TY - JOUR
T1 - A multi-institution prospective observational study of small bowel obstruction
T2 - Clinical and computerized tomography predictors of which patients may require early surgery
AU - Kulvatunyou, Narong
AU - Pandit, Viraj
AU - Moutamn, Sadoun
AU - Inaba, Kenji
AU - Chouliaras, Konstantinos
AU - Demoya, Marc
AU - Naraghi, Leily
AU - Kalb, Bobby
AU - Arif, Hina
AU - Sravanthi, Reddy
AU - Joseph, Bellal
AU - Gries, Lynn
AU - Tang, Andrew L.
AU - Rhee, Peter
N1 - Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/9/5
Y1 - 2015/9/5
N2 - BACKGROUND For patients with adhesive small bowel obstruction (ASBO), early surgery after a failed trial of nonoperative treatment can improve outcome. However, deciding which patients require early surgery is difficult, given the lack of specific clinical or radiographic signs. The study goals were to identify clinical and computed tomography (CT) predictors of which patients may need early surgery and to evaluate the utility of the common CT findings. METHODS This was a multi-institution prospective observational study for patients who were admitted with ASBO. Patients were excluded if their SBO were not managed conservative initially; were within 30 days postoperatively; were caused by external hernias, small bowel tumor, or intussusception; and were related to Crohn's disease. Clinical and laboratory variables were collected prospectively. CT findings were interpreted by a blinded designated radiologist. To identify significant predictors, we performed a multivariable regression analysis. RESULTS During 22 months, we enrolled 200 patients with ASBO. Patients' mean (SD) age was 60 (18) years; 50% were male. Fifty-two patients (26%) underwent surgery. Of those who underwent surgery, the median duration of nonoperative treatment was 1.5 days (interquartile range, 1-2.5 days). In the regression model, we identified no flatus (odds ratio [OR], 3.28; 95% confidence interval [CI], 1.51-7.12; p = 0.003), presence of free fluid on CT (OR, 2.59; 95% CI, 1.13-5.90; p = 0.023), and high-grade obstruction by CT (OR, 2.44; 95% CI, 1.10-5.43; p = 0.028) to be significant predictors for ASBO patients who may need early surgery. CONCLUSION In this study, we prospectively derived one clinical and two CT predictors which ASBO patients may benefit from an early surgical intervention. However, a future study to validate these predictors is needed.
AB - BACKGROUND For patients with adhesive small bowel obstruction (ASBO), early surgery after a failed trial of nonoperative treatment can improve outcome. However, deciding which patients require early surgery is difficult, given the lack of specific clinical or radiographic signs. The study goals were to identify clinical and computed tomography (CT) predictors of which patients may need early surgery and to evaluate the utility of the common CT findings. METHODS This was a multi-institution prospective observational study for patients who were admitted with ASBO. Patients were excluded if their SBO were not managed conservative initially; were within 30 days postoperatively; were caused by external hernias, small bowel tumor, or intussusception; and were related to Crohn's disease. Clinical and laboratory variables were collected prospectively. CT findings were interpreted by a blinded designated radiologist. To identify significant predictors, we performed a multivariable regression analysis. RESULTS During 22 months, we enrolled 200 patients with ASBO. Patients' mean (SD) age was 60 (18) years; 50% were male. Fifty-two patients (26%) underwent surgery. Of those who underwent surgery, the median duration of nonoperative treatment was 1.5 days (interquartile range, 1-2.5 days). In the regression model, we identified no flatus (odds ratio [OR], 3.28; 95% confidence interval [CI], 1.51-7.12; p = 0.003), presence of free fluid on CT (OR, 2.59; 95% CI, 1.13-5.90; p = 0.023), and high-grade obstruction by CT (OR, 2.44; 95% CI, 1.10-5.43; p = 0.028) to be significant predictors for ASBO patients who may need early surgery. CONCLUSION In this study, we prospectively derived one clinical and two CT predictors which ASBO patients may benefit from an early surgical intervention. However, a future study to validate these predictors is needed.
KW - CT scan
KW - Small bowel obstruction
KW - adhesion
KW - predictors
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U2 - 10.1097/TA.0000000000000759
DO - 10.1097/TA.0000000000000759
M3 - Article
C2 - 26307871
AN - SCOPUS:84940856733
SN - 2163-0755
VL - 79
SP - 393
EP - 398
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 3
ER -