Factors Predicting Need for and Delay in Surgery in Small Bowel Obstruction

Abstract

Safe management of small bowel obstruction (SBO) depends on rapid diagnosis. The objective of this study was to determine factors predictive for operation and resulting in operative delay. A retrospective review was done of 1613 patients over 4 years (2003 to 2007) with International Classification of Diseases, 9th Revision codes for SBO. After excluding patients with incomplete clinical data, incorrectly coded, and age younger than 5 years, 872 patients were reviewed. Analysis was done for factors predictive for operation and factors associated with operative delay. Statistics was done using t test, Wilcoxon-rank-sum, and χ2. Four hundred ninety-four patients (56.6%) underwent surgery for SBO. Three hundred seventy-eight patients (43.4%) were managed nonoperatively. Of factors examined, younger patients ( P = 0.001), no previous operation ( P < 0.001), and absence of adhesive disease ( P < 0.001) were more likely to go to operation. Acquiring a computed tomographic scan ( P = 0.029) or radiograph ( P < 0.001) were the only factors that increased time to the operating room (OR). Increased time to the OR was associated with a higher incidence of bowel resection. With those with time to OR less than 24 hours, 39 of 325 patients(12%) had bowel resection versus time to OR greater than 24 hours, 23 of 80 patients (29%) required bowel resection. Identifying patients who may safely undergo nonoperative management remains difficult. Delay in operation for SBO places patients at higher risk for bowel resection.

Optimal time of surgery for acute adhesive small bowel obstruction

“…-высокий риск ишемии и некроза кишки, усугубление тяжести состояния вследствие энтеральной недостаточности, эндотоксикоза, бактериальной контаминации, нарастания ишемии на фоне неразрешенной кишечной непроходимости [13,[15][16][17];…”

“…Отсутствие в анамнезе операций на органах брюшной полости не исключает странгуляцию, более того, при соответствующей симптоматике рас-сматривается в качестве фактора риска [1,15] -до 10% пациентов имеют спайки без операций в анамнезе [24]. В целом общеизвестные критерии -лихорадка, лейкоцитоз, тахикардия, постоянная боль, метаболический ацидоз, признаки перитонита -позволяют правильно определить ишемию кишечника только в 40-50% наблюдений.…”

Ileus in Adults

“…There is no specific laboratory test for the assessment of mechanical ileus with accompanying bowel ischemia (5,6). Only the procalcitonin concentration seems to be a potentially useful mark.…”

“…For incomplete ileus, the success rate of purely suppor tive treatment is 80%, while the probability that bowel resection will be needed is under 5% (9,15,16). On the other hand, if complete ileus is treated conservatively, the probability that bowel resection will be needed is roughly 30% (5).…”

“…Conservative treatment can even be continued for several days under close clinical and laboratory observation. It should be borne in mind, however, that a failed trial of conservative treatment for more than three days is associated with a greater need for bowel resection (12% versus 29%) and with higher morbidity and mortality (level IV evidence) (5,17,18).…”