Prediction factors for ischemia of closed-loop small intestinal obstruction

Abstract

A closed-loop type of intestinal obstruction leads to ischemic necrosis. There have been indicators that may predict ischemia and its severity, such as biomarkers and computed tomography scans. In addition to the usual inflammation markers, such as white blood count-neutrophil count and c-reactive protein (CRP), the most accurate predictors that have been proposed are the CRP-to-albumin ratio, the neutrophil/lymphocyte ratio and the platelet/lymphocyte ratio. Endothelin 1 is another promising biomarker of ischemia that must be assessed in daily clinical practice. Advanced age and frailty status were assessed as predictors of mortality. A timely operative procedure without any delay ensures a better outcome.

Keywords: Acute abdomen; Obstructive ileus; Bowel ischemia; Closed loop; Predictive factors; Inflammatory markers

Core Tip: Early recognition of closed loops is important to interrupt ongoing ischemia by prompt surgical intervention, especially for older age patients. In such a case, we achieve avoidance of bowel necrosis and enterectomy as well as septic complications, which ultimately resulted in an improved outcome. Endothelin 1, c-reactive protein and leukocyte-neutrophil count must be more often used in daily practice as a severity marker of small bowel ischemia.