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).
All consecutive patients who underwent surgery from January 2013 to June 2018 for adhesion-induced SBO were retrospectively included.
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%.
The present score, validated in a different population, could be a significant tool in the decision for surgical management.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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.
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.
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.
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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 (2021). https://doi.org/10.1007/s00068-020-01580-1
- Intestinal obstruction/diagnosis
- Postoperative complications*/diagnosis
- Retrospective studies