Value analysis of ultrasound classification in disease judgment and treatment plan formulation of patients with adhesive intestinal obstruction

Abstract

BACKGROUND

Ultrasound classification can be used to determine the severity of adhesive intestinal obstruction and to guide the formulation of treatment plans.

AIM

To explore the value of ultrasound classification in disease judgment and treatment plan formulation for patients with adhesive intestinal obstruction.

METHODS

The medical records of 120 patients with adhesive intestinal obstruction presenting at Taihe Hospital Affiliated with Hubei Medical College were retrospectively analyzed from January 2022 to January 2024 according to the severity of ultrasound images, divided into simple (mild), complex (moderate), and critical (severe), analyzing the imaging characteristics of patients with different ultrasound classifications, and developing the corresponding treatment plan according to the ultrasound typing results, that is, conservative treatment and surgical treatment, contrast the ultrasound signs of patients in the conservative vs surgical treatment groups, and the value of ultrasound classification in the treatment of adhesive ileus.

RESULTS

Among the 120 patients, P > 0.05, compared with the general data (sex, age, body quality index, time to onset, and history of onset), the proportion of bowel distension and abdominal effusion (P > 0.05), and the proportion of adhesion mass and cross-cross in the conservative treatment group, P < 0.05.

CONCLUSION

Ultrasound typing can aid in the clinical evaluation of the severity of adhesive intestinal obstruction and provide an imaging reference for clinicians to develop targeted treatment plans.

Key Words: Adhesive ileus; Ultrasound classification; Severity of disease; Treatment plan; Clinic

Core Tip: This study highlights the clinical value of ultrasound classification in assessing the severity of adhesive intestinal obstruction. By categorizing cases into simple, complex, and critical types based on ultrasound findings, clinicians can more accurately determine the appropriate treatment approach - conservative or surgical. The results support ultrasound as a non-invasive, practical tool to guide personalized treatment plans and improve clinical decision-making in managing adhesive ileus.

INTRODUCTION

Adhesive intestinal obstruction is one of the most common types of intestinal obstruction, accounting for approximately 40%-60% of all cases. This condition results from adhesions within the abdominal cavity and is characterized by abdominal pain, distension, and vomiting. If not treated promptly and effectively, the condition can progress, leading to dehydration and shock, posing a threat to the patient’s life[1,2]. The clinical treatment options for this disease include surgical and nonsurgical methods. However, the selection of the most appropriate treatment plan for patients with varying degrees of adhesive intestinal obstruction is challenging in clinical practice. Poor treatment outcomes can lead to high recurrence rates and poor prognosis[3]. Therefore, it is crucial to use effective methods to accurately assess the severity of the condition at an early stage in order to provide a basis for formulating targeted clinical treatment plans.

Computed tomography (CT) is commonly used to diagnose adhesive intestinal obstructions in clinical settings. CT scans can provide radiological characteristic data of the “transition zone” between dilated and collapsed bowel loops, which can help determine the cause of the intestinal obstruction. However, CT scans without contrast cannot assess the blood supply to the mesentery, which limits their application in judging the severity of the condition[4]. Ultrasound, a medical imaging technique that uses ultrasonic waves, can accurately reflect the anatomical structures of the various layers of human tissues. In the examination of adhesive intestinal obstruction, ultrasound can not only detect the adhesion bands in the “transition zone” but also display the blood supply of the intestinal wall, making it more valuable in application[5]. However, there are few reports on the value of ultrasound typing in judging the condition of patients with adhesive intestinal obstruction and formulating treatment plans. Therefore, this retrospective study was conducted using the medical records of 120 patients who were pathologically diagnosed with adhesive intestinal obstruction at Taihe Hospital Affiliated with Hubei Medical College between January 2022 and January 2024. The details are as follows.

MATERIALS AND METHODS

General data

This study was a retrospective review of 120 patients diagnosed with adhesive intestinal obstruction at Taihe Hospital Affiliated with Hubei Medical College from January 2022 to January 2024. Among them, there were 54 males (45.00%) and 66 females (55.00%). The age range was from 23 years to 70 years, with an average age of (46.50 ± 6.34) years. The body mass index ranged from 17 kg/m² to 24 kg/m², with an average of (20.50 ± 1.23) kg/m². The time from onset of symptoms to visit was 1 days to 10 days, with an average of (5.50 ± 1.45) days. Medical history included a history of abdominal surgery in 103 patients (85.83%), gynecological surgery in 10 patients (8.33%), and a history of acute or chronic inflammation of the abdomen or intestine in seven patients (5.83%).

The inclusion criteria were as follows: (1) Diagnosis of adhesive intestinal obstruction according to clinical practice guidelines[6]; (2) All patients presenting with symptoms such as abdominal pain, distension, and vomiting; (3) All patients who underwent ultrasound examination; and (4) Patients who provided informed consent for their medical records to be included in the study. The exclusion criteria were as follows: (1) Patients with malignant tumors; (2) Patients unable to tolerate surgery; and (3) Patients who withdrew from the study midway.

Ultrasound examination method

A color doppler ultrasound diagnostic device (Manufacturer: General Electric Company, United States, Model: VOLUSON P8, Approval Number: National Medical Device Registration 20152061495) was used. Before the examination, it was confirmed that the patients had fasted for > 12 hours. Routine scanning of the abdominal organs was performed and patients with other diseases were excluded. A standard abdominal probe was used to comprehensively scan the intestines from top to bottom and left to right to examine the stomach, duodenum, small intestine, colon, abdominal cavity, and pelvis. A high-frequency probe was used to further inspect whether a lesion was detected during the examination.

Ultrasound typing standards for the severity of adhesive intestinal obstruction

Based on previous clinical ultrasound diagnostic experience, patient condition, and ultrasound image characteristics, and through multicenter research and expert consensus, ultrasound typing standards for the severity of adhesive intestinal obstruction were established. Further details are listed in Table 1.

Table 1 Ultrasound typing criteria for adhesive intestinal obstruction.

The severity of the condition	Ultrasound typing criteria
Simple type (mild)	Local intestinal adhesion: Local adhesion of the intestinal wall and intestinal wall and abdominal wall, no obvious abdominal-pelvic effusion, local intestinal expansion
Complex type (moderate)	There are extensive intestinal adhesions in the abdominal cavity, with adhesion band formation, adhesive masses, extensive intestinal dilatation, and a small amount of effusion in the abdominal and pelvic cavity
Critical condition type (severe type)	There were extensive abdominal adhesions, with intestinal ischemia and necrosis, and more effusion in the abdominal and pelvic cavity

Treatment plan

Conservative treatment for mild patients: This includes fasting, gastrointestinal decompression, enemas, anti-infection, use of acid suppressants and somatostatin, correction of water and electrolyte imbalances, and acid-base balance. All necessary examinations were performed during the treatment period. The emergency observation time ranged from 12 hours to 24 hours.

Surgical treatment for moderate and severe cases: Laparoscopic adhesiveness is performed for patients with adhesive intestinal obstruction; if the adhesions are too severe to be released, partial intestinal resection is performed. Emergency laparotomy was performed in cases of strangulation of the intestinal obstruction.

Observational indicators

Based on the severity of ultrasound images, patients were classified as simple (mild), complex (moderate), or severe (severe), and the imaging characteristics of patients with different ultrasound types were analyzed. Treatment plans corresponding to the ultrasound typing results were formulated, including conservative and surgical treatments. The ultrasound signs of patients in the conservative and surgical treatment groups were compared.

Statistical analysis

The data for this study were processed using the statistical software SPSS 26.0. Qualitative data are presented as n (%) and analyzed using the χ² test. Quantitative data are expressed as the mean ± SD and analyzed using the t-test. Statistical significance was set at P < 0.05.

RESULTS

Analysis of imaging characteristics of adhesive intestinal obstruction patients with different ultrasound typing

Among the 120 patients, 58 had the simple type (mild), 40 had the complex type (moderate), and 22 had the severe type (severe). In the mild patients, 52 cases had adhesion of the intestinal wall to the intestinal wall (Figure 1A), and 52 cases had adhesion of the intestinal wall to the abdominal wall (Figure 1B); in the moderate patients, 40 cases had adhesion of the intestinal wall to the intestinal wall, 20 cases had adhesion of the intestinal wall to the abdominal wall, 20 cases had adhesion bands (Figure 2A), and 20 cases had adhesive masses (Figure 2B); in the severe patients, 22 cases had adhesion of the intestinal wall to the intestinal wall, 22 cases had adhesion of the intestinal wall to the abdominal wall, 10 cases had formation of adhesion bands, 6 cases had adhesive masses, and 22 cases had complications of adhesive intestinal obstruction, with internal hernias/intestinal volvulus/internal hernias with volvulus/intussusception/intestinal ischemic necrosis occurring in 6 cases, 2 cases, 2 cases, 1 case, and 12 cases, respectively (Figure 3).

Figure 1 Mild adhesive ileus involving intestinal and abdominal wall adhesions. A: Mild adhesive ileus (intestinal wall and abdominal wall adhesion). The small intestinal wall is attached to the anterior abdominal wall under the peritoneum. When taking a deep breath or during intestinal peristalsis, the adhered intestinal wall is not separated from the abdominal wall; B: Mild adhesive intestinal obstruction with adhesion to the intestinal wall. The small intestinal wall is attached to the small intestinal wall. When the small intestinal wall is adhered to the abdominal wall during deep inhalation or intestinal peristalsis, there is no separation.

Figure 2 Clinical and radiological features of moderate adhesive ileus with adhesive cord vs adhesive mass. A: Moderate adhesive ileus, adhesive cord. A fibrous band is formed between the intestinal tubes, showing a strong band echo; B: Moderate adhesive ileus, adhesive mass. The intestinal tract and mesentery are adhered together, and the mass is adhered and fixed to the anterior abdominal wall. The mass is relatively fixed, the intestinal wall is thickened, the local intestinal peristalsis is weakened or even disappeared, and the air-liquid flow is seen in the mass.

Figure 3 Severe adhesive ileus with complications. A: Severe viscous ileus with internal hernia. The hernia ring structure is the adhered bowel, and the internal hernia shows the hernia ring structure and the bowel herniated into it; B: Severe adhesive ileus with intestinal volvulus. The root of the expanded loop is rotated; C: Severe adhesive ileus with intussusception. The short axis of the intestine is “concentric circle” sign, and the intestinal wall within the intussusception mass shows increased blood flow signal; D: Severe adhesive ileus with intestinal ischemic necrosis. The intestinal wall ischemia ultrasound shows that the layers of the ischemic intestinal wall are not clear.

Comparison of ultrasound signs between conservative treatment and surgical treatment groups

Among the 120 patients, 58 mild cases underwent conservative treatment and 62 moderate and severe cases underwent surgical treatment. There were no significant differences in general data (sex, age, body mass index, and duration from onset to consultation/medical history) between the conservative and surgical treatment groups (P > 0.05). When comparing the ultrasound signs of bowel dilatation and abdominal effusion between the two groups, P > 0.05. However, the proportions of adhesion masses and cross signs in the surgical treatment group were significantly higher than those in the conservative treatment group (P < 0.05) (Table 2).

Table 2 Contrast ultrasound signs of patients in the conservative vs surgical treatment groups, n (%).

Item		Conservative treatment group (n = 58)	Surgical treatment group (n = 62)	χ2 (t)	P value
Gender	Male	25 (43.10)	29 (46.77)	0.163	0.686
	Female	33 (56.90)	33 (53.23)
Age (year), mean ± SD		46.50 ± 6.34	46.35 ± 6.40	(0.129)	0.898
Body mass index (kg/m2), mean ± SD		20.50 ± 1.23	20.40 ± 1.30	(0.432)	0.666
Time of onset to presentation (day), mean ± SD		5.50 ± 1.45	5.48 ± 1.46	(0.075)	0.940
Medical history of the disease	History of abdominal surgery	50 (86.21)	53 (85.48)	0.012	0.909
	History of gynecological surgery	5 (8.62)	5 (8.06)	0.048	0.825
	History of acute and chronic inflammation in the abdominal cavity or bowel	3 (5.17)	4 (6.45)	0.008	0.927
Ultrasonic sign	Dilatation of intestine	49 (84.48)	59 (95.16)	3.796	0.051
	Pyoperitoneum	38 (65.52)	50 (80.65)	3.506	0.061
	Adhesion block	35 (60.34)	58 (93.55)	12.958	0.000
	Decussation	5 (8.62)	54 (87.10)	73.840	0.000

DISCUSSION

Intestinal obstruction is a common acute abdominal condition encountered in clinical surgery and is often caused by intestinal adhesions, tumors, intestinal inflammation, and hernias, with adhesive intestinal obstruction being the most common[7,8]. Adhesive intestinal obstruction has a sudden onset and rapidly changing condition, making the early selection of the best treatment plan crucial. Early determination of the lesion site and severity of the condition are key to deciding whether to adopt conservative or surgical treatment[9]. Combining the patient's typical manifestations with the results of abdominal radiographic examinations can roughly determine whether the patient has an intestinal obstruction and its specific location; however, it cannot accurately assess the progression of the condition. CT is also a commonly used imaging technology in clinical management, providing doctors with more condition information; however, this examination technique requires strict control over the radiation dose and usage frequency, which have limitations[10].

The widespread adoption and continuous advancement of ultrasound technology has led to its increasingly broad application in clinical practice. It has been reported that the sensitivity of ultrasound for diagnosing intestinal obstruction reaches 92.40%, with a specificity as high as 96.60%[11]. However, there are few reports on the value of ultrasound typing in determining the severity of adhesive intestinal obstruction and treatment plans. This article conducts a retrospective study aimed to provide guidance for the clinical assessment of disease severity and formulation of treatment plans. In this study, 120 patients with adhesive intestinal obstruction were classified based on their clinical experience and ultrasound signs, resulting in 58 cases of simple obstruction, 40 cases of complex obstruction, and 22 cases of severe obstruction. By analyzing the imaging characteristics of patients with different ultrasound types, we found that patients with the simple type (mild) mainly exhibited adhesion of the intestinal wall to the intestinal wall and adhesion of the intestinal wall to the abdominal wall. Patients with the complex type (moderate) also showed adhesion bands and adhesive masses, whereas those with the severe type (severe) had complications such as internal hernias (6 cases), intestinal volvulus (2 cases), internal hernias with volvulus (2 cases), intussusception (1 case), and intestinal ischemic necrosis (12 cases) on imaging[12]. The analysis suggests that in severely ill patients, the occurrence of intestinal volvulus can also lead to the corresponding obstruction of the mesenteric vessels. Internal hernias and intestinal volvuli often lead to a closed loop and strangulated intestinal obstruction[13,14]. If the contents of the closed-loop intestine cannot be expelled, bloody transudates will increase in the intestinal lumen (due to strangulation). In more severe cases, adhesion bands further compress the intestines, leading to local vascular obstruction, and ultimately causing internal hernias. It is evident that ultrasound typing imaging characteristics are closely related to the progression of a patient's condition, and clinicians can judge the severity of the condition based on the results of ultrasound typing[15-17].

Treatment methods for adhesive intestinal obstruction include conservative and surgical treatments. The use of effective factors to guide the formulation of preoperative treatment plans can ensure better therapeutic effects[18-20]. This study also found that the proportion of bowel dilatation and abdominal effusion between the two groups (P > 0.05), and the proportion of adhesion masses and cross-signs in the surgical treatment group were higher than those in the conservative treatment group (P < 0.05), indicating that there was a difference in ultrasound signs between patients who underwent conservative or surgical treatment[21]. The conclusions of section 2.1 of this study showed that patients with the complex type (moderate) and severe type (severe) have adhesion masses and cross-signs on their ultrasound images[22]. Table 2 suggests that patients undergoing surgical treatment had a higher proportion of adhesion masses and cross signs on their ultrasound images. As patients undergoing surgical treatment are mostly those with severe conditions, it is speculated that ultrasound typing can guide clinical physicians in formulating treatment plans. However, clinical practice has not yet reached an accurate conclusion and further exploration is required[23,24].

CONCLUSION

In conclusion, this study demonstrated that ultrasound classification holds significant value in both condition judgment and formulation of treatment plans for patients with adhesive intestinal obstruction. Specifically, ultrasound typing criteria established through multicenter research and expert consensus have proven reliable and effective in guiding clinical decision-making. These criteria not only allow for a more accurate assessment of disease severity but also provide a solid basis for clinicians to tailor treatment plans according to specific ultrasound findings.