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

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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.

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Authors and Affiliations

  1. Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia

    Mahdi Bouassida, Ghazi Laamiri, Slim Zribi, Helmi Slama, Bassem Mroua, Selim Sassi, Rania Aboudi, Mohamed Mongi Mighri & Hassen Touinsi

  2. Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia

    Mahdi Bouassida, Ghazi Laamiri, Slim Zribi, Helmi Slama, Bassem Mroua, Selim Sassi, Rania Aboudi, Mohamed Mongi Mighri, Khaled Bouzeidi & Hassen Touinsi

  3. Department of Radiology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia

    Khaled Bouzeidi

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  1. Mahdi Bouassida
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  2. Ghazi Laamiri
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  3. Slim Zribi
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  4. Helmi Slama
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Corresponding author

Correspondence to Mahdi Bouassida.

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

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

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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

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  • DOI: https://doi.org/10.1007/s00268-020-05377-6

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