الفهرس 
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Abstract
This study demonstrates that intra-abdominal adhesions are the most common form of intestinal obstruction, and are a common problem which accounts for a large general surgical workload and a significant cost to the health service. It also illustrates that there is a wide variation among general surgeons in their approach to the treatment of adhesional bowel obstruction and the prevention of adhesion formation.
Adhesions may be classified as either congenital or acquired, the acquired type is subdivided into inflammatory or postoperative. Congenital and inflammatory adhesions have been reported to cause intestinal obstruction, although they do so only rarely, the majority of cases are post surgical. Adhesive intestinal obstruction can be diagnosed on the basis of patients history, clinical evaluation and radiographic findings and whether the patient underwent operation and the findings during operation.
Because over 50 % of all cases of SBO are the direct result of postoperative adhesions, it is probably just as important as the actual management of SBO for all practicing abdominal surgeon to familiarize themselves with the widely accepted ”ischemic theory” of adhesion formation. A number of intraoperative measures, many of which go against established surgical principles, are now encouraged during routine elective abdominal surgery to reduce the incidence of detrimental adhesions that might subsequently produce SBO. At the same time, surgeons should continue their aggressive attitude towards elective repair of any and all abdominal hernias, which continue to account for close to 15 % of all cases of small intestinal obstruction and still remain the most common cause of strangulation.
Considerable controversy still exists concerning the ideal therapy for adhesive intestinal obstruction and the indications for and the timing of surgery. The main problem is how to avoid strangulation or other forms of bowel damage and still minimize the use of unnecessary operations.
We concluded that patients with complete or partial post operative intestinal obstruction can be managed conservatively provided that there is no obvious signs of intestinal strangulation. A conservative trial of up to 5 days duration offers a safe and reasonable opportunity for spontaneous resolution of obstruction. A conservative trial has not increased the incidence of strangulation and mortality. Additionally, surgical intervention is neither the final solution nor the safest method in adhesive intestinal obstruction, because incidental bowel injury may occur during operation and recurrences are encountered.
Additionally we deduced that in patients with postoperative intestinal obstruction in whom the previous laparotomy was for appendectomy or tubo-ovarian surgery, the obstruction is highly unlikely to settle without operative intervention and prolonged observation may lead to bowel ischaemia. It is considered safe to give a trial of non-operative management less often.