Skip to main content

Advertisement

SpringerLink
Log in

A multi-analysis of nomogram model for the identification of banded adhesions and matted adhesions in adhesive small bowel obstruction

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Preoperative diagnosis of the cause of adhesive small bowel obstruction (ASBO) is very challenging for surgeons. We aimed to develop a nomogram model for the identification of banded adhesions (BA) and matted adhesions (MA) of ASBO.

Methods

This retrospective study enrolled patients with ASBO between January 2012 and December 2020, classified into BA and MA groups according to the intraoperative findings. A nomogram model was developed by using multivariable logistic regression analysis.

Results

A total of 199 patients were included, with 117 (58.8%) cases of BA and 82 (41.2%) cases of MA. There were 150 patients designed for training the model, and the other 49 cases for validation. Multivariate logistic regression analysis showed that prior surgery for once (p = 0.008), white blood cells (WBC) (p = 0.001), beak sign (p < 0.001), fat notch sign (p = 0.013), and mesenteric haziness (p = 0.005) were independently associated with BA. The AREA under the receiver operating characteristic curve (AUC-ROC) of the nomogram model in the training and validation sets were 0.861 (95% CI 0.802–0.921) and 0.884 (95% CI 0.789–0.980), respectively. The calibration plot demonstrated a good agreement. A decision curve analysis demonstrated that the nomogram model was clinically useful.

Conclusions

The multi-analysis of the nomogram model might have a favorable clinical applicability for the identification of BA and MA in patients with adhesive small bowel obstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

All relevant data are within the manuscript and its Supporting Information files.

Abbreviations

ASBO:

Adhesive small bowel obstruction

BA:

Banded adhesions

MA:

Matted adhesions

WBC:

White blood cells

NEU %:

Neutrophil %

CRP:

C-reactive protein

CT:

Computed tomography

ASA:

American society of anesthesiologists score

References

  1. Behman R, Nathen AB, Mason S, Byrne JP, Hong NL, Pechlivanoglou P, et al. Association of surgical intervention for adhesive small-bowel obstruction with the risk of recurrence. JAMA Surg. 2019;154(5):413–20.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Millet I, Ruyer A, Alili C, Curros Doyon F, Molinari N, Pages E, 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  PubMed  Google Scholar 

  3. 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  PubMed  Google Scholar 

  4. Ng YY, Ngu JC, Wong AS. Small bowel obstruction in the virgin abdomen: time to challenge surgical dogma with evidence. ANZ J Surg. 2018;88:91–4.

    Article  PubMed  Google Scholar 

  5. Amara Y, Leppaniemi A, Catena F, Ansaloni L, Sugrue M, Fraga GP, et al. Diagnosis and management of small bowel obstruction in virgin abdomen: a WSES position paper. World J Emerg Surg. 2021;16:36.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Podda M, Khan M, Saverio SD. Adhesive small bowel obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate? Scand J Surg. 2021;110(2):159–69.

    Article  CAS  PubMed  Google Scholar 

  7. Harvitkar RU, Kumar PH, Joshi A. Role of laparoscopy in the surgical management of acute small bowel obstruction: fact or fiction? Cureus. 2021;13: e18828.

    PubMed  PubMed Central  Google Scholar 

  8. Hajibandeh S, Hajibandeh S, Panda N, Khan RMA, Bandyopadhyay SK, Dalmia S, et al. Operative versus non-operative management of adhesive small bowel obstruction: a systematic review and meta-analysis. Int J Surg. 2017;45:58–66.

    Article  PubMed  Google Scholar 

  9. Ten Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L, 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  PubMed  PubMed Central  Google Scholar 

  10. Guerrini J, Zugna D, Poretti D, Samà L, Costa G, Mei S, et al. Adhesive small bowel obstruction: single band or matted adhesions? a predictive model based on computed tomography scan. J Trauma Acute Care Surg. 2021;90:917–23.

    Article  PubMed  Google Scholar 

  11. Duron JJ, Silva NJ, du Montcel ST, Berger A, Muscari F, Hennet H, 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  PubMed  PubMed Central  Google Scholar 

  12. Zein L, Calame P, Chausset C, Doussot A, Turco C, Malakhia A, et al. Preoperative prediction of inadvertent enterotomy during adhesive small bowel obstruction surgery using combination of CT features. Eur Radiol 2022.

  13. O’Connor DB, Winter DC. The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases. Surg Endosc. 2012;26:12–7.

    Article  PubMed  Google Scholar 

  14. Berge P, Delestre M, Paisant A, Hamy A, Aubé C, Hamel JF, et al. Diagnosis of single adhesive bands versus matted adhesions in small bowel obstructions: a radiological predictive score. Eur J Trauma Emerg Surg. 2022;48:13–22.

    Article  PubMed  Google Scholar 

  15. Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status - historical perspectives and modern developments. Anaesthesia. 2019;74:373–9.

    Article  CAS  PubMed  Google Scholar 

  16. Skoglar A, Gunnarsson U, Falk P. Band adhesions not related to previous abdominal surgery - a retrospective cohort analysis of risk factors. Ann Med Surg (Lond). 2018;36:185–90.

    Article  PubMed  Google Scholar 

  17. Meissner K, Szécsi T, Jirikowski B. Intestinal obstruction caused by solitary bands: aetiology, presentation, diagnosis, management, results. Acta Chir Hung. 1994;34:355–63.

    CAS  PubMed  Google Scholar 

  18. Long B, Robertson J, Koyfman A. Emergency medicine evaluation and management of small bowel obstruction: evidence-based recommendations. J Emerg Med. 2019;56:166–76.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Gopireddy DR, Soule E, Arif-Tiwari H, Sharma S, Kanmaniraja D, Jain K, et al. Spectrum of CT findings related to bowel adhesions without bowel obstruction: a comprehensive imaging review. J Clin Imaging Sci. 2020;10:80.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Li H, Sun D, Sun D, Xiao Z, Zhuang J, Yuan C. The diagnostic value of coagulation indicators and inflammatory markers in distinguishing between strangulated and simple intestinal obstruction. Surg Laparosc Endosc Percutan Tech. 2021;31:750–5.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bogusevicius A, Grinkevicius A, Maleckas A, Pundzius J. The role of D-dimer in the diagnosis of strangulated small-bowel obstruction. Medicina (Kaunas). 2007;43:850–4.

    Article  PubMed  Google Scholar 

  23. Bostancı MT, Yılmaz I, Seki A, Saydam M, Kosmaz K, Kaya IO. Haematological inflammatory markers for indicating ischemic bowel in patients with incarcerated abdominal wall hernias. Hernia. 2022;26:349–53.

    Article  PubMed  Google Scholar 

  24. Park SY, Chung JS, Kim SH, Kim YW, Ryu H, Kim DH. The safety and prognostic factors for mortality in extremely elderly patients undergoing an emergency operation. Surg Today. 2016;46:241–7.

    Article  CAS  PubMed  Google Scholar 

  25. Kulvatunyou N, Pandit V, Moutamn S, Inaba K, Chouliaras K, DeMoya M, et al. A multi-institution prospective observational study of small bowel obstruction: clinical and computerized tomography predictors of which patients may require early surgery. J Trauma Acute Care Surg. 2015;79:393–8.

    Article  PubMed  Google Scholar 

  26. Millet I, Taourel P, Ruyer A, Molinari N. Value of CT findings to predict surgical ischemia in small bowel obstruction: a systematic review and meta-analysis. Eur Radiol. 2015;25:1823–35.

    Article  PubMed  Google Scholar 

  27. Kim J, Lee Y, Yoon JH, Lee HJ, Lim YJ, Yi J, et al. Non-strangulated adhesive small bowel obstruction: CT findings predicting outcome of conservative treatment. Eur Radiol. 2021;31:1597–607.

    Article  PubMed  Google Scholar 

  28. Osada H, Watanabe W, Ohno H, Okada T, Yanagita H, Takahashi T, 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  PubMed  Google Scholar 

  29. de Kok BM, Toneman MK, Oei S, Westerterp M, van Acker GJD, van der Pool AEM, Zijta FM, et al. Correlation of CT findings with intra-operative outcome in closed-loop small bowel obstruction (CL-SBO). Eur J Radiol. 2021;142: 109844.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all the participants of this study and the nursing and department staff of Fujian Medical University Union Hospital.

Funding

The project was supported by the Natural Science Foundation of Fujian Province(grant numbers: 2022J01247 to Yong Wei); Education Department of Fujian Province Young and Middle-aged Teacher Education Research Project(grant numbers: JAT210109 to Yong Wei); Joint Funds for the Innovation of Science and Technology, Fujian province(grant numbers: 2018Y9054 to Xian-qiang Chen); Medical “creating double high” construction funds, Fujian Province (grant numbers: 2021No.76 to Xian-qiang Chen).

Author information

Authors and Affiliations

  1. Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China

    Yong Wei, Tianran Liao, Xinchang Shangguan, Manduo Ouyang, Bingqiang Lin & Xianqiang Chen

  2. Department of Radiology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China

    Zhiyong Chen & Enshuang Zheng

Authors
  1. Yong Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tianran Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xinchang Shangguan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manduo Ouyang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhiyong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Enshuang Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bingqiang Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xianqiang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YW conceived the study, searched the literature and drafted the manuscript; TL and XS analyzed the data, made the tables and figures. XC reviewed the tables and figures and participated in revising the manuscript. BL helped to revise the manuscript critically for important intellectual content; MO helped to collect data and design the study; ZC and EZ analyzed CT scans and recorded the results. All authors participated in the final revision and agreed to the admission of this final version of the manuscript.

Corresponding author

Correspondence to Xianqiang Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki (in 1964). The study was approved by the Ethics Committee Board of Fujian Medical University Union Hospital (2022KY114). Considering the retrospective nature of the study, the Ethics Committee waived the requirement for patients’ informed consent.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wei, Y., Liao, T., Shangguan, X. et al. A multi-analysis of nomogram model for the identification of banded adhesions and matted adhesions in adhesive small bowel obstruction. Eur J Trauma Emerg Surg 49, 2277–2285 (2023). https://doi.org/10.1007/s00068-023-02270-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-023-02270-4

Keywords

Search

Navigation