Predicting Strangulated Small Bowel Obstruction: An Old Problem Revisited

Jancelewicz, Timothy; Vu, Lan; Shawo, Alexandra; Yeh, B; Gasper, Warren J.; Harris, Hobart W.

doi:10.1007/s11605-008-0610-z

Cited by 109 publications

(84 citation statements)

References 17 publications

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“…6 Failure to predict strangulation early among these patients often delays surgical intervention there by leaving a significant impact on the outcomes. On history strangulation can be predicted among patients presenting with small intestinal obstruction based on delayed presentation beyond 72 hours with continuous abdominal pain, bleeding per rectum or blood stained aspirate in the nasogastric tube and with high grade fever.…”

Section: Discussionmentioning

confidence: 99%

“…5 Identification of defined clinical criteria predictive of strangulation among patients with small bowel obstruction will allow an early decision making regarding exploratory laparotomy and thereby can lead to improved outcomes. 6 Several laboratory parameters which can predict strangulation like serum amylase, serum lactate, serum LDH have been investigated though none of them have been proved to be neither sensitive nor specific. Imaging wise only CT scan has been proved to be of some value in the detection of strangulation among patients with small bowel obstruction but most often it is not a readily available investigation and it often predicts strangulation only after irreversible ischemia has already set in.…”

Section: Introductionmentioning

confidence: 99%

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A study of preoperative predictive factors of strangulation in acute small intestinal obstruction

2016

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INTRODUCTIONAcute intestinal obstruction is a common surgical emergency with small bowel obstruction being the most common cause accounting for more than 80% of the cases. 1 Obstructed hernias had been the commonest cause for acute intestinal obstruction in the past. In the recent times with increase in the number of laparotomies performed for various reasons, post-operative adhesions has been the most common cause documented.The most critical factor affecting the outcome among these patients is whether obstruction has progressed to the point of strangulation or not. 2The accurate and early recognition of the presence of intestinal strangulation in patients with mechanical bowel obstruction is important to plan an early exploratory laparotomy as delayed diagnosis and intervention can result in higher incidence of postoperative morbidity and mortality. [2][3][4] Although advances in diagnosis and management have reduced the mortality rate of simple intestinal obstruction ABSTRACT Background: Acute small intestinal obstruction is a common surgical emergency where outcomes are often influenced by the presence of strangulation. Identification of criteria which can predict strangulation among patients presenting with acute small intestinal obstruction can help in early decision making regarding management and thereby can ensure better outcomes. A prospective observational study was carried out among 54 patients presenting with acute small intestinal obstruction to document clinically the signs and symptoms which can predict strangulation early along with laboratory parameters and findings on imaging using ultrasound and color doppler. Methods: A delayed presentation beyond 72 hours with bleeding per rectum and fever along with marked tachycardia with hypotension were the significant criteria observed among patients with strangulated obstruction. Results: On laboratory evaluation, leukocytosis with an elevated serum lactate was significant in strangulated obstruction whereas on imaging ultrasound abdomen supplemented with a color doppler proved to be an investigation of choice in predicting strangulation. Conclusions: A combination of clinical, laboratory and imaging criteria can be useful in predicting strangulation among patients presenting with acute small intestinal obstruction thereby ensuring an early surgical intervention and better outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A study of preoperative predictive factors of strangulation in acute small intestinal obstruction

2016

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“…Nevertheless, radiologists sometimes encounter cases in which the diagnosis of strangulation is very difficult; this situation is certainly not uncommon in clinical practice. Of interest, Jancelewicz et al (6) recently investigated 72 preoperative clinical, laboratory, and radiologic (CT) findings in 192 patients who presented with SBO, and reported that reduced bowel wall enhancement was the most significant independent predictor of bowel strangulation. However, although specificity of this CT sign was 94%, sensitivity was only 56% (6).…”

Section: Discussionmentioning

confidence: 99%

“…Of interest, Jancelewicz et al (6) recently investigated 72 preoperative clinical, laboratory, and radiologic (CT) findings in 192 patients who presented with SBO, and reported that reduced bowel wall enhancement was the most significant independent predictor of bowel strangulation. However, although specificity of this CT sign was 94%, sensitivity was only 56% (6). Thus, the diagnosis of strangulation remains a challenge even when using CT.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, accurate preoperative exclusion of strangulation may avoid unnecessary surgical procedures (1). Computed tomography (CT) is the most commonly used method for the evaluation of complete or high-grade partial SBO, but the diagnosis of strangulation remains difficult (4)(5)(6). Conventional and contrast-enhanced ultrasonography are able to depict akinetic bowel loops with high sensitivity and specificity for small bowel strangulation (7)(8)(9), but may sometimes be limited by excessive bowel gas in the dilated bowel loops.…”

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confidence: 99%

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Low b‐value diffusion‐weighted imaging for diagnosing strangulated small bowel obstruction: A feasibility study

Takahara

Kwee

Sadahiro

et al. 2011

Magnetic Resonance Imaging

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Purpose: To assess the feasibility of low b-value diffusion-weighted imaging (DWI) for diagnosing strangulated small bowel obstruction (SBO). Apparent diffusion coefficients (ADCs) and signal preservation ratios (SPRs) were measured in the distal jejunum in the volunteers before and after butylscopolamine administration, and in the (strangulated) closed loop, near the obstructive site, and far from the obstructive site in the patients. Low b-value diffusion-weighted images in the patients were quantitatively evaluated for diagnosing strangulation.Results: In the volunteers, mean ADC (10 À3 mm 2 /s) and SPR (%) before butylscopolamine administration (18.3 6 5.9 and 41.4 6 11.5) were significantly different (P < 0.05) from those after butylscopolamine administration (6.4 6 3.6 and 73.7 6 12.9). In the patients, mean ADCs and SPRs among the strangulated closed loop (3.8 6 2.2 and 83.3 6 9.3), near the obstructive site (12.1 6 6.9 and 57.3 6 18.5), and far from the obstructive site (26.8 6 10.7 and 29.9 6 16.4) were significantly different (P < 0.05). Areas under the receiver operating characteristic curve for the diagnosis of strangulation varied between 0.937 and 1.000.Conclusion: Low b-value DWI is a feasible technique to distinguish the strangulated closed loop from nonstrangulated loops in SBO, and show promise for diagnosing strangulated SBO.

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Small Bowel Obstruction

Gharib¹

2023

Evidence‐Based Emergency Care

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Predicting Strangulated Small Bowel Obstruction: An Old Problem Revisited

Abstract: Regression analysis of multiple preoperative criteria demonstrates that reduced wall enhancement on CT, peritoneal signs, and elevated WBC are the only variables independently predictive of bowel strangulation in patients with SBO.

Cited by 109 publications

References 17 publications

A study of preoperative predictive factors of strangulation in acute small intestinal obstruction

A study of preoperative predictive factors of strangulation in acute small intestinal obstruction

Low b‐value diffusion‐weighted imaging for diagnosing strangulated small bowel obstruction: A feasibility study

Small Bowel Obstruction

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