Predicting Intestinal Ischaemia in Patients with Adhesive Small Bowel Obstruction: A Simple Score
Intestinal ischaemia (II) is the most critical factor to determine in patients with adhesive small bowel obstruction (ASBO) because intestinal ischaemia could be reversible. The aim of this study was to create a clinicoradiological score to predict II in patients with ASBO.
We conducted a retrospective study including 124 patients with ASBO. Logistic regression analysis was used to identify predictive factors of II. We assigned points for the score according to the regression coefficient. The area under the curve (AUC) was determined using receiver operating characteristic curves.
Six independent predictive factors of II were identified: age, pain duration, body temperature, WBC, reduced wall enhancement and segmental mesenteric fluid at CT scan. According to the regression, coefficient points were assigned to each of the variables associated with II. The estimated rates of II were calculated for the total scores ranging from 0 to 24. The AUC of this clinicoradiological score was 0.92. A cut-off score of 6 was used for the low-probability group (the risk of II was 1.13%). A score ranging from 7 to 15 defined intermediate-probability group (the risk of II was 44%). A score ≥16 defined high-probability group (100% of patients in this group had II).
We performed a score to predict the risk of intestinal II with a good accuracy (the AUC of our score exceeded 0.90). This score is reliable and reproducible, so it can help surgeon to prioritize patients with II for surgery because ischaemia could be reversible, avoiding thus intestinal necrosis.
No grant support for the research.
Compliance with ethical standards
Conflict of interest
No conflict of interest to declare.
The study was approved by the institutional research and ethics board of Mohamed Tahar Maamouri Hospital.
Informed consent was obtained from all individual participants included in the study.
- 1.Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L et al (2013) Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 8:42CrossRefGoogle Scholar
- 2.Lorentzen L, Øines MN, Oma E, Jensen KK, Jorgensen LN (2017) Recurrence after operative treatment of adhesive small-bowel obstruction. J Gastrointest Surg 13:329–334Google Scholar
- 9.Ten Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L et al (2018) Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 13:24CrossRefGoogle Scholar
- 12.Duron JJ (2001) Acute intestinal occlusion. Rev Pract 51(15):1670–1674Google Scholar