Small Bowel Obstruction: the Sun Also Rises?

Zamary, Kirellos; Spain, David A.

doi:10.1007/s11605-019-04351-5

Cited by 9 publications

(7 citation statements)

References 35 publications

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“…Postoperative intestinal adhesions are the most common cause of intestinal obstruction [13]. A number of studies in the literature have shown that the success rate of ileus tubes is more than 80% for benign intestinal obstruction [7,12].…”

Section: Discussionmentioning

confidence: 99%

A nomogram to predict the success rate of patients with small bowel obstruction relief by ileus tube

Chen

Lin

Zhang

et al. 2022

Preprint

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Purpose: This article investigated patient clinical data to establish a nomogram to predict the success rate of patients with small bowel obstruction relief by ileus tube.Methods: We identified 210 patients with small bowel obstruction treated with ileus tube (January 2014 to January 2020) from a prospectively collected database. Among them, 117 cases were successfully relieved (Successful group), and 93 cases failed (Failure group).Results: The Successful group had a higher age and body mass index, as well as a shorter time from obstruction to insertion than the failure group before insertion of the ileus tube. White blood cell, neutrophil, red blood cell distribution width and neutrophil-to-lymphocyte ratio were lower in the successful group after insertion of the ileus tube. In addition, white blood cell, neutrophil, and neutrophil-to-lymphocyte ratio decreased in the successful group after insertion. However, the result was the opposite in the Failure group. The success rate of paralytic ileus was the highest (79.4%). Patients with fecal stone ileus had the most rapid ventilation and defecation times. Multivariate analysis showed that the platelet-change, albumin after insertion, time from obstruction to insertion and obstruction factors were independent factors influencing the success rate of ileus tube insertion. In addition, we established nomograms to predict the success rate of patients with small bowel obstruction relief by ileus tube (C-index=0.753).Conclusion: This nomogram can effectively predict whether patients can successfully relieve obstruction by ileus tube, which provides convenience for clinical treatment.

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Section: Discussionmentioning

confidence: 99%

A nomogram to predict the success rate of patients with small bowel obstruction relief by ileus tube

Chen

Lin

Zhang

et al. 2022

Preprint

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“…Small bowel obstruction (SBO) is common: It accounts for 20% of abdominal surgery in patients presenting with acute abdominal pain [ 1 ], and around one-quarter of SBO admissions culminate in surgery [ 2 ]. In the developed world, adhesions remain the most common cause.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors to identify resolution of small bowel obstruction without need for operative management: systematic review

Eze,

Parry,

Boone

et al. 2023

Eur Radiol

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Objectives To identify imaging, clinical, and laboratory variables potentially prognostic for surgical management of small bowel obstruction. Methods Two researchers systematically reviewed indexed literature 2001–2021 inclusive for imaging, clinical, and laboratory variables potentially predictive of surgical management of small bowl obstruction and/or ischaemia at surgery, where performed. Risk of bias was assessed. Contingency tables for variables reported in at least 5 studies were extracted and meta-analysed to identify strong evidence of association with clinical outcomes, across studies. Results Thirty-one studies were ultimately included, reporting 4638 patients (44 to 313 per study). 11 (35%) studies raised no risk of bias concerns. CT was the modality reported most (29 studies, 94%). Meta-analysis of 21 predictors identified 5 strongly associated with surgical intervention, 3 derived from CT (peritoneal free fluid, odds ratio [OR] 3.24, 95%CI 2.45 to 4.29; high grade obstruction, OR 3.58, 95%CI 2.46 to 5.20; mesenteric inflammation, OR 2.61, 95%CI 1.94 to 3.50; abdominal distension, OR 2.43, 95%CI 1.34 to 4.42; peritonism, OR 3.97, 95%CI 2.67 to 5.90) and one with conservative management (previous abdominopelvic surgery, OR 0.58, 95%CI 0.40 to 0.85). Meta-analysis of 10 predictors identified 3 strongly associated with ischaemia at surgery, 2 derived from CT (peritoneal free fluid, OR 3.49, 95%CI 2.28 to 5.35; bowel thickening, OR 3.26 95%CI 1.91 to 5.55; white cell count, OR 4.76, 95%CI 2.71 to 8.36). Conclusions Systematic review of patients with small bowel obstruction identified four imaging, three clinical, and one laboratory predictors associated strongly with surgical intervention and/or ischaemia at surgery. Clinical relevance statement Via systematic review and meta-analysis, we identified imaging, clinical, and laboratory predictors strongly associated with surgical management of small bowel obstruction and/or ischaemia. Multivariable model development to guide management should incorporate these since they display strong evidence of potential utility. Key Points • While multivariable models incorporating clinical, laboratory, and imaging factors could predict surgical management of small bowel obstruction, none are used widely. • Via systematic review and meta-analysis we identified imaging, clinical, and laboratory variables strongly associated with surgical management and/or ischaemia at surgery. • Development of multivariable models to guide management should incorporate these predictors, notably CT scanning, since they display strong evidence of potential utility.

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“…In terms of location, intestinal obstruction may occur in small intestine and/or large intestine. Small bowel obstruction accounts for about 50–80% [ 3 , 4 ], mostly resulting from adhesions [ 5 , 6 ], and approximately 20–30% of patients require surgical intervention [ 7 ]. Large intestinal obstruction accounts for about 10–15% [ 8 ], which is mainly induced by tumors, and considering that it may form a closed loop [ 9 ], the majority of patients (about 75%) need surgical treatment [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction

Shi²,

Zhang³

et al. 2022

Contrast Media & Molecular Imaging

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We aimed to analyze the computed tomography (CT) imaging signs of bowel wall ischemia in patients with acute intestinal obstruction and construct an imaging prediction model to guide clinical treatment. The CT imaging signs of patients with acute intestinal obstruction diagnosed in our center in recent 6 years were collected for retrospective analysis. The etiology of intestinal obstruction and incidence rate of bowel wall ischemia were recorded, and the specific CT findings of bowel wall ischemia, including mesenteric edema, bowel wall thickening, and fish tooth sign, were analyzed. Among the 302 patients selected, 130 surgically treated patients were eligible for analysis. Bowel wall ischemia in acute intestinal obstruction showed an incidence rate of 14.90%, and the incidence rates of bowel wall ischemia in intra-abdominal hernia, intussusception, incarcerated external abdominal hernia, and volvulus were about 92.30%, 50%, 35.71%, 33.33%, and 12.59%, respectively. The incidence rate of bowel wall ischemia in simple adhesive intestinal obstruction was about 12.59%, and that in malignancy-induced intestinal obstruction was about 6.56%. Univariate analysis revealed 5 factors with statistical significance, including bowel wall thickening, mesenteric edema, bowel wall pneumatosis, ascites, and fish tooth sign. Multivariate logistic regression analysis indicated that fish tooth sign, bowel wall thickening, and mesenteric edema were able to predict bowel wall ischemia, and the corresponding partial regression coefficients were 2.164, 1.129, and 1.173, odds ratios (ORs) were 8.707, 3.093, and 3.232, sensitivity was 0.356, 0.400, and 0.844, and specificity was 0.859, 0.835, and 0.529, respectively. Imaging signs of bowel wall thickening, mesenteric edema, and fish tooth sign are valuable in predicting bowel wall ischemia, among which bowel wall thickening and mesenteric edema have relatively high specificity and fish tooth sign has a relatively high sensitivity. Furthermore, a fish tooth sign has the most favorable predictive value for bowel wall ischemia in acute intestinal obstruction, followed by bowel wall thickening and mesenteric edema.

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Small Bowel Obstruction: the Sun Also Rises?

Cited by 9 publications

References 35 publications

A nomogram to predict the success rate of patients with small bowel obstruction relief by ileus tube

A nomogram to predict the success rate of patients with small bowel obstruction relief by ileus tube

Prognostic factors to identify resolution of small bowel obstruction without need for operative management: systematic review

Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction

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