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Non-strangulated adhesive small bowel obstruction: CT findings predicting outcome of conservative treatment

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To clarify CT findings that predict outcome of conservative treatment in patients with non-strangulated adhesive small bowel obstruction (SBO).

Methods

Unenhanced and contrast-enhanced abdominopelvic CT studies in 189 patients with adhesive SBO who had initial conservative treatment were reviewed. The CT findings included transition zone, beak signs, maximum bowel diameter, bowel diameter ratio, decreased bowel wall enhancement, increased unenhanced bowel wall attenuation, anterior parietal adhesion, bowel wall thickening, closed-loop obstruction, small bowel feces sign, whirl sign, mesenteric haziness, mesenteric, peritoneal fluid, and submucosal edema. These findings were statistically compared according to the success or failure of treatment.

Results

Conservative treatment succeeded in 144 patients (76.2%) and failed in 45 patients (23.8%). At multivariate analysis, the lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid were independent findings predicting failure of conservative treatment, with odds ratios of 5.23, 5.5, 13.55, and 4.89, respectively. The presence of all significant findings showed a high specificity of 97.2% with positive likelihood ratio of 8.8. If CT scans showed none of the three significant findings, the negative predictive value was 97.6% and negative likelihood ratio was 0.08.

Conclusions

The lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid are independent CT findings predicting the failure of conservative treatment in patients with non-strangulated adhesive SBO. The combination of all CT findings suggests the need for surgery; absence of two or all CT findings should suggest an attempt for conservative treatment.

Key Points

• To minimize delayed operation, it is important to identify non-strangulated adhesive small bowel obstruction patients in whom initial conservative treatment is likely to fail.

• The lack of small bowel feces sign, the presence of mesenteric haziness, and a moderate amount of mesenteric fluid are independent factors predicting the failure of conservative treatment in patients with non-strangulated adhesive small bowel obstruction.

• The combination of all three CT findings suggests the need for surgery; absence of two or all three CT findings should suggest an attempt for conservative treatment.

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Abbreviations

APCT:

Abdominopelvic CT

CI:

Confidence interval

C-loop:

Closed-loop

ICC:

Interclass correlation coefficient

ĸ:

Cohen’s unweighted kappa

NLR:

Negative likelihood ratio

NPV:

Negative predictive value

OR:

Odds ratio

PLR:

Positive likelihood ratio

PPV:

Positive predictive value

SBO:

Small bowel obstruction

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Funding

This study has received funding by the Dasol Life Science Inc.

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Authors and Affiliations

  1. Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea

    Jieun Kim, Yedaun Lee, Jung-Hee Yoon, Ho-Joon Lee, Yun-Jung Lim & Jisook Yi

  2. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Jieun Kim

  3. Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea

    Won Beom Jung

Authors
  1. Jieun Kim
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  2. Yedaun Lee
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  3. Jung-Hee Yoon
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  4. Ho-Joon Lee
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  5. Yun-Jung Lim
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  6. Jisook Yi
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  7. Won Beom Jung
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Corresponding author

Correspondence to Yedaun Lee.

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The scientific guarantor of this publication is Yedaun Lee.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Kim, J., Lee, Y., Yoon, JH. et al. Non-strangulated adhesive small bowel obstruction: CT findings predicting outcome of conservative treatment. Eur Radiol 31, 1597–1607 (2021). https://doi.org/10.1007/s00330-020-07406-3

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  • DOI: https://doi.org/10.1007/s00330-020-07406-3

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