284 Management of Small Bowel Obstruction in a Virgin Abdomen: A Retrospective Cohort Study from a District General Hospital

Abstract Aim Small bowel obstruction (SBO) is a common surgical emergency, typically caused by post-operative adhesions. In patients with a virgin abdomen—no prior abdominal surgery—the traditional approach has been operative management. However, emerging evidence supports non-operative treatment in selected cases. This study evaluates the management and outcomes of SBO in a virgin abdomen. Method We retrospectively reviewed all CT-confirmed SBO cases between 01/01/2019 and 08/07/2024. Inclusion criteria were a clear transition point and no history of abdominal surgery, radiotherapy, or intra-abdominal inflammatory disease. Patients with SBO due to hernia, malignancy, Crohn’s disease, strictures, or foreign bodies were excluded. Data included demographics, imaging, management strategy, time to surgery, complications, and readmissions. Results Thirty-seven patients were included (59% male; age range 26–96). Eleven (29.7%) underwent surgery, primarily for suspected ischaemia or internal hernia. Eight of these had laparoscopic procedures, and two required bowel resection. One patient experienced a Clavien-Dindo IIIa complication. Median time to surgery was 1 day. Twenty-six patients (70.3%) were managed non-operatively, of whom 10 received contrast and 20 had NG decompression. None required surgery during admission. Mean length of stay was comparable: 7.7 days (operative) vs. 7.2 days (non-operative). Three patients were readmitted within 30 days. Conclusions Non-operative management appears safe and effective for selected patients with SBO in a virgin abdomen. With 70% successfully managed without surgery, our findings support reconsidering the routine operative approach in this population.