Adhesive small bowel obstruction: Single band or matted adhesions? A predictive model based on computed tomography scan

Guerrini, Jacopo; Zugna, Daniela; Poretti, Dario; Samà, Laura; Costa, Guido; Mei, S.; Ceolin, Martina; Biloslavo, Alan; Zago, Mauro; Viganò, Luca; Kurihara, Hayato

doi:10.1097/ta.0000000000003182

Cited by 8 publications

(11 citation statements)

References 21 publications

(58 reference statements)

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“…Bootstrap is a powerful, computer-based method for statistical to form a sampling distribution just from only one sample data. This method is recommended for internal validation of prognostic models (Austin and Tu, 2012;Gu et al, 2020;Chen et al, 2021;Guerrini et al, 2021). An ROC curve is a graph showing the performance of a classification model at all classification thresholds that illustrates the diagnostic ability of a binary classifier system.…”

Section: Discussionmentioning

confidence: 99%

Neutrophils and Lymphocytes Can Help Distinguish Asymptomatic COVID-19 From Moderate COVID-19

Sha

Zhang

et al. 2021

Front. Cell. Infect. Microbiol.

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IntroductionAsymptomatic coronavirus disease 2019 (COVID-19) and moderate COVID-19 may be the most common COVID-19 cases. This study was designed to develop a diagnostic model for patients with asymptomatic and moderate COVID-19 based on demographic, clinical, and laboratory variables.MethodsThis retrospective study divided the subjects into 2 groups: asymptomatic COVID-19 (without symptoms, n = 15) and moderate COVID-19 (with symptoms, n = 57). Demographic characteristics, clinical data, routine blood tests, other laboratory tests, and inpatient data were collected and analyzed to compare patients with asymptomatic COVID-19 and moderate COVID-19.ResultsComparison of the asymptomatic COVID-19 group with the moderate COVID-19 group yielded the following results: the patients were younger (P = 0.045); the cluster of differentiation (CD)8+ (cytotoxic) T cell level was higher (P = 0.017); the C-reactive protein (CRP) level was lower (P = 0.001); the white blood cell (WBC, P < 0.001), neutrophil (NEU, P = 0.036), lymphocyte (LYM, P = 0.009), and eosinophil (EOS, P = 0.036) counts were higher; and the serum iron level (P = 0.049) was higher in the asymptomatic COVID-19 group. The multivariate analysis showed that the NEU count (odds ratio [OR] = 2.007, 95% confidence interval (CI): 1.162 - 3.715, P = 0.014) and LYM count (OR = 9.380, 95% CI: 2.382 - 36.934, P = 0.001) were independent factors for the presence of clinical symptoms after COVID-19 infection. The NEU count and LYM count were diagnostic predictors of asymptomatic COVID-19. This diagnostic prediction model showed high discriminatory power, consistency, and net clinical benefits.ConclusionsThe proposed model can distinguish asymptomatic COVID-19 from moderate COVID-19, thereby helping clinicians identify and distinguish patients with potential asymptomatic COVID-19 from those with moderate COVID-19.

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Section: Discussionmentioning

confidence: 99%

Neutrophils and Lymphocytes Can Help Distinguish Asymptomatic COVID-19 From Moderate COVID-19

Sha

Zhang

et al. 2021

Front. Cell. Infect. Microbiol.

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“…T h e d i a g n o s i s o f A S B O i s b a s e d o n c l i n i c a l manifestations, previous patient history, and CT features (1,5,6). The radiologist is able to determine the site, level, and cause of bowel obstruction from CT images (9)(10)(11)(12). However, the adhesion is generally not identifiable on CT scans.…”

Section: Discussionmentioning

confidence: 99%

“…At present, the diagnosis of ASBO is mainly based on abdominal X-ray and computerized tomography (CT) (9)(10)(11)(12). When evaluating patients suspected of having ASBO, radiologists play a crucial role and should address the issues that will arise during emergency diagnostic imaging.…”

Section: Introductionmentioning

confidence: 99%

“…When evaluating patients suspected of having ASBO, radiologists play a crucial role and should address the issues that will arise during emergency diagnostic imaging. However, adhesive bands are not typically visible on CT imaging, and it is still difficult to diagnose the degree and amount of adhesions with medical imaging (6,(9)(10)(11)(12)(13). Surgeons typically use personal experience and imaging to obtain a presumptive diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy and applicability of the novel pneumoperitoneum three-dimensional volume rendering technique in adhesive small bowel obstruction

Wei¹,

Chen²,

Zhang³

et al. 2023

Quant Imaging Med Surg

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Background: The accurate diagnosis of adhesive small bowel obstruction (ASBO) is challenging for surgeons. The aim of this study was to demonstrate that pneumoperitoneum 3-dimensional volume rendering (3DVR) can provide an accurate diagnosis and has applicability in ASBO.Methods: In this retrospective study, patients who underwent preoperative pneumoperitoneum 3DVR and surgery for ASBO between October 2021 and May 2022 were enrolled. The surgical findings were taken as the gold standard, and the kappa test was used to verify the consistency of the pneumoperitoneum 3DVR results and surgical findings.Results: A total of 22 patients with ASBO were included in this study, 27 sites of obstruction adhesions were found during surgery, and 5 patients had both parietal adhesions and interintestinal adhesions. Sixteen parietal adhesions (16/16) were found using pneumoperitoneum 3DVR (κ=1.00; P<0.001), and the diagnosis of parietal adhesions on pneumoperitoneum 3DVR was perfectly consistent with the surgical findings. Eight (8/11) interintestinal adhesions were found using pneumoperitoneum 3DVR (κ=0.727; P<0.001), and the diagnosis of interintestinal adhesions on pneumoperitoneum 3DVR was substantially consistent with the surgical findings. Conclusions:The novel pneumoperitoneum 3DVR is accurate and applicable in ASBO. It can help personalize the treatment of patients and can be useful in planning a more effective surgical approach.

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“…These series, however, lack a control group in which the natural course of recurrence was evaluated. On the other hand, even partial reformation of adhesion might undo the benefits of surgery to reduce the risk of ASBO and ASBO can even be caused by just one strand of adhesions [ 16 ]. The use of an adhesion barrier has not been properly studied in elective adhesiolysis for recurrent ASBO.…”

Section: Introductionmentioning

confidence: 99%

Elective adhesiolysis for chronic abdominal pain reduces long-term risk of adhesive small bowel obstruction

et al. 2023

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Background Selected patients with adhesion-related chronic abdominal pain can be treated effectively by adhesiolysis with the application of adhesion barriers. These patients might also have an increased risk to develop adhesive small bowel obstruction (ASBO). It is unknown how frequently these patients develop ASBO, and how elective adhesiolysis for pain impacts the risk of ASBO. Methods Patients with adhesion-related chronic pain were included in this cohort study with long-term follow-up. The diagnosis of adhesions was confirmed using CineMRI. The decision for operative treatment of adhesions was made by shared agreement based on the correlation of complaints with CineMRI findings. The primary outcome was the 5-years incidence of readmission for ASBO. Incidence was compared between patients with elective adhesiolysis and those treated non-operatively and between patients with and without previous ASBO. Univariable and multivariable Cox regression analysis was performed to identify predictive factors for ASBO. Secondary outcomes included reoperation for ASBO and self-reported pain and other abdominal symptoms. Results A total of 122 patients were included, 69 patients underwent elective adhesiolysis. Thirty patients in both groups had previous episodes of ASBO in history. During 5-year follow-up, the readmission rate for ASBO was 6.5% after elective adhesiolysis compared to 26.9% after non-operative treatment (p = 0.012). These percentages were 13.3% compared to 40% in the subgroup of patients with previous episodes of ASBO (p = 0.039). In multivariable analysis, elective adhesiolysis was associated with a decreased risk of readmission for ASBO with an odds ratio of 0.21 (95% CI 0.07–0.65), the risk was increased in patients with previous episodes with a odds ratio of 19.2 (95% CI 2.5–144.4). There was no difference between the groups in the prevalence of self-reported abdominal pain. However, in surgically treated patients the impact of pain on daily activities was lower, and the incidence of other symptoms was lower. Conclusion More than one in four patients with chronic adhesion-related pain develop episodes of ASBO when treated non-operatively. Elective adhesiolysis reduces the incidence of ASBO in patients with chronic adhesion-related symptoms, both in patients with and without previous episodes of ASBO in history. Trial registration The study was registered at Clinicaltrials.gov under NCT01236625.

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Adhesive small bowel obstruction: Single band or matted adhesions? A predictive model based on computed tomography scan

Cited by 8 publications

References 21 publications

Neutrophils and Lymphocytes Can Help Distinguish Asymptomatic COVID-19 From Moderate COVID-19

Neutrophils and Lymphocytes Can Help Distinguish Asymptomatic COVID-19 From Moderate COVID-19

Accuracy and applicability of the novel pneumoperitoneum three-dimensional volume rendering technique in adhesive small bowel obstruction

Elective adhesiolysis for chronic abdominal pain reduces long-term risk of adhesive small bowel obstruction

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