This risk is higher when fluid intake is diminished as in small bowel obstruction.
Most elderly patients have reduced renal function increasing the risk of contrast nephropathy from contrast-enhanced CT. Elderly patients often present with atypical clinical features, causing a delay in diagnosis and progressed disease at first presentation. They represent a diverse group consisting of vital elderly patients who have enough resilience to cope with a ‘second hit’ like surgery compared to frail elderly patients with limited reserve capacity and high risk of complications even without surgery. It is questionable if elderly patients with small bowel obstruction benefit from the progress in the management in small bowel obstruction because of specific challenges and demands in diagnosis and treatment in this patient population. Also, laparoscopic surgery of small bowel obstruction has been introduced as treatment option potentially reducing postoperative morbidity, although this minimal invasive approach is not suitable for every patient and harbours its own complications. Today, more than 70% of small bowel obstructions are treated successfully by conservative approach, avoiding the risks of a potentially complicated operation. These diagnostic tools led to a more tailored approach and to a reduction of immediate operations. Adding water-soluble contrast can accurately predict completeness of obstruction and successful conservative treatment. Computed tomography (CT) has been a step forward in detecting different etiologies of bowel obstruction and of the completeness of the obstruction. Management of small bowel obstruction has advanced over recent years resulting in improved treatment results for small bowel obstruction in the general population. Any emergency surgery in elderly is associated with high morbidity and mortality compared to elective operations. Adhesiolysis and small bowel resection are two of seven main causes counting for 80% of morbidity and death related to emergency surgery.
In the UK, small bowel obstruction accounts for 51% of all emergency laparotomies. Small bowel obstruction in general is one of the most frequent causes of general emergency surgery. Approximately 10–12% of patients above 65 years presenting with abdominal pain at the emergency department (ED) is diagnosed with small bowel obstruction. Small bowel obstruction (SBO) is a common emergency diagnosis in elderly patients, which occurrence tends to increase parallel to the increasing number of elderly patients requiring acute medical care and emergency surgery.
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