A multi-institution prospective observational study of small bowel obstruction: Clinical and computerized tomography predictors of which patients may require early surgery

Narong Kulvatunyou, Viraj Pandit, Sadoun Moutamn, Kenji Inaba, Konstantinos Chouliaras, Marc Demoya, Leily Naraghi, Bobby T Kalb, Hina Arif, Reddy Sravanthi, Bellal A Joseph, Lynn Gries, Andrew - Tang, Peter M Rhee

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17 Scopus citations

Abstract

BACKGROUND For patients with adhesive small bowel obstruction (ASBO), early surgery after a failed trial of nonoperative treatment can improve outcome. However, deciding which patients require early surgery is difficult, given the lack of specific clinical or radiographic signs. The study goals were to identify clinical and computed tomography (CT) predictors of which patients may need early surgery and to evaluate the utility of the common CT findings. METHODS This was a multi-institution prospective observational study for patients who were admitted with ASBO. Patients were excluded if their SBO were not managed conservative initially; were within 30 days postoperatively; were caused by external hernias, small bowel tumor, or intussusception; and were related to Crohn's disease. Clinical and laboratory variables were collected prospectively. CT findings were interpreted by a blinded designated radiologist. To identify significant predictors, we performed a multivariable regression analysis. RESULTS During 22 months, we enrolled 200 patients with ASBO. Patients' mean (SD) age was 60 (18) years; 50% were male. Fifty-two patients (26%) underwent surgery. Of those who underwent surgery, the median duration of nonoperative treatment was 1.5 days (interquartile range, 1-2.5 days). In the regression model, we identified no flatus (odds ratio [OR], 3.28; 95% confidence interval [CI], 1.51-7.12; p = 0.003), presence of free fluid on CT (OR, 2.59; 95% CI, 1.13-5.90; p = 0.023), and high-grade obstruction by CT (OR, 2.44; 95% CI, 1.10-5.43; p = 0.028) to be significant predictors for ASBO patients who may need early surgery. CONCLUSION In this study, we prospectively derived one clinical and two CT predictors which ASBO patients may benefit from an early surgical intervention. However, a future study to validate these predictors is needed.

Original languageEnglish (US)
Pages (from-to)393-398
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume79
Issue number3
DOIs
StatePublished - Sep 5 2015

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Keywords

  • adhesion
  • CT scan
  • predictors
  • Small bowel obstruction

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

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