Adhesions Drive Most Small Bowel Obstructions in the Virgin Abdomen

For decades, surgical teaching has dictated that patients presenting with a small bowel obstruction and no history of abdominal surgery, the so-called virgin abdomen, require prompt operative exploration. This aggressive approach stems from the historical assumption that without prior surgical trauma, the obstruction is likely driven by catastrophic or malignant etiologies rather than benign adhesions [1, 2]. However, recent systematic reviews have begun to challenge this clinical consensus, revealing that de novo adhesions actually account for a significant portion of these cases and that many patients can resolve with conservative measures [3, 4]. Despite this shifting perspective, the decision to forego surgery remains fraught with clinical anxiety due to the persistent fear of missing an underlying neoplasm or closed-loop obstruction [5]. A retrospective analysis now offers granular insights into the specific etiologies and prognostic factors that can help clinicians safely navigate this diagnostic dilemma, allowing for more tailored triage in the emergency department.