Small Bowel Obstructions in the Elderly

According to the World Health Organization, old age is defined as 60 years of age or older, although in poorer countries with lower life expectancy than in developed countries, an age range between 50 and 55 is also taken into account. Small bowel obstruction (SBO) is a frequent emergency diagnosis in elderly patients and its occurrence tends to increase with the increasing number of elderly patients thus requiring sometimes acute medical care and emergency surgery. About 10–12% of patients above 65 years of age presenting with abdominal pain at the emergency department (ED) is diagnosed with small bowel obstruction (Spangler et al. Int J Emerg Med. 7:43, 2014; Ozturk et al. World J Emerg Surg. 13:48, 2018). The three most frequent causes of SBO are postoperative adhesions, hernias, and neoplasms. A correct diagnosis may be difficult in the elderly population, due to a lack of detailed studies on symptoms. In fact, they seem to present later and to be less profound in the elderly compared to younger patients thus resulting in a higher rate of misdiagnosis (Bugliosi et al. Ann Emerg Med. 19:1383–1386, 1990; Leuthauser and McVane. Emerg Med Clin North Am. 34:363–375, 2016). A tailored surgical approach should be done for elderly patients with SBO due to frailty.