Predictors for success of non-operative management of adhesive small bowel obstruction

doi:10.4240/wjgs.v15.i6.1116

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Jun 27, 2023; 15(6): 1116-1124
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1116

Predictors for success of non-operative management of adhesive small bowel obstruction

Zi Qin Ng, Vivien Hsu, William Wei Han Tee, Jih Huei Tan, Ruwan Wijesuriya

Zi Qin Ng, Vivien Hsu, Ruwan Wijesuriya, Department of General Surgery, St John of God Midland Hospital, Midland 6056, Western Australia, Australia

William Wei Han Tee, Department of Radiology, St John of God Midland Hospital, Midland 6056, Western Australia, Australia

Jih Huei Tan, Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru 80000, Johor, Malaysia

Author contributions: Ng ZQ contributed to the data analysis and drafting of manuscript; Hsu V collected the data; Tee WWH collected the radiological data collection, review of manuscript; Tan JH contributed to the statistical data analysis; Hsu V, Tee WWH, and Tan JH involved in the review of the manuscript; Ng ZQ and Wijesuriya R designed the study; Wijesuriya R contributed to critical review of manuscript and supervision of study; and all authors approved the final version of this manuscript for submission and publication.

Institutional review board statement: Ethical approval was obtained from the St John of God Healthcare’s ethics committee (Ref: 1358).

Informed consent statement: The consent was waived from the institute’s ethics committee.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. Dr Zi Qin Ng received the General Surgeons Australia Junior Doctor Research Grant in 2018 for this study.

Data sharing statement: Data is available upon reasonable request grounds.

Corresponding author: Zi Qin Ng, MBBS (Hons), FRACS Senior Researcher, Surgeon, Department of General Surgery, St John of God Midland Hospital, 1 Clayton Street, Midland 6056, Western Australia, Australia. kentng@hotmail.co.uk

Received: December 27, 2022
Peer-review started: December 27, 2022
First decision: January 20, 2023
Revised: January 21, 2023
Accepted: April 13, 2023
Article in press: April 13, 2023
Published online: June 27, 2023
Processing time: 170 Days and 4.8 Hours

Abstract

BACKGROUND

Majority of adhesive small bowel obstruction (SBO) cases can be managed non-operatively. However, a proportion of patients failed non-operative management.

AIM

To evaluate the predictors of successful non-operative management in adhesive SBO.

METHODS

A retrospective study was performed for all consecutive cases of adhesive SBO from November 2015 to May 2018. Data collated included basic demographics, clinical presentation, biochemistry and imaging results and management outcomes. The imaging studies were independently analyzed by a radiologist who was blinded to the clinical outcomes. The patients were divided into group A operative (including those that failed initial non-operative management) and group B non-operative for analysis.

RESULTS

Of 252 patients were included in the final analysis; group A (n = 90) (35.7%) and group B (n = 162) (64.3%). There were no differences in the clinical features between both groups. Laboratory tests of inflammatory markers and lactate levels were similar in both groups. From the imaging findings, the presence of a definitive transition point [odds ratio (OR) = 2.67, 95% confidence interval (CI): 0.98-7.32, P = 0.048], presence of free fluid (OR = 2.11, 95%CI: 1.15-3.89, P = 0.015) and absence of small bowel faecal signs (OR = 1.70, 95%CI: 1.01-2.88, P = 0.047) were predictive of the need of surgical intervention. In patients that received water soluble contrast medium, the evidence of contrast in colon was 3.83 times predictive of successful non-operative management (95%CI: 1.79-8.21, P = 0.001).

CONCLUSION

The computed tomography findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.

Keywords: Small bowel obstruction; Adhesive; Conservative; Non-operative

Core Tip: Adhesive small bowel obstruction (SBO) is a common acute surgical presentation. Majority of the cases can be managed successfully with non-operative management. The findings on computed tomography abdomen/pelvis are useful in predicting patients that are unlikely to resolve with conservative management for adhesive SBO and therefore guide decision-making in early surgical intervention to prevent morbidities associated with it.