A Case Series on Acute Bowel Obstruction in Virgin Abdomen

Bowel obstruction [BO] remains an important cause of morbidity, accounting for a major part of surgical admissions for acute nontraumatic abdominal pain. While most of the BO cases are due to prior abdominal surgeries with adhesions as primary cause, it can also occur in patients without any surgical history, known as ‘bowel obstruction in virgin abdomen’ [BO-VA]. Traditional medical teaching advocates for early surgical intervention in BO due to inconsistent clinical signs and complications, summarised by, “Never let the sun rise or set on an obstruction abdomen”. However, recent management trends favour a nonoperative approach in patients with adhesion related BO from prior surgeries. In contrast, for patients with BO-VA, many centres still recommend early laparotomy, suspecting obstructive lesions. The management of BO in virgin abdomen remains controversial due to limited understanding of its aetiology, highlighting the need for further investigation to aid in surgical decision making This case series has highlighted the common as well as some rare cases of BO-VA. Most importantly, management of BO-VA requires careful preoperative assessment, proper knowledge of the surgical anatomy and appropriate decision making to be used in varying situations to prevent the complications