Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care

Ekin Ozturk, Marianne van Iersel, Martijn Mwj Stommel, Yvonne Schoon, Richard Rpg Ten Broek, Harry van Goor, Ekin Ozturk, Marianne van Iersel, Martijn Mwj Stommel, Yvonne Schoon, Richard Rpg Ten Broek, Harry van Goor

Abstract

Small bowel obstruction is one of the most frequent emergencies in general surgery, commonly affecting elderly patients. Morbidity and mortality from small bowel obstruction in elderly is high. Significant progress has been made in the diagnosis and management of bowel obstruction in recent years. But little is known whether this progress has benefitted outcomes in elderly patients, particularly those who are frail or have a malignancy as cause of the obstruction, and when considering quality of life and functioning as outcomes. In this review, we discuss the specific challenges and needs of elderly in diagnosis and treatment of small bowel obstruction. We address quality of life aspects and explore how the concept of geriatric assessment can be utilized to improve decision-making and outcomes for elderly patients with a small bowel obstruction.

Keywords: Adhesions; Elderly patients; Quality of life; Small bowel obstruction.

Conflict of interest statement

Not applicableNot applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of search in PubMed and Embase databases; 120 studies were selected and searched with elderly patients as focus. Exclusion criteria: not focused on older adults, case reports, laparotomy vs laparoscopy, non-English/Dutch/German studies and studies focusing on phytobezoars
Fig. 2
Fig. 2
Algorithm with suggested diagnostic and therapeutic steps for the elderly patient with small bowel obstruction. After assessing cognition, frailty and patient goals according to diagnosis, risks and benefits of surgical and conservative management should be weighed. SBO small bowel obstruction, SDM shared decision-making

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