Abstract
Introduction
Early recognition of bowel ischemia is critical in patients suffering from acute adhesive
small bowel obstruction (ASBO). Recent studies attempted to propose a score combining
clinical and radiological factors to predict the risk of bowel ischemia in patients
with ASBO. This study aimed to compare and validate the existing clinical scores with
a cohort of surgical patients.
Methods
We conducted a retrospective study including all ASBO cases admitted to our institution
between January 1, 2005 and December 31, 2019. Based on three existing clinical scores,
we calculated the risk of bowel ischemia for each patient. We then divided the cohort
into groups based on the risk for bowel ischemia. For each risk-based category, the
proportion of patients who underwent surgical resection and were found to have evidence
of ischemic bowel was calculated.
Results
A total of 160 patients presenting with 217 episodes of acute ASBO were included.
One hundred seventy-one (78.8%) cases were managed nonoperatively while 46 cases (21.2%)
required surgery. Sixteen patients (7.3%) were eventually found to have ischemic bowel
while 13 required small bowel resection (5.9%). All three clinical scores showed correlation
between the calculated risk of ischemia and the intraoperative finding of ischemia.
However, all three scores overestimated ischemia rates in the high-risk groups, yielding
a PPV of 8.3%-28.5% and a NPV of 93.3%-94.7%.
Conclusions
Current clinical scores for predicting bowel ischemia in patients with ASBO are of
high value in ruling out ischemia, yet are of extremely low sensitivity, warranting
an overly aggressive and unnecessary surgical approach.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Surgical ResearchAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Use of national burden to define operative emergency general surgery.JAMA Surg. 2016; 151: e160480
- Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis.BMJ. 2013; 347: f5588
- How many sunsets? Timing of surgery in adhesive small bowel obstruction: a study of the nationwide Inpatient Sample.J Trauma Acute Care Surg. 2013; 74 (discussion 187-9): 181-187
- Adhesiolysis-related morbidity in abdominal surgery.Ann Surg. 2013; 258: 98-106
- Predicting strangulated small bowel obstruction: an old problem revisited.J Gastrointest Surg. 2009; 13: 93-99
- Clinicoradiological score for predicting the risk of strangulated small bowel obstruction.Br J Surg. 2010; 97: 1119-1125
- A prediction model for recognizing strangulated small bowel obstruction.Gastroenterol Res Pract. 2018; 2018: 7164648
- Predicting intestinal ischaemia in patients with adhesive small bowel obstruction: a simple score.World J Surg. 2020; 44: 1444-1449
- Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2010 evidence-based guidelines of the world society of emergency surgery.World J Emerg Surg. 2011; 6: 5
- Small bowel obstruction: a practical step-by-step evidence-based approach to evaluation, decision making, and management.J Trauma Acute Care Surg. 2015; 79: 661-668
- Association of surgical intervention for adhesive small-bowel obstruction with the risk of recurrence.JAMA Surg. 2019; 154: 413-420
- Long-term prognosis after operation for adhesive small bowel obstruction.Ann Surg. 2004; 240: 193-201
- Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia.World J Surg. 2009; 33: 1374-1383
- Adhesive postoperative small bowel obstruction: incidence and risk factors of recurrence after surgical treatment: a multicenter prospective study.Ann Surg. 2006; 244: 750-757
- Long-term prognosis after operation for adhesive small bowel obstruction.Ann Surg. 2004; 240: 193-201
- Adhesive small-bowel obstruction—surgery for all?—reply.JAMA Surg. 2019; 154: 1076-1077
- Adhesive small-bowel obstruction-surgery for all?.JAMA Surg. 2019; 154: 1075-1076
Article info
Publication history
Published online: November 23, 2022
Accepted:
October 24,
2022
Received in revised form:
October 11,
2022
Received:
July 12,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
