Plain X-rays of the abdomen reveal dilatation of the small bowel and air-fluid levels [3]. CT scan, eventually with oral contrast, shows the dilatation of proximal bowel and the collapse of distal bowel [4, 5]. Also ultrasounds may be high throughput screening buy Tipifarnib useful [6, 7]. The key of management of small bowel obstruction is the identification of intestinal strangulation,

because mortality increases from 2 to 10 folds in such cases. Therefore an immediate surgical repair with an eventual bowel resection is mandatory. However, the clinical diagnosis of small bowel strangulation is extremely difficult and CT scan becomes very useful, usually on the basis of either bowel wall thickening, mesenteric edema, asymmetrical enhancement with contrast, pneumatosis, or portal venous gas. Mortality for small bowel obstruction has decreased during the past 50 to 60 years from 25% to 5% [8–20]. 17-AAG molecular weight Initial therapy aims at correction of depletion of intravascular fluids and electrolyte

abnormalities. The patient should be given nothing by mouth and nasogastric tube should be inserted in patients with emesis. In patients with adhesive small intestine obstruction, water-soluble contrast medium (Gastrografin®) with a follow-through study has not only a diagnostic but also a therapeutic role, because it is safe and reduces the operative rate and the time to resolution of obstruction, as well as the hospital stay [21–23]. Surgical intervention is instead mandatory for patients with a complete small bowel obstruction with signs or symptoms indicative of strangulation, perforation or those patients with simple obstruction that has not resolved within 24 to 48 hours Megestrol Acetate of non operative treatment [23]. The surgical approach

includes adhesiolysis and resection of non viable intestine. The extension of intestinal resection depends on the purple or black discoloration of ischemic or necrotic bowel. Viable intestine also has mesenteric arterial pulsation and normal motility. When ischemic damage is more limited, is sufficient adhesiolysis followed by a 10-15 minutes period of observation to allow for possible improvement in the gross appearance of the involved segment. The role of laparoscopy in small bowel obstruction has still to be defined. Certainly, laparoscopy represents a diagnostic act and sometimes has a therapeutic role [24, 25]. The major indication is small bowel obstruction due to unique band adhesion without signs of ischemia and necrosis. In laparoscopic procedures the first trocar has to be positioned using Hasson’s technique for open laparoscopy to avoid accidental bowel perforations related to bowel distension and adhesions with the abdominal wall. After that, two 5 mm trocars must be introduced under vision to explore the peritoneal cavity and find the bowel segment obstructed by the band adhesion. If ischemic or necrotic bowel is present conversion to open surgery may be necessary.