BLOCKING THE WAY TO SPACE: EVALUATION OF A PATIENT WITH RECURRENT SMALL BOWEL OBSTRUCTION FOR SPACEFLIGHT.

INTRODUCTION: This case report describes a 40-60 year-old astronaut seeking a waiver after a small bowel obstruction status post-lysis of adhesions. The individual had a past medical history of appendicitis status post open appendectomy as a young child complicated by a small bowel obstruction (SBO) approximately 20 years later treated with laparotomy and adhesion release. They were previously granted a waiver for long duration spaceflight. They developed another SBO and underwent laparoscopic adhesiolysis without complication. After recovery, they were evaluated for certification for long-duration spaceflight. BACKGROUND: SBOs are a common complication of intra-abdominal surgery due to the formation of adhesions. SBOs can be treated conservatively with oral intake restriction, rehydration, and symptom management but may be treated with surgical intervention. Recurrence of an SBO is common but less frequent with operative intervention. Screening for adhesions predisposing an individual to recurrence are not commonly performed. Case Presentation: After recovery, this individual underwent evaluation for long-duration spaceflight. Outside of prior abdominal surgeries they had no other complicating medical conditions. Due to the concern for recurrence of SBO, the individual underwent additional screening evaluation for adhesions via abdominal ultrasound evaluation which showed "visceral slide" and did not find evidence of bowel adhesions. The astronaut was presented to the Multilateral Space Medical Board and granted certification for long-duration spaceflight. DISCUSSION: This case presentation describes a common complication of intra-abdominal surgery, SBO, and one process for evaluation for qualification for spaceflight. Intra-abdominal surgery is a common operation that an individual may undergo for a variety of conditions, including childhood surgery for appendicitis. Any individual with a history of prior intra-abdominal surgery is at risk for a small bowel obstruction and prior SBO puts an individual at risk for recurrence. An SBO in spaceflight would put the individual at risk of uncontrollable nausea and vomiting, dehydration, and be potentially mission ending. Possible adhesions and SBOs can be diagnosed with ultrasound. Risk reduction and prediction of recurrence is important for safety of the individual and the mission. Learning Objectives 1. The participant will understand the potential risks of a prior small bowel obstruction during medical evaluation for spaceflight. 2. The participant will understand one possible method of evaluation of a crewmember with a history of a small bowel obstruction for certification for spaceflight. [ABSTRACT FROM AUTHOR]