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Diagnosis of single adhesive bands versus matted adhesions in small bowel obstructions: a radiological predictive score

  • Original Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The objective was to develop a radiological score obtained from multi-detector computed tomography (MDCT) to differentiate between single band adhesion (SBA) and matted adhesions (MA) as the etiology of small bowel obstruction (SBO).

Methods

All consecutive patients who underwent surgery from January 2013 to June 2018 for adhesion-induced SBO were retrospectively included.

Results

Among the 193 patients having surgery for SBO, 119 (61.6%) had SBA and 74 (38.4%) had MA surgically proven. In multivariate analysis, the presence of a beak sign (OR = 3.47, CI [1.26; 9.53], p = 0.02), a closed loop (OR = 11.37, CI [1.84; 70.39], p = 0.009), focal mesenteric haziness (OR = 3.71, CI [1.33; 10.34], p = 0.01) and focal and diffuse peritoneal fluid (OR = 4.30, CI [1.45; 12.73], p = 0.009 and OR = 6.34, CI [1.77; 22.59], p = 0.004, respectively) were significantly associated with SBA. Conversely, the presence of diffuse mesenteric fluid without focal fluid (OR = 0.23, CI [0.06; 0.92], p = 0.04) and an increase of the diameter of the most dilated loop (OR = 0.94, CI [0.90; 0.99], p = 0.02) were inversely associated with SBA. Using the significant predictive factors of SBA, we built a composite score to radiologically predict the etiology of SBO. The area under the receiver operating characteristic (ROC) curve of the score was 0.8274. For a cut-off score of -0.523, sensitivity, specificity and the percentage of patients correctly classified were 78.4%, 84.6% and 80%, respectively. If the score is ≥ 7, the probability that the mechanism of SBO is not SBA was 100%.

Conclusions

The present score, validated in a different population, could be a significant tool in the decision for surgical management.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Pierre Berge and Maxime Delestre have equal contribution.

Authors and Affiliations

  1. Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France

    Pierre Berge, Anita Paisant & Christophe Aubé

  2. Department of Medicine, University of Health- Angers, Angers, France

    Pierre Berge, Maxime Delestre, Anita Paisant, Antoine Hamy, Christophe Aubé, Jean-François Hamel & Aurélien Venara

  3. Department of Digestive and Endocrine Surgery, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France

    Maxime Delestre, Antoine Hamy & Aurélien Venara

  4. HIFIH, UPRES, University of Angers, 3859, Angers, EA, France

    Anita Paisant, Antoine Hamy, Christophe Aubé & Aurélien Venara

  5. Department of Biostatistics, Maison de la Recherche, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France

    Jean-François Hamel

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Contributions

PB: conception, design, analysis and interpretation of data, manuscript author, provided feedback on the manuscript, drafted the article and revised it critically with regards to important intellectual content. Final approval of the version to be published; MD: conception, design, analysis and interpretation of data, manuscript author, provided feedback on the manuscript, drafted the article and revised it critically with regards to important intellectual content. Final approval of the version to be published; AP: provided care for study patients, provided feedback on the manuscript, drafted the article, and revised it critically regarding important intellectual content. Final approval of the version to be published; CA: provided care for study patients, provided feedback on the manuscript, drafted the article, and revised it critically regarding important intellectual content. Final approval of the version to be published; AH: provided care for study patients, provided feedback on the manuscript, drafted the article, and revised it critically regarding important intellectual content. Final approval of the version to be published; JFH: provided care for study patients, provided feedback on the manuscript, drafted the article, and revised it critically with regards to important intellectual content. Final approval of the version to be published; AV: conception, design, analysis, and interpretation of data, manuscript author, provided feedback on the manuscript, drafted the article and revised it critically with regards to important intellectual content. Final approval of the version to be published.

Corresponding author

Correspondence to Aurélien Venara.

Ethics declarations

Conflict of interest

Mr Delestre declares that he has no conflict of interest related to the present work, Mr Berge declares that he has no conflict of interest related to the present work, Dr. Venara declares that he has no conflict of interest related to the present work, Dr Hamel declares that he has no conflict of interest related to the present work, Dr. Paisant declares that he has no conflict of interest related to the present work, Pr Hamy declares that he has no conflict of interest related to the present work and Pr Aubé declares that he has no conflict of interest related to the present work.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Patients were informed their data could be used for research and were asked to inform the physician if they refused this use. None of the patients included in the study gave his/her non-acceptance to use data.

Consent for publication

Patients were informed their data could be used for publication and were asked to inform the physician if they refused this. None of the patients included in the study gave his/her non-acceptance to publish their data.

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Berge, P., Delestre, M., Paisant, A. et al. Diagnosis of single adhesive bands versus matted adhesions in small bowel obstructions: a radiological predictive score. Eur J Trauma Emerg Surg 48, 13–22 (2022). https://doi.org/10.1007/s00068-020-01580-1

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  • DOI: https://doi.org/10.1007/s00068-020-01580-1

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