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. 2023 Jun 27;15(6):1116-1124.
doi: 10.4240/wjgs.v15.i6.1116.

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

Zi Qin Ng  1 , Vivien Hsu  2 , William Wei Han Tee  3 , Jih Huei Tan  4 , Ruwan Wijesuriya  2
Affiliations

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

Zi Qin Ng et al. World J Gastrointest Surg. .

Abstract

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.

Keywords: Adhesive; Conservative; Non-operative; Small bowel obstruction.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. Dr Zi Qin Ng received the General Surgeons Australia Junior Doctor Research Grant in 2018 for this study.

Figures

Figure 1
Figure 1
Images. A: Abdominal X-ray showing the presence of water soluble contrast medium in the large colon; B: Coronal slice of the computed tomography (CT) scan showing small bowel faecal sign (blue arrow) and transition point (yellow arrow) in adhesive small bowel obstruction; C: Axial slice of CT scan showing a segment of small bowel thickening/reduced wall enhancement (yellow arrow) with mesenteric stranding (blue arrow) in the presence of small bowel obstruction.
See this image and copyright information in PMC

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