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Introduction: Adhesion-related small bowel obstruction (ASBO) management is difficult if there are no signs of strangulation or peritonitis when intestinal transit has not been restored. The aim of the present study was to determine the impact of combining a procalcitonin (PCT)-based algorithm with clinical signs on the management of uncomplicated ASBO., Method: We performed a pilot, retrospective, single-center "before-after" study. During the "before" period (2007 to 2012), patients with uncomplicated ASBO (n=93, the Gastrografin ® group) underwent a clinical examination and a Gastrografin ® index. During the "after" period (2013 to 2016), patients with uncomplicated ASBO (n=70, the algorithm group) underwent a clinical examination and were assessed with the PCT-based algorithm. The study's primary outcome was the appropriateness of ASBO management. The secondary outcomes were the need for surgery and the time to surgery, the LOS, the morbidity and mortality rates, and the recurrence rate., Results: The proportion of well-managed patients was higher in the algorithm group than in the Gastrografin ® group (86% vs. 47%; P<0.001). The time to surgery (48h vs 72h; P=0.02) and the LOS (4 vs. 6days, P=0.02) were significantly lower in the algorithm group. The need for surgery was similar in both groups (31% vs. 37%, P=0.49). The morbidity (P=0.69), mortality (P=0.82) and recurrence rates (P=0.57) were similar in the two groups., Conclusion: The use of a PCT-based algorithm is of value in the routine clinical management of ASBO; it reduces the LOS and the time to surgery without increasing the need for surgery., (Copyright © 2017. Published by Elsevier Masson SAS.)

Acute calculous cholecystitis may progress in a variety of ways from mild cases treatable with (or even without) oral antibiotics to severe cases complicated by bile peritonitis that require emergency surgical or radiological intervention. A sample of bile should always be sent for microbial cultures to identify aerobic and anaerobic bacterial organisms. Empirically selected broad spectrum antibiotic therapy (with a defined duration, dosage and administration route) should be prescribed according to the severity of the cholecystitis, an associated history of recent antibiotic therapy, and local bacterial susceptibility patterns. As soon as causative organisms have been identified, antibiotic therapy should be adjusted to a narrower spectrum antimicrobial agent based on the specific micro-organism(s) and the results of sensitivity testing., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)