Early operation in radiologically negative adhesion ileus

: From January 1987 to December 1990 46 patients underwent laparotomy for mechanical ileus by adhesive bands at the Burgerspital Solothurn. Supine and upright X-ray films of the abdomen had been taken in all cases. 31 patients presented typical radiographic signs. In 15 patients (32.8%) no air-fluid levels and no distention of small bowel loops were visible initially. Despite negative X-ray signs 7 of these patients underwent surgery within a median of 2 hours after hospital admission. Six times the indication was based on clinical findings alone and once on further examinations. On average symptoms had been present for 9 hours. The rate of resection was 14%. Eight cases underwent primary clinical observation. This resulted in a median delay to operation of 23 hours and a rate of resection of 50%. The 31 cases with initially positive radiologic findings had a lower rate of resection (25%) despite of a significantly (p = 0.011) longer duration of symptoms (46 hours) before admission. Diagnostic problems arise especially when X-ray signs are negative. Our cases confirm, that negative radiographs can not exclude the presence of an ileus. Quite to the contrary this group accumulates a significantly higher (p = 0.004) number of strangulation ileus. The accentuated pain leads to a significantly (p = 0.011) earlier hospital admission at a time when X-ray signs are not yet visible. Because of the real danger of intestinal necrosis the typical clinical symptoms and signs should lead to surgery without waiting for the later appearance of air-fluid levels.(ABSTRACT TRUNCATED AT 250 WORDS)