Predicting Intestinal Ischaemia in Patients with Adhesive Small Bowel Obstruction: A Simple Score

Abstract

Background/aims

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.

Methods

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.

Results

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).

Conclusions

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 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 8:42

    Article  Google Scholar 

  2. 2.

    Lorentzen L, Øines MN, Oma E, Jensen KK, Jorgensen LN (2017) Recurrence after operative treatment of adhesive small-bowel obstruction. J Gastrointest Surg 13:329–334

    Google Scholar 

  3. 3.

    Bilderback PA, Massman JD 3rd, Smith RK, La Selva D, Helton WS (2015) Small bowel obstruction is a surgical disease: patients with adhesive small bowel obstruction requiring operation have more cost-effective care when admitted to a surgical service. J Am Coll Surg 221:7–13

    Article  Google Scholar 

  4. 4.

    Di Saverio S, Gori A, Chisari E, Wheeler J, Lim R (2019) Laparoscopic management of adhesive small bowel obstruction with strangulation: when to resect and how to distinguish reversible from nonreversible bowel ischaemia—a video vignette. Colorectal Dis 21(6):727–729

    Article  Google Scholar 

  5. 5.

    Schwenter F, Poletti PA, Platon Perneger T, Morel P, Gervaz P (2010) Clinicoradiological score for predicting the risk of strangulated small bowel obstruction. Br J Surg 37(7):1119–1125

    Article  Google Scholar 

  6. 6.

    Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D et al (2001) Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum 44(6):829–830

    Article  Google Scholar 

  7. 7.

    Ellis H (1998) The magnitude of adhesion related problems. Ann Chir Gynaecol 87(1):9–11

    CAS  PubMed  Google Scholar 

  8. 8.

    Choudhry AJ, Haddad NN, Rivera M, Morris DS, Zietlow SP, Schiller HJ et al (2016) Medical malpractice in the management of small bowel obstruction: A 33-year review of case law. Surgery 160(4):1017–1027

    Article  Google Scholar 

  9. 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 13:24

    Article  Google Scholar 

  10. 10.

    Huang X, Fang G, Lin J, Xu K, Shi H, Zhuang L (2018) A prediction model for recognizing strangulated small bowel obstruction. Gastroenterol Res Pract 2018:7164648

    Article  Google Scholar 

  11. 11.

    Duron JJ, du Montcel ST, Berger A, Muscari F, Hennet H, Veyrieres M et al (2008) Prevalence and risk factors of mortality and morbidity after operation for adhesive postoperative small bowel obstruction. Am J Surg 195(6):726–734

    Article  Google Scholar 

  12. 12.

    Duron JJ (2001) Acute intestinal occlusion. Rev Pract 51(15):1670–1674

    CAS  Google Scholar 

  13. 13.

    Fevang BT, Jensen D, Fevang J, Søndenaa K, Ovrebø K, Røkke O et al (2000) Upper gastrointestinal contrast study in the management of small bowel obstruction–a prospective randomised study. Eur J Surg 166(1):39–43

    CAS  Article  Google Scholar 

  14. 14.

    Bizer L, Liebling RW, Delany HM, Gliedman ML (1981) Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction. Surgery 89(4):407–413

    CAS  PubMed  Google Scholar 

  15. 15.

    Lo AM, Evans WE, Carey LC (1966) Review of small bowel obstruction at Milwaukee County General Hospital. Am J Surg 111(6):884–887

    CAS  Article  Google Scholar 

  16. 16.

    Nandyala VN, Chintakindi SB, Kundarapu G (2016) A study of preoperative predictive factors of strangulation in acute small intestinal obstruction. Int Surg J 3(3):1386–1391

    Article  Google Scholar 

  17. 17.

    Lefall LD, Syphax B (1970) Clinical aids in strangulation intestinal obstruction. Am J Surg 120:756–759

    Article  Google Scholar 

  18. 18.

    Strik C, Stommel MW, Schipper LJ, van Goor H, Ten Broek RP (2016) Long term impact of adhesions on bowel obstruction. Surgery 159(5):1351–1359

    Article  Google Scholar 

  19. 19.

    Cosse C, Regimbeau JM, Fuks D, Mauvais F, Scotte M (2013) Serum procalcitonin for predicting the failure of conservative management and the need for bowel resection in patients with small bowel obstruction. J Am Coll Surg 216(5):997–1004

    Article  Google Scholar 

  20. 20.

    Mu JF, Wang Q, Wang SD, Wang C, Song JX, Jiang J et al (2018) Clinical factors associated with intestinal strangulating obstruction and recurrence in adhesive small bowel obstruction: A retrospective study of 288 cases. Medicine (Baltimore) 97(34):e12011

    Article  Google Scholar 

  21. 21.

    Matsushima K, Inaba K, Dollbaum R, Cheng V, Khan M, Herr K et al (2016) High-density free fluid on computed tomography: a predictor of surgical intervention in patients with adhesive small bowel obstruction. Gastrointestinal Surg 20:1861–1866

    Article  Google Scholar 

  22. 22.

    Hwang JY, Lee JK, Lee JE, Baek SY (2009) Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion. Eur Radiol 19:2424–2431

    Article  Google Scholar 

  23. 23.

    Zalcman M, Sy M, Donckier V, Closset J, Gansbeke DV (2000) Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction. AJR Am J Roentgenol 175:1601–1607

    CAS  Article  Google Scholar 

  24. 24.

    Sheedy SP, Earnest F 4th, Fletcher JG, Fidler JL, Hoskin TL (2006) CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology 241(3):729–736

    Article  Google Scholar 

  25. 25.

    Hayakawa K, Tanikake M, Yoshida S, Yamamoto A, Yamamoto E, Morimoto T (2013) CT findings of small bowel strangulation: the importance of contrast enhancement. Emerg Radiol 20(1):3–9

    Article  Google Scholar 

Download references

Funding

No grant support for the research.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mahdi Bouassida.

Ethics declarations

Conflict of interest

No conflict of interest to declare.

Ethical approval

The study was approved by the institutional research and ethics board of Mohamed Tahar Maamouri Hospital.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bouassida, M., Laamiri, G., Zribi, S. et al. Predicting Intestinal Ischaemia in Patients with Adhesive Small Bowel Obstruction: A Simple Score. World J Surg 44, 1444–1449 (2020). https://doi.org/10.1007/s00268-020-05377-6

Download citation