So the obstructed bowel segment is liberated. The rate of laparotomic conversions ranges find more widely from 0% to 52%, depending on patient selection and surgical skills [24–29]. The principle reason is a difficult exposition and treatment of band adhesions due to a reduced operating field caused by small bowel dilatation, multiple band adhesions, and sometimes

the presence of posterior band adhesion which are more difficult to treat laparoscopically. The predictive factors for successful laparoscopic adhesiolysis are a number of previous laparotomies lower than 3, a non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, a unique band adhesion, an early laparoscopic management (possibly within 24 hours), no signs of peritonitis and the experience of the surgeon [24–29]. Relative contraindication are 3 or more previous laparotomies and multiple adherences. Finally, absolute contraindications to laparoscopic adhesiolysis are an abdominal film showing a remarkable dilatation (more than 4 cm) of the small Alpelisib bowel, signs of peritonitis, severe cardiovascular

or respiratory co-morbidities and haemostatic disease, and hemodynamic instability. Laparotomic conversion is often related to a higher morbidity rate, so when the predictive factors for a successful laparoscopy are not present a primary laparotomic access becomes necessary [25]. In any case, early conversion is recommended to reduce postoperative morbidity [25]. Many studies in literature suggest that laparoscopic adhesiolysis in small bowel obstruction is convenient if performed by skilled surgeons in correctly selected patients, resulting in a shorter hospital stay with a early flatus and a early realimentation and in a lower postoperative morbidity. Nonetheless laparoscopic surgery requires a longer operating time and recurrent obstruction remains the major postoperative risk in the management of these patients. Crohn’s disease Acute surgical emergencies in patients with inflammatory bowel disease are infrequent but may be dangerous for life.

Crohn’s disease is an important cause of small bowel acute surgery [1, 30–32]. Ileal localization, particularly terminal ileum, is the most frequent in Crohn’s disease, Cediranib (AZD2171) despite its pan-intestinal nature. Skip lesions interest full-thickness the bowel wall and are able to induce a wide spectrum of acute surgical emergencies. Small bowel is the main site of bleeding in Crohn’s disease. The bleeding is often from a localized source, caused by erosion of a blood vessel within multiple deep ulcerations that extend into bowel wall. Severe hemorrhage is rare and requires surgery [33, 31]. Other surgical indications include a bleeding who doesn’t slow after 4 to 6 units of blood and recurrent hemorrhage [1]. Because of segmental disease, the best approach is to localize the source of bleeding preoperatively. The patient is stabilized and a nasogastric tube is inserted.