# Small Bowel Obstruction in Virgin Abdomen: Experience From a Community Center

## TL;DR

This study examines causes and outcomes of small bowel obstruction in patients without prior abdominal surgery, finding mostly benign causes and suggesting selective exploration may be sufficient.

## Contribution

The study provides descriptive insights into modern SBO-VA cases, challenging historical assumptions about malignancy risk and suggesting CT features and patient factors may guide treatment decisions.

## Key findings

- 38% of SBO-VA cases were due to abnormal adhesions causing internal hernias.
- CT features like transition point and mesenteric swirl were more common in patients needing therapeutic exploration.
- Hypertension and ACE inhibitor use were more frequent in patients with negative explorations.

## Abstract

Background

Small bowel obstruction in patients without prior abdominal surgery, referred to as a “virgin abdomen” (SBO-VA), is historically believed to signal a higher risk of malignancy and therefore mandate exploration. However, recent systematic reviews challenge this dogma, suggesting benign etiologies predominate. This study evaluates the etiology, imaging characteristics, and outcomes of SBO-VA in a modern US cohort.

Methods

A retrospective analysis was performed at Bayhealth Medical Center (2017-2024). Patients with SBO and no prior abdominal surgery were included. Preoperative computed tomography (CT) findings, operative reports, pathology, laboratory values, and postoperative outcomes were analyzed. Given the small sample size, analyses were descriptive and intended to generate hypotheses rather than establish statistical associations.

Results

Fifteen patients were identified; 13 met the inclusion criteria. The mean age was 62 ± 17 years (11 male patients). Abnormal adhesions leading to internal hernia accounted for 38% of cases. Therapeutic exploration occurred in 10 patients (67%), while four patients (31%) had negative exploration. Patients undergoing therapeutic intervention tended to be older and had longer hospital stays compared with those undergoing negative exploration.

CT findings more frequently observed in patients undergoing therapeutic exploration included the presence of a transition point, mesenteric swirl, and stricture or adhesive disease. Hypertension and angiotensin-converting enzyme (ACE) inhibitor use were more commonly observed among patients with negative exploration. Readmissions occurred more frequently in patients with negative exploration. Pathology demonstrated ischemic necrosis in 17% of patients.

Conclusion

SBO-VA in this cohort was predominantly benign, with a low observed rate of malignancy, consistent with contemporary literature. Certain CT features appeared more common in patients requiring therapeutic exploration, while hypertension and ACE inhibitor use were observed more frequently among patients with negative exploration. These findings are descriptive and hypothesis-generating, supporting a selective rather than mandatory approach to exploration in SBO-VA.