Adhesions may be a simple cord-like band that creates and internal hernia when bowel loops slip beneath it, or may be widespread and cause kinking and recurrent obstruction. The former situation may be relieved when the loop of bowel extricates itself by by its contractions. Kinked bowel may become obstructed by undigested fibrous vegetable matter (see the other Chinese restaurant syndrome), and the resulting obsruction may be relieved when the blockage breaks up. Gastrografin, by stimulating peristalsis, may assist in this process. Thus many obstructions may resolve with non-operative management.
It requires surgical judgment and a time limit to operate when resolution is no longer likely and before a loop of bowel becomes compromised and an acute abdomen results. With a complete obstruction, a bowel loop may become compromised as early as 6 hours from onset (see intestinal obstruction with bowel resection.)
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