Adhesive Small-Bowel Obstruction: Value of CT in Identifying Findings Associated with the Effectiveness of Nonsurgical Treatment

Millet, Ingrid; Ruyer, Alban; Alili, Chakib; Doyon, F. Curros; Molinari, Nicolas; Pagès, E.; Zins, Marc; Taourel, Patrice

doi:10.1148/radiol.14132872

Cited by 81 publications

(56 citation statements)

References 26 publications

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“…Furthermore, it has been suggested that the oral administration of a small amount of Gastrografin can lead to the resolution of ASBO [2][3][4][5][6][7][8][9][10].…”

Section: Radiologic Diagnosismentioning

confidence: 99%

“…A double-contrast CT scan is the imaging procedure of choice because of its high sensitivity and specificity in the diagnosis of ischemia and degree of obstruction (partial vs complete) [3][4][5][6][7][8][9][10][11][12]. It can be helpful to determine the etiology of obstruction, such as internal or abdominal wall hernias, intussusception, tumor or mass, Crohn's disease, metastatic cancer, ischemia, and sign of intestinal compromise such as pneumatosis intestinalis or pneumoperitoneum.…”

Section: Radiologic Diagnosismentioning

confidence: 99%

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Adhesive Small Bowel Obstruction (ASBO)

Simone

Abongwa

Saverio

et al. 2016

Acute Care Surgery Handbook

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“…Furthermore, it has been suggested that the oral administration of a small amount of Gastrografin can lead to the resolution of ASBO [2][3][4][5][6][7][8][9][10].…”

Section: Radiologic Diagnosismentioning

confidence: 99%

Section: Radiologic Diagnosismentioning

confidence: 99%

Adhesive Small Bowel Obstruction (ASBO)

Simone

Abongwa

Saverio

et al. 2016

Acute Care Surgery Handbook

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“…In a closed loop obstruction, 2 transition point beak signs may be seen. The absence of a 'beak sign' is associated with successful non-operative management in the setting of adhesion related SBO, along with the presence of a small bowel feces sign and an anterior parietal adhesion 59 . On the other hand, two 'beak signs' or more, a whirl sign, a C-or U-shaped bowel loop and highgrade obstruction are more likely to require surgical management in the setting of adhesional SBO 59,60 .…”

Section: Transition Point 'Beak Sign'mentioning

confidence: 99%

“…Complete obstruction on the other hand is the opposite of these entities. High-grade obstruction is more likely to require operative management in the setting of adhesion related SBO 59 .…”

Section: Gradingmentioning

confidence: 99%

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Imaging of Ischemia, Obstruction and Infection in the Abdomen

Murphy¹,

Twomey²,

McLaughlin³

et al. 2015

Radiologic Clinics of North America

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Association of Surgical Intervention for Adhesive Small-Bowel Obstruction With the Risk of Recurrence

et al. 2019

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IMPORTANCE Adhesive small-bowel obstruction (aSBO) is a potentially chronic, recurring surgical illness. Although guidelines suggest trials of nonoperative management, the long-term association of this approach with recurrence is poorly understood. OBJECTIVE To compare the incidence of recurrence of aSBO in patients undergoing operative management at their first admission compared with nonoperative management. DESIGN, SETTING, AND PARTICIPANTS This longitudinal, propensity-matched, retrospective cohort study used health administrative data for the province of Ontario, Canada, for patients treated from April 1, 2005, through March 31, 2014. The study population included adults aged 18 to 80 years who were admitted for their first episode of aSBO. Patients with nonadhesive causes of SBO were excluded. A total of 27 904 patients were included and matched 1:1 by their propensity to undergo surgery. Factors used to calculate propensity included patient age, sex, comorbidity burden, socioeconomic status, and rurality of home residence. Data were analyzed from September 10, 2017, through October 4, 2018. EXPOSURES Operative vs nonoperative management for aSBO. MAIN OUTCOMES AND MEASURES The primary outcome was the rate of recurrence of aSBO among those with operative vs nonoperative management. Time-to-event analyses were used to estimate hazard ratios of recurrence while accounting for the competing risk of death. RESULTS Of 27 904 patients admitted with their first episode of aSBO, 6186 (22.2%) underwent operative management. Mean (SD) patient age was 61.2 (13.6) years, and 51.1% (14 228 of 27 904) were female. Patients undergoing operative management were younger (mean [SD] age, 60.2 [14.3] vs 61.5 [13.4] years) with fewer comorbidities (low burden, 382 [6.2%] vs 912 [4.2%]). After matching, those with operative management had a lower risk of recurrence (13.0% vs 21.3%; hazard ratio, 0.62; 95% CI, 0.56-0.68; P < .001). The 5-year probability of experiencing another recurrence increased with each episode until surgical intervention, at which point the risk of subsequent recurrence decreased by approximately 50%. CONCLUSIONS AND RELEVANCE According to this study, operative management of the first episode of aSBO is associated with significantly reduced risk of recurrence. Guidelines advocating trials of nonoperative management for aSBO may assume that surgery increases the risk of recurrence putatively through the formation of additional adhesions. The long-term risk of recurrence of aSBO should be considered in the management of this patient population.

show abstract

Adhesive Small-Bowel Obstruction: Value of CT in Identifying Findings Associated with the Effectiveness of Nonsurgical Treatment

Abstract: The number of beak signs and the location of the transition zone in relation to the anterior peritoneal layer are independent signs associated with the success or failure of nonsurgical treatment.

Cited by 81 publications

References 26 publications

Adhesive Small Bowel Obstruction (ASBO)

Adhesive Small Bowel Obstruction (ASBO)

Imaging of Ischemia, Obstruction and Infection in the Abdomen

Association of Surgical Intervention for Adhesive Small-Bowel Obstruction With the Risk of Recurrence

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