Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1116
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
Adhesive small bowel obstruction (SBO) is a common presentation in acute care surgery. Majority of cases are managed with non-operative approach successfully. Nevertheless, there is a small proportion of patients will fail non-operative management and require surgical intervention.
The delay surgical intervention in patients that fail non-operative management in adhesive SBO may result in small bowel ischemia requiring resection. This may lead to further morbidity and mortality.
The aim of this study was to identify predictors from clinical presentation, laboratory tests and imaging results that may help identify cases of adhesive SBO that are unlikely to resolve with non-operative management.
A retrospective analysis of all cases of SBO in our institute were undertaken. The cases of SBO secondary to causes such as incarceration, tumour, volvulus, inflammatory bowel disease etc were excluded. The computed tomography (CT) scans were independently reviewed by a consultant radiologist who was blinded to the outcomes for specific signs that may determine the success of non-operative management of adhesive SBO.
Clinical presentation and laboratory results were not predictive of the success of non-operative management of SBO. Only the CT findings of a definitive transition point, presence of free fluid and absence of small bowel faecal sign were predictive of the need of surgical intervention in adhesive SBO.
The CT 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.
Future studies should focus on universal definitions of the CT findings and outcomes to allow accurate comparison of the efficacy of the therapeutic options.