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

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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References

  1. 1.

    Behman R, Nathens AB, Byrne JP, Mason S, Look Hong N, Karanicolas PJ. Laparoscopic surgery for adhesive small bowel obstruction is associated with a higher risk of bowel injury: a population-based analysis of 8584 patients. Ann Surg. 2017;266:489–98.

    Article  Google Scholar 

  2. 2.

    Sebastian-Valverde E, Poves I, Membrilla-Fernández E, Pons-Fragero MJ, Grande L. The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction. BMC Surg. 2019;19:40.

    Article  Google Scholar 

  3. 3.

    Ten Broek RPG, Krielen P, Di Saverio S, et al. 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. 2018;13:24.

    Article  Google Scholar 

  4. 4.

    Behman R, Nathens AB, Pechlivanoglou P, Karanicolas P, Jung J, Look Hong N. Early operative management in patients with adhesive small bowel obstruction: population-based cost analysis. BJS Open. 2020;4:914.

    CAS  Article  Google Scholar 

  5. 5.

    Fung BSC, Behman R, Nguyen M-A, et al. Longer trials of non-operative management for adhesive small bowel obstruction are associated with increased complications. J Gastrointest Surg. 2020;24:890–8.

    Article  Google Scholar 

  6. 6.

    Behman R, Nathens AB, Mason S, et al. Association of surgical intervention for adhesive small-bowel obstruction with the risk of recurrence. JAMA Surg. 2019;154:413–20.

    Article  Google Scholar 

  7. 7.

    Medvecz AJ, Dennis BM, Wang L, Lindsell CJ, Guillamondegui OD. Impact of operative management on recurrence of adhesive small bowel obstruction: a longitudinal analysis of a statewide database. J Am Coll Surg. 2020;230(544–551):e1.

    Google Scholar 

  8. 8.

    Tabchouri N, Dussart D, Giger-Pabst U, et al. Only surgical treatment to be considered for adhesive small bowel obstruction: a new paradigm. Gastroenterol Res Pract. 2018;2018:9628490.

    Article  Google Scholar 

  9. 9.

    Duron J-J, Silva NJ-D, du Montcel ST, et al. Adhesive postoperative small bowel obstruction: incidence and risk factors of recurrence after surgical treatment: a multicenter prospective study. Ann Surg. 2006;244:750–7.

    Article  Google Scholar 

  10. 10.

    Fevang BT, Fevang J, Lie SA, Soreide O, Svanes K, Viste A. Long-term prognosis after operation for adhesive small bowel obstruction. Ann Surg. 2004;240:193–201.

    Article  Google Scholar 

  11. 11.

    Delabrousse E, Lubrano J, Jehl J, et al. Small-bowel obstruction from adhesive bands and matted adhesions: CT differentiation. AJR Am J Roentgenol. 2009;192:693–7.

    Article  Google Scholar 

  12. 12.

    Millet I, Ruyer A, Alili C, et al. Adhesive small-bowel obstruction: value of CT in identifying findings associated with the effectiveness of nonsurgical treatment. Radiology. 2014;273:425–32.

    Article  Google Scholar 

  13. 13.

    Osada H, Watanabe W, Ohno H, et al. Multidetector CT appearance of adhesion-induced small bowel obstructions: matted adhesions versus single adhesive bands. Jpn J Radiol. 2012;30:706–12.

    Article  Google Scholar 

  14. 14.

    Vibert E, Regimbeau JM, Panis Y, et al. Post-operative small bowel obstruction: spiral computed tomography. Ann Chir. 2002;127:765–70.

    CAS  Article  Google Scholar 

  15. 15.

    Paulson EK, Thompson WM. Review of small-bowel obstruction: the diagnosis and when to worry. Radiology. 2015;275:332–42.

    Article  Google Scholar 

  16. 16.

    Chuong AM, Corno L, Beaussier H, et al. Assessment of Bowel wall enhancement for the diagnosis of intestinal ischemia in patients with small bowel obstruction: value of adding unenhanced CT to contrast-enhanced CT. Radiology. 2016;280:98–107.

    Article  Google Scholar 

  17. 17.

    Rami Reddy SR, Cappell MS. A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep. 2017;19:28.

    Article  Google Scholar 

  18. 18.

    Miller G, Boman J, Shrier I, Gordon PH. Natural history of patients with adhesive small bowel obstruction. Br J Surg. 2000;87:1240–7.

    CAS  Article  Google Scholar 

  19. 19.

    Behman R, Nathens AB, Haas B, Look Hong N, Pechlivanoglou P, Karanicolas P. Surgery for adhesive small-bowel obstruction is associated with improved long-term survival mediated through recurrence prevention: a population-based, propensity-matched analysis. J Trauma Acute Care Surg. 2019;87:636–44.

    Article  Google Scholar 

  20. 20.

    Behman R, Nathens AB, Look Hong N, Pechlivanoglou P, Karanicolas PJ. Evolving management strategies in patients with adhesive small bowel obstruction: a population-based analysis. J Gastrointest Surg. 2018;22:2133–41.

    Article  Google Scholar 

  21. 21.

    Udelsman BV, Chang DC, Parina R, Talamini MA, Lillemoe KD, Witkowski ER. Population level analysis of adhesive small bowel obstruction: sustained advantage of a laparoscopic approach. Ann Surg. 2020;271:898–905.

    Article  Google Scholar 

  22. 22.

    Teixeira PG, Karamanos E, Talving P, Inaba K, Lam L, Demetriades D. Early operation is associated with a survival benefit for patients with adhesive bowel obstruction. Ann Surg. 2013;258:459–65.

    Article  Google Scholar 

  23. 23.

    Bauer J, Keeley B, Krieger B, et al. Adhesive small bowel obstruction: early operative versus observational management. Am Surg. 2015;81:614–20.

    Article  Google Scholar 

  24. 24.

    Krielen P, Di Saverio S, Ten Broek R, et al. Laparoscopic versus open approach for adhesive small bowel obstruction, a systematic review and meta-analysis of short term outcomes. J Trauma Acute Care Surg. 2020;88:866–74.

    Article  Google Scholar 

  25. 25.

    Di Saverio S, Birindelli A, Broek RT, Davies JR, Mandrioli M, Sallinen V. Laparoscopic adhesiolysis: not for all patients, not for all surgeons, not in all centres. Updates Surg. 2018;70(4):557–61.

    Article  Google Scholar 

  26. 26.

    Fukami Y, Kobayashi S, Sekoguchi E, Kurumiya Y. Randomized controlled trial of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction. Langenbecks Arch Surg. 2018;403:555–9.

    Article  Google Scholar 

  27. 27.

    Grafen FC, Neuhaus V, Schöb O, Turina M. Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital. Langenbecks Arch Surg. 2010;395:57–63.

    Article  Google Scholar 

  28. 28.

    Matsushima K, Inaba K, Dollbaum R, et al. High-density free fluid on computed tomography: a predictor of surgical intervention in patients with adhesive small bowel obstruction. J Gastrointest Surg. 2016;20:1861–6.

    Article  Google Scholar 

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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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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.

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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.

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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

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Keywords

  • Intestinal obstruction/diagnosis
  • Postoperative complications*/diagnosis
  • Retrospective studies