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Intestinal Fluid CT Level Could Predict Pathological Small Bowel Ischemia in Small Bowel Obstruction

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Abstract

The aim of this study is to explore pivotal preoperative findings of small bowel ischemia in patients with small bowel obstruction.

We enrolled 285 consecutive patients with small bowel obstruction requiring in-hospital treatment. The clinical parameters involved in small bowel ischemia were retrospectively explored. Non-enhanced computed tomography (CT) findings were analyzed. The definition of bowel ischemia was pathologically determined.

The median age of the patients was 74. A total of 127 patients underwent surgery, and small bowel ischemia was observed in 26 patients. Univariate analysis revealed that ascites on CT (p = 0.0005), mesenteric haziness on CT (p < 0.0001), closed loop sign on CT (p < 0.0001), wall thickness ≥ 4 mm on CT (p = 0.0003), ascites CT level ≥ 15 Hounsfield units (HU) on CT (p = 0.0176), intestinal fluid CT level ≥ 12 HU on CT (p = 0.0052), and white blood cell > 15,000 /μL (p = 0.0223) were correlated with small bowel ischemia. Multivariate logistic regression analysis revealed that mesenteric haziness on CT (p = 0.0131), closed loop sign on CT (p = 0.0002), and intestinal fluid CT level ≥ 12 HU on CT (p = 0.0056) were independently correlated with small bowel ischemia.

An intestinal fluid CT level ≥ 12 HU could be a new clinical predictor of bowel ischemia in addition to the well-known predictors of mesenteric haziness and closed loop sign on CT in patients with small bowel obstruction.

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Data Availability

Any clinical data relevant to this study are publicly available on legal or ethical grounds.

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Acknowledgements

We thank Ms. Isechi K for organizing the clinical data.

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Authors and Affiliations

  1. Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan

    Hiroki Hirao, Hirohisa Okabe, Toshiro Masuda, Daisuke Ogawa, Norio Uemura, Daisuke Kuroda, Katsunobu Taki, Shinjiro Tomiyasu, Masahiko Hirota & Hiroki Sugita

  2. Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Hiroki Hirao & Taizo Hibi

  3. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Hideo Baba

Authors
  1. Hiroki Hirao
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  2. Hirohisa Okabe
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  3. Toshiro Masuda
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  4. Daisuke Ogawa
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  5. Norio Uemura
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  6. Daisuke Kuroda
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  7. Katsunobu Taki
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  8. Shinjiro Tomiyasu
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  9. Masahiko Hirota
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  10. Taizo Hibi
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  11. Hideo Baba
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  12. Hiroki Sugita
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Contributions

Conceived and designed the study, H. H. and H. O. Collected the clinical data, T. M., D. O., N. U., D. K., K. T., S. T., and M. H. Analyzed the data, H. H. and H. O. Supervised the content of study, T. H., H. B., and H. S. Wrote the paper, H. H. and H. O.

Corresponding author

Correspondence to Hirohisa Okabe.

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The authors declare no competing interests.

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Hirao, H., Okabe, H., Masuda, T. et al. Intestinal Fluid CT Level Could Predict Pathological Small Bowel Ischemia in Small Bowel Obstruction. Indian J Surg 85, 596–601 (2023). https://doi.org/10.1007/s12262-022-03437-w

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  • DOI: https://doi.org/10.1007/s12262-022-03437-w

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