Clinical strategies for the management of intestinal obstruction and pseudo-obstruction: a Delphi consensus study from the Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT)

Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT society designed a consensus study aimed to define their optimal workout.
The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Four main topic areas included nosology, diagnosis, management and treatment.  The panel identified four major criteria of diagnosis including absence of flatus, presence of >3.5 cm ileal levels or >6 cm colon dilatation and abdominal distension.  Criteria for immediate surgery included: presence of strangulated hernia, a >10 cm cecal dilatation, signs of vascular pedicles obstructions and persistence of metabolic acidosis. Also, rules for non-operative management  included a naso-gastric drainage placement and clinical and laboratory controls each 12 hours.