Predicting the Need for Surgery in Uncomplicated Adhesive Small Bowel Obstruction: A Scoring Tool

Maraux, Lucien; Dammaro, Carmelisa; Gaillard, M.; Laïnas, Panagiotis; Derienne, Joseph; Maître, Sophie; Chagué, Pierre; Rocher, Laurence; Dagher, Ibrahim; Tranchart, Hadrien

doi:10.1016/j.jss.2022.05.015

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“…The presence of other two CT findings of mesenteric stranding and small bowel thickening did not achieve statistical significance which could be explained by the duration of symptoms/presentation as it is often a late sign that arose as a result of small bowel ischemia and venous congestion and often subjected to interobserver variability in interpretation. In another study, distal (ileal) obstruction, maximum small bowel diameter over abdominal diameter ratio were associated with failure of non-operative management[ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors for success of non-operative management of adhesive small bowel obstruction

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et al. 2023

World J Gastrointest Surg

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BACKGROUND Majority of adhesive small bowel obstruction (SBO) cases can be managed non-operatively. However, a proportion of patients failed non-operative management. AIM To evaluate the predictors of successful non-operative management in adhesive SBO. METHODS A retrospective study was performed for all consecutive cases of adhesive SBO from November 2015 to May 2018. Data collated included basic demographics, clinical presentation, biochemistry and imaging results and management outcomes. The imaging studies were independently analyzed by a radiologist who was blinded to the clinical outcomes. The patients were divided into group A operative (including those that failed initial non-operative management) and group B non-operative for analysis. RESULTS Of 252 patients were included in the final analysis; group A ( n = 90) (35.7%) and group B ( n = 162) (64.3%). There were no differences in the clinical features between both groups. Laboratory tests of inflammatory markers and lactate levels were similar in both groups. From the imaging findings, the presence of a definitive transition point [odds ratio (OR) = 2.67, 95% confidence interval (CI): 0.98-7.32, P = 0.048], presence of free fluid (OR = 2.11, 95%CI: 1.15-3.89, P = 0.015) and absence of small bowel faecal signs (OR = 1.70, 95%CI: 1.01-2.88, P = 0.047) were predictive of the need of surgical intervention. In patients that received water soluble contrast medium, the evidence of contrast in colon was 3.83 times predictive of successful non-operative management (95%CI: 1.79-8.21, P = 0.001). CONCLUSION The computed tomography findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%