Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Apr;47(4):975-984.
doi: 10.1007/s00268-023-06906-9. Epub 2023 Jan 17.

The Angers CT Score is a Risk Factor for the Failure of the Conservative Management of Adhesive Small Bowel Obstruction: A Prospective Observational Multicentric Study

Anita Paisant  1   2 , Jeanne Burgmaier  3 , Paul Calame  4 , Mélanie Loison  5 , Sébastien Molière  6 , Cécile Brigand  7 , Dihia Belabbas  8 , Emilie Duchalais  9 , Jean-Marc Regimbeau  10   11 , Thierry Yzet  12 , Arnaud Alves  13   14 , Audrey Fohlen  15 , Damien Bergeat  3 , Estelle Vauclair  16 , Julie Pellegrini  17 , Emilia Ragot  18 , Alexandre Lansier  19 , Emeric Abet  20 , Alexandre Nevot  21 , Pascal Rousset  22 , Mehdi Ouaissi  23 , Marie Besson  24 , Maxime Ronot  25   26 , Massimo Giacca  27 , Edouard Girard  28 , Yann Tessier  29 , Damien Massalou  30 , Florent Poirier  31 , Zaher Lakkis  32 , Christophe Aubé  1   2 , Jean Francois Hamel  33 , Guillaume Passot  34 , Aurélien Venara  35   36
Affiliations
Observational Study

The Angers CT Score is a Risk Factor for the Failure of the Conservative Management of Adhesive Small Bowel Obstruction: A Prospective Observational Multicentric Study

Anita Paisant et al. World J Surg. 2023 Apr.

Abstract

Background: Identifying the 30% of adhesive small bowel obstructions (aSBO) for which conservative management will require surgery is essential. The association between the previously described radiological score and failure of the conservative management of aSBO remains to be confirmed in a large prospective multicentric cohort. Our aim was to assess the risk factors of failure of the conservative management of aSBO considering the radiological score.

Material and methods: This prospective observational study took place in 15 French centers over 3 months. Consecutive patients experiencing aSBO with no early surgery were included. The six radiological features from the Angers radiological computed tomography (CT) score were noted (beak sign, closed loop, focal or diffuse intraperitoneal liquid, focal or diffuse mesenteric haziness, focal or diffuse mesenteric liquid, and diameter of the most dilated small bowel loop > 40 mm).

Results: Two hundred and seventy nine patients with aSBO were screened. Sixty patients (21.5%) underwent early surgery, and 219 (78.5%) had primary conservative management. In the end, 218 patients were included in the analysis of the risk factors for conservative treatment failure. Among them, 162 (74.3%) had had successful management while for 56 (25.7%) management had failed. In multivariate analysis, a history of surgery was not a significant risk factor for the failure of conservative treatment (OR = 0.11; 95%CI = 0-1.23). A previous episode of aSBO was protective against the failure of conservative treatment (OR = 0.36; 95%CI = 0.15-0.85) and an Angers CT score ≥ 5 as the only individual risk factor (OR = 2.39; 95%CI = 1.01-5.69).

Conclusion: The radiological score of aSBO is a promising tool in improving the management of aSBO patients. A first episode of aSBO and/or a radiological score ≥5 should lead physicians to consider early surgical management.

PubMed Disclaimer

References

    1. Ten Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L et al (2018) Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 13:24 - DOI - PubMed - PMC
    1. Demessence R, Lyoubi Y, Feuerstoss F, Hamy A, Aubé C, Paisant A et al (2018) Surgical management of adhesive small bowel obstruction: is it still mandatory to wait? An update. J Visc Surg S1878–7886(22):00036–00044
    1. Thornblade LW, Verdial FC, Bartek MA, Flum DR, Davidson GH (2019) The safety of expectant management for adhesive small bowel obstruction: a systematic review. J Gastrointest Surg 23:846–859 - DOI - PubMed - PMC
    1. Fukami Y, Kobayashi S, Sekoguchi E, Kurumiya Y (2018) Randomized controlled trial of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction. Langenbecks Arch Surg 403:555–559 - DOI - PubMed
    1. Koh A, Adiamah A, Chowdhury A, Mohiuddin MK, Bharathan B (2020) Therapeutic role of water-soluble contrast media in adhesive small bowel obstruction: a systematic review and meta-analysis. J Gastrointest Surg 24:473–483 - DOI - PubMed

Publication types