic surgery with hardly anyexternal scarring. Moreover, pervaginal or pergastric sur-gery leaves entirely no trace, thus forcing the examiner torely on the patient’s own recollection or records or those ofhis relatives.References1. Butt MU, Velmahos GC, Zacharias N et al (2009) Adhesionalsmall bowel obstruction in the absence of previous operations:management and outcomes. World J Surg 33(11):2368–23712. Cotton MH (1995) Changing pattern of intestinal obstruction inBulawayo, Zimbabwe. E Cent Afr J Surg 1:71–72M. Cotton (&)Me´decin Associe´ aux Urgences, Centre Hospitalier UniversitaireVaudois, 1011 Lausanne, Switzerlande-mail: mikeytha@bluewin.ch123World J Surg (2010) 34:1133DOI 10.1007/s00268-010-0445-0

Adhesive Bowel Obstruction: Letter to the Editor

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Adhesive Bowel Obstruction: Letter to the Editor

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