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Lamant F, Simon G, Busse-Coté A, Hassoun Y, Roussel B, Verdot P, Doussot A, Lakkis Z, Delabrousse E, Calame P. Assessment of small bowel ischemia in mechanical small bowel obstruction: Diagnostic value of bowel wall iodine concentration using dual-energy CT. Diagn Interv Imaging 2025; 106:126-134. [PMID: 39550287 DOI: 10.1016/j.diii.2024.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 10/19/2024] [Accepted: 10/30/2024] [Indexed: 11/18/2024]
Abstract
PURPOSE The purpose of this study was to determine whether dual-energy computed tomography (DECT), specifically by measuring bowel wall iodine concentration (BWIC), is superior to monoenergetic reconstructions (MR) for the diagnosis and staging of small bowel ischemia in patients with mechanical small bowel obstruction (SBO). MATERIALS AND METHODS From November 2021 to December 2023, all patients with mechanical SBO who underwent contrast-enhanced DECT of the abdomen and pelvis were evaluated for inclusion. Demographic, clinical and biochemical data were collected. Two abdominal radiologists, blinded to all patient information, reviewed all DECT examinations. Conventional CT features (including a closed loop mechanism, mesenteric haziness, decreased bowel wall enhancement (DBE), and increased unenhanced attenuation of the bowel wall) were first reviewed on 70-keV-MR and 40-keV-MR, followed by BWIC measurements in five regions of interest in the walls of both normal and abnormal small bowel loops. The diagnostic performance of a simple CT score, which included a closed loop mechanism, mesenteric haziness and DBE, was compared to that of BWIC measurements made on dilated and/or abnormal small bowel segments for the diagnosis of small bowel ischemia. The diagnostic capabilities were compared using areas under the receiver operating characteristic curves (AUCs). RESULTS A total of 142 patients were included (80 men, 62 women; mean age, 67 ± 17 [standard deviation (SD)] years). Fifty-six patients underwent surgery; 22 of them had confirmed small bowel ischemia, including 12 patients with small bowel necrosis requiring surgical resection. Significant differences in mean BWIC were found between patients without small bowel ischemia (1.73 ± 0.44 [SD] mg/mL), those with small bowel ischemia without necrosis (0.79 ± 0.37 [SD] mg/mL), and those with small bowel ischemia and necrosis (0.48 ± 0.32 [SD] mg/mL) (P < 0.001). The overall AUC of the BWIC measurement for diagnosing small bowel ischemia was 0.98 (95 % confidence interval [CI]: 0.97-1.00), similar to the AUC of the simple CT score (0.97; 95 % CI: 0.92-1.00). However, using a cut off-value of 1.16 mgI/mL, BWIC outperformed subjective assessment of DBE at 70-keV-MR and 40-keV-MR (Youden index, 0.90 vs. 0.54 and vs. 0.71, respectively) (P < 0.001 for both). CONCLUSION BWIC measurement outperforms subjective assessment of DBE for the diagnosis of small bowel ischemia in patients with SBO and can allow stratification of ischemia. However, BWIC does not outperfomr a global comprehensive analysis of conventional CT images.
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Affiliation(s)
- Flora Lamant
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Gabriel Simon
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Andreas Busse-Coté
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Youness Hassoun
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Bastien Roussel
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Pierre Verdot
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgery, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France; EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, 25000 Besançon, France
| | - Paul Calame
- Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France; EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, 25000 Besançon, France.
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Räty P, Bonsdorff A, Parviainen H, Lantto E, Hackenberg T, Lampela H, Nykänen T, Lyytinen I, Mentula P, Sallinen V. Development and external validation of prediction risk scores (STRISK and NOFA) to predict immediate surgical need in adhesive small bowel obstruction: an observational prospective multicentre study. Br J Surg 2025; 112:znaf025. [PMID: 40105480 PMCID: PMC11921420 DOI: 10.1093/bjs/znaf025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 10/26/2024] [Accepted: 01/16/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND Adhesive small bowel obstruction (SBO) is a common cause of emergency admission. Identification of patients at high risk of strangulation or failure of non-operative treatment is difficult. In this multicentre prospective observational study, prediction models for strangulation and non-operative treatment failure in adhesive SBO were developed. METHOD This study was carried out in three Finnish hospitals between June 2014 to May 2022. Patients with CT-confirmed adhesive SBO and prospective case report forms were included. The main outcomes were strangulation defined by operative finding of any intestinal ischaemia and failure of non-operative treatment within 30 days from admission. The model was developed using binary logistic regression, internally validated by bootstrapping and then externally validated. RESULTS Of 626 patients, 481 were included; 355 patients formed the model development group and 126 formed the external validation group. Strangulation occurred in 58 (16%) patients and non-operative treatment failed in 93 (31%) patients in development cohort. The following six variables were included in the risk model for strangulation and non-operative treatment failure: neutrophil-leucocyte ratio, number of previous SBOs, abdominal guarding, mesenteric changes and free abdominal fluid, closed loop sign, and faeces sign on CT. In the development cohort, the optimism corrected area under the receiver operator characteristics curve for the strangulation model was 0.860 (95% c.i. 0.808-0.917), and 0.751 (95% c.i. 0.694-0.816) for the non-operative treatment failure model respectively. At external validation, the models retained their discrimination and demonstrated stable calibration. CONCLUSION A clinically relevant prediction model to predict strangulation and non-operative treatment failure in adhesive small bowel obstruction has been developed.
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Affiliation(s)
- Panu Räty
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Akseli Bonsdorff
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Helka Parviainen
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eila Lantto
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Hanna Lampela
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Taina Nykänen
- Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland
| | - Ilana Lyytinen
- Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Panu Mentula
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ville Sallinen
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Zhong QH, Zhan CH, Xu WX, Cai Y, Chen S, Wang H, Tu PS, Chen XQ, Zhang JR, Hou P. A novel scoring system for better management of small bowel obstruction. Eur J Trauma Emerg Surg 2025; 51:91. [PMID: 39907751 DOI: 10.1007/s00068-024-02715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/04/2024] [Indexed: 02/06/2025]
Abstract
PURPOSE Due to the lack of a comprehensive evaluation of the prognosis of small bowel obstruction (SBO), recent clinical strategies have remained subjective and controversial. The recognition of pretreatment risk factors and tailored treatment could improve SBO outcomes. METHODS A series of posttreatment laboratory tests were integrated into a two-step clustering (TSC) analysis. The TSC outcome was determined according to different predictor importance (PI). A risk score (RS) system for the TSC outcome model was constructed by multivariable analysis. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were calculated to assess prediction accuracy. RESULTS Of the 355 patients, 66 (18.6%) were sorted into the better prognosis group (BPG), 149 (42.0%) were sorted into the poor prognosis group (PPG), and 140 (39.4%) were sorted into the severe prognosis group (SPG) by TSC analysis. For the TSC outcome, four variables with higher PI were identified, namely, Ca (PI = 1), albumin (PI = 0.62), WBC count (PI = 0.5) and NE% (PI = 0.45). Compared with the SPG, the BPG presented better outcomes after surgery events. The TSC outcome model was efficient in distinguishing the duration of bowel function recovery and hospital stay by Kaplan‒Meier curves. Via multivariate analysis, a RS consisting of four risk factors, namely, constipation duration (OR = 1.002), APTT (OR = 0.923), PT (OR = 1.449) and PCT (OR = 1.540), was identified. The AUC of the RS on the TSC outcome model was 0.719 (95% CI, 0.635-0.804). CONCLUSION A novel TSC outcome model and RS system was constructed to comprehensively reflect the tailored treatment, surgical events and posttreatment recovery for SBO patients.
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Affiliation(s)
- Qi-Hong Zhong
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Can-Hong Zhan
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Wei-Xuan Xu
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Yong Cai
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Shuai Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Hui Wang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Peng-Sheng Tu
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Xian-Qiang Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Jun-Rong Zhang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
| | - Ping Hou
- Institute of Immunotherapy, Fujian Medical University, Fuzhou, 350122, Fujian Province, China.
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Desiato E, Lucia AMA, Giudici S, Ammirabile A, Francone M, Lanza E, Del Fabbro D. Prognostic value of CT findings for conservative treatment failure in adhesive small bowel obstruction. Emerg Radiol 2025; 32:33-40. [PMID: 39073730 DOI: 10.1007/s10140-024-02276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE This study aimed to identify the radiological CT findings that are significantly correlated with the outcome of conservative management with oral water-soluble contrast medium in patients presenting with Adhesive Small Bowel Obstruction (ASBO) to the Emergency Room. METHODS In this retrospective single-center study, we considered all consecutive patients admitted to the ER from February 2019 to February 2023 for ASBO with an available contrast-enhanced CT scan performed at diagnosis and treated with conservative management. The investigated CT findings were type and location of transition zone, ASBO degree, fat notch sign, beak sign, small bowel feces sign, presence of peritoneal free fluid and pneumatosis intestinalis. Radiological parameters were analyzed using univariable and multivariable logistic regression to test the significant association between the CT parameters and the target. RESULTS Among the 106 included patients (median age 74.5 years), conservative treatment was effective in 59 (55.7%) and failed in 47 (44.3%), needing delayed surgery. In the failure group, there was a higher prevalence of patients who had previous ASBO episodes (p = 0.03), a greater proportion of females (p = 0.04) and a longer hospital stay (p < 0.001). At multivariable analysis, two CT findings were significantly correlated with failure of conservative treatment: fat notch sign (OR = 2.95; p = 0.04) and beak sign (OR = 3.42; p = 0.04). CONCLUSIONS Two radiological signs correlate with failure of non-operative management in ASBO, suggesting their importance in surgical decision-making. Patients presenting with these signs are at higher risk of unsuccessful conservative treatment and may require undelayed surgical intervention.
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Affiliation(s)
- Elena Desiato
- Department of Biomedical Science, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20090, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Ada Maria Antonella Lucia
- Department of Biomedical Science, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20090, Italy
| | - Simone Giudici
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Angela Ammirabile
- Department of Biomedical Science, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20090, Italy.
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy.
| | - Marco Francone
- Department of Biomedical Science, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20090, Italy
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Ezio Lanza
- Department of Biomedical Science, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20090, Italy
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Daniele Del Fabbro
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
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Zhu Y, Wang Q, Cao L, Zhang T, Chang J, Wang X. Development and validation of a nomogram model to predict the risk of strangulated intestinal obstruction. Sci Rep 2024; 14:31049. [PMID: 39730785 PMCID: PMC11681171 DOI: 10.1038/s41598-024-82131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 12/03/2024] [Indexed: 12/29/2024] Open
Abstract
To develop and validate a nomogram model for discriminating simple intestinal obstruction and strangulated intestinal obstruction, thus providing objective evidence for clinical decision-making. Following pre-established inclusion and exclusion criteria, a retrospective analysis was conducted on the clinical data of 560 patients diagnosed with intestinal obstruction who were admitted to the Emergency Surgery Department of the First Affiliated Hospital of Anhui Medical University between January 1, 2020, and December 31, 2022. The data was subsequently split into a training cohort (n = 393) and a validation cohort (n = 167) using a 7:3 ratio. To identify independent risk and protective factors associated with strangulated intestinal obstruction, a multivariate logistic regression analysis was employed. Based on the identified factors, a nomogram prediction model was constructed. The model's discriminatory ability was assessed using the receiver operating characteristic (ROC) curve, the area under the curve (AUC), and the corrected C-index. The Hosmer-Lemeshow test was utilized to evaluate the model's goodness of fit in both the training and validation cohorts. Calibration curves were generated to assess the model's accuracy in predicting the probability of strangulated intestinal obstruction. Finally, decision curve analysis (DCA) was performed to evaluate the model's potential clinical utility. Multivariate logistic regression analysis identified neutrophil percentage, peritoneal irritation sign, and abdominal fluid as independent risk factors for strangulated intestinal obstruction, while albumin emerged as an independent protective factor. These factors were incorporated into the nomogram, demonstrating high discrimination (AUC of 0.842[95%CI: 0.787-0.897] in the training set and 0.839 [95%CI: 0.742-0.937] in the validation set) and good calibration. The corrected C-index further supported the model's performance in the training (0.833) and validation (0.813) cohorts. The Hosmer-Lemeshow test results (p = 0.759 and p = 0.505, respectively) indicated a good model fit in both cohorts. Calibration curves confirmed the close agreement between the nomogram predictions and actual observations. Finally, DCA corroborated the model's net clinical benefit. The comprehensive nomogram developed in this study emerged as a promising and convenient tool for evaluating the risk of strangulated intestinal obstruction, thereby aiding clinicians in screening the high-risk population.
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Affiliation(s)
- Yanjing Zhu
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Qiangqiang Wang
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Lvhao Cao
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Tongyuan Zhang
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Jiawei Chang
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Xingyu Wang
- Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China.
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Wang ZZ, Liu ZK, Ma WX, Wu YH, Duan XL. Prediction of the risk of severe small bowel obstruction and effects of Houpu Paiqi mixture in patients undergoing surgery for small bowel obstruction. BMC Surg 2024; 24:63. [PMID: 38368321 PMCID: PMC10874535 DOI: 10.1186/s12893-024-02343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
AIM Small bowel obstruction is a common condition that requires emergency surgery. Slow recovery of bowel function after surgery or the occurrence of one or more complications can exacerbate the disease and result in severe small bowel obstruction (SSBO), significantly impacting recovery. It is characterized by a failure to regain enteral nutrition promptly, requiring long-term intensive care. Therefore, it is necessary to identify factors that predict SSBO, to allow early intervention for patients likely to develop this condition. METHODS Of the 260 patients who underwent emergency or elective surgery for small bowel obstruction between January 2018 and December 2022, 45 developed SSBO. The least absolute shrinkage and selection operator regression model was applied to optimize factor selection and multivariable logistic regression analysis was used to construct a predictive model. The performance and clinical utility of the nomogram were determined and internal validation was conducted. In addition, the effects of the Houpu Paiqi mixture on postoperative recovery were analyzed by comparing the clinical data of 28 patients who were treated with the mixture and 61patients who did not receive it. RESULTS The predictors included in the prediction nomogram were age, peritonitis, intestinal resection and anastomosis, complications, operation time, Acute Physiology and Chronic Health Evaluation II score, white blood cell count, and procalcitonin level. The model had an area under the receiver operating characteristic curve of 0.948 (95% confidence interval: 0.814-0.956). Decision curve analysis demonstrated that the SSBO risk nomogram had a good net clinical benefit. In addition, treatment with the Houpu Paiqi mixture reduced postoperative exhaust time, postoperative defecation time, time to first postoperative liquid feed, and length of stay in hospital. CONCLUSIONS We developed a nomogram that can assist clinicians in identifying patients at greater risk of SSBO, which may aid in early diagnosis and intervention. Additionally, we found that the Houpu Paiqi mixture promoted postoperative recovery.
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Affiliation(s)
- Ze-Zheng Wang
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, Shaanxi, 710068, China
- Yan'an University, Yan'an, 716000, China
| | - Zhe-Kui Liu
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, Shaanxi, 710068, China
| | - Wen-Xing Ma
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, Shaanxi, 710068, China
- Yan'an University, Yan'an, 716000, China
| | - Yun-Hua Wu
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, Shaanxi, 710068, China.
| | - Xiang-Long Duan
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, Shaanxi, 710068, China.
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Wei Y, Liao T, Shangguan X, Ouyang M, Chen Z, Zheng E, Lin B, Chen X. A multi-analysis of nomogram model for the identification of banded adhesions and matted adhesions in adhesive small bowel obstruction. Eur J Trauma Emerg Surg 2023; 49:2277-2285. [PMID: 37029198 DOI: 10.1007/s00068-023-02270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/02/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Preoperative diagnosis of the cause of adhesive small bowel obstruction (ASBO) is very challenging for surgeons. We aimed to develop a nomogram model for the identification of banded adhesions (BA) and matted adhesions (MA) of ASBO. METHODS This retrospective study enrolled patients with ASBO between January 2012 and December 2020, classified into BA and MA groups according to the intraoperative findings. A nomogram model was developed by using multivariable logistic regression analysis. RESULTS A total of 199 patients were included, with 117 (58.8%) cases of BA and 82 (41.2%) cases of MA. There were 150 patients designed for training the model, and the other 49 cases for validation. Multivariate logistic regression analysis showed that prior surgery for once (p = 0.008), white blood cells (WBC) (p = 0.001), beak sign (p < 0.001), fat notch sign (p = 0.013), and mesenteric haziness (p = 0.005) were independently associated with BA. The AREA under the receiver operating characteristic curve (AUC-ROC) of the nomogram model in the training and validation sets were 0.861 (95% CI 0.802-0.921) and 0.884 (95% CI 0.789-0.980), respectively. The calibration plot demonstrated a good agreement. A decision curve analysis demonstrated that the nomogram model was clinically useful. CONCLUSIONS The multi-analysis of the nomogram model might have a favorable clinical applicability for the identification of BA and MA in patients with adhesive small bowel obstruction.
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Affiliation(s)
- Yong Wei
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Tianran Liao
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Xinchang Shangguan
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Manduo Ouyang
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Zhiyong Chen
- Department of Radiology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Enshuang Zheng
- Department of Radiology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Bingqiang Lin
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Xianqiang Chen
- Department of Emergency Surgery (General Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
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Kim HR, Lee Y, Kim J, Baek TW, Kim H, Son JH, Park EJ, Kim SH. Closed loop obstruction of small bowel: CT signs predicting successful non-surgical treatment. Eur J Radiol 2023; 161:110716. [PMID: 36758277 DOI: 10.1016/j.ejrad.2023.110716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/04/2022] [Accepted: 01/24/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE To clarify the computed tomography (CT) findings related to successful conservative treatments in patients with closed-loop small bowel obstruction (CL-SBO) without evidence of bowel strangulation. METHODS Sixty-four patients (71 CT scans) diagnosed with CL-SBO by CT and received initial conservative treatments from May 2010 to August 2020 were retrospectively included. Two blinded radiologists reviewed the CT findings, including the transition zone (number, distance, and location), maximum bowel diameter, mesenteric haziness, mesenteric fluid, increased unenhanced bowel wall attenuation, decreased bowel wall enhancement, small bowel feces sign, whirl sign, bowel wall thickening, ascites, and degree of obstruction. The findings of the success and failure groups of conservative treatment were compared. Interobserver agreement was assessed for all findings. RESULTS Among the 71 cases, conservative treatments were successful in 42 cases (59 %) but failed in 29 cases (41 %). In multivariable analyses, the distance between the transition zones (>1 cm) and low-degree obstruction were independently associated with successful conservative treatments, with odds ratios of 6.23 and 3.52, respectively. The combination of these two CT findings exhibited a specificity of 89.7 % with a positive likelihood ratio of 3.01. Interobserver agreement of the degree of obstruction and the distance between the transition zones was almost perfect (ĸ = 0.814 and 0.914, respectively). CONCLUSIONS The distance between the transition zones (>1 cm) and low-grade obstruction are independent CT predictors of successful conservative treatments in CL-SBO patients. Initial conservative treatments are recommended for patients with both CT findings.
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Affiliation(s)
- Hye Ri Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Yedaun Lee
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea.
| | - Jieun Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Tae Wook Baek
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Hyunwoong Kim
- Clinical Trial Center, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Jung Hee Son
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Eun Joo Park
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Seung Ho Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
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Xu WX, Zhong QH, Cai Y, Zhan CH, Chen S, Wang H, Tu PS, Chen WX, Chen XQ, Zhang JR. Comprehensively evaluate the short outcome of small bowel obstruction: A novel medical-economic score system. World J Gastroenterol 2023; 29:1509-1522. [PMID: 36998422 PMCID: PMC10044851 DOI: 10.3748/wjg.v29.i9.1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/01/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Small bowel obstruction (SBO) still imposes a substantial burden on the health care system. Traditional evaluation systems for SBO outcomes only focus on a single element. The comprehensive evaluation of outcomes for patients with SBO remains poorly studied. Early intensive clinical care would effectively improve the short-term outcomes for SBO, however, the full spectrum of the potential risk status regarding the high complication-cost burden is undetermined.
AIM We aim to construct a novel system for the evaluation of SBO outcomes and the identification of potential risk status.
METHODS Patients who were diagnosed with SBO were enrolled and stratified into the simple SBO (SiBO) group and the strangulated SBO (StBO) group. A principal component (PC) analysis was applied for data simplification and the extraction of patient characteristics, followed by separation of the high PC score group and the low PC score group. We identified independent risk status on admission via a binary logistic regression and then constructed predictive models for worsened management outcomes. Receiver operating characteristic curves were drawn, and the areas under the curve (AUCs) were calculated to assess the effectiveness of the predictive models.
RESULTS Of the 281 patients, 45 patients (16.0%) were found to have StBO, whereas 236 patients (84.0%) had SiBO. Regarding standardized length of stay (LOS), total hospital cost and the presence of severe adverse events (SAEs), a novel principal component was extracted (PC score = 0.429 × LOS + 0.444 × total hospital cost + 0.291 × SAE). In the multivariate analysis, risk statuses related to poor results for SiBO patients, including a low lymphocyte to monocyte ratio (OR = 0.656), radiological features of a lack of small bowel feces signs (OR = 0.316) and mural thickening (OR = 1.338), were identified as risk factors. For the StBO group, higher BUN levels (OR = 1.478) and lower lymphocytes levels (OR = 0.071) were observed. The AUCs of the predictive models for poor outcomes were 0.715 (95%CI: 0.635-0.795) and 0.874 (95%CI: 0.762-0.986) for SiBO and StBO stratification, respectively.
CONCLUSION The novel PC indicator provided a comprehensive scoring system for evaluating SBO outcomes on the foundation of complication-cost burden. According to the relative risk factors, early tailored intervention would improve the short-term outcomes.
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Affiliation(s)
- Wei-Xuan Xu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Qi-Hong Zhong
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Yong Cai
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Can-Hong Zhan
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Shuai Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Hui Wang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Peng-Sheng Tu
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Wen-Xuan Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Xian-Qiang Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Jun-Rong Zhang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
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10
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Diagnostic nomogram for closed-loop small bowel obstruction requiring emergency surgery. Am J Emerg Med 2023; 63:5-11. [PMID: 36283292 DOI: 10.1016/j.ajem.2022.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 12/07/2022] Open
Abstract
PURPOSE This study aimed to build a diagnostic model of closed-loop small bowel obstruction (CL-SBO) using clinical information, blood test results, and computed tomography (CT) findings. METHODS All patients who were diagnosed with small bowel obstruction (SBO) and underwent surgery between January 1, 2018, and October 31, 2021, in the affiliated hospital of Qingdao university were reviewed, and their relevant preoperative information was collected. All variables were selected using univariate analysis and backward stepwise regression to build a diagnostic nomogram model. K-fold cross-validation and bootstrap resampling techniques were used for internal validation, and data from Qingdao Central Hospital were used for external validation. We also evaluated the diagnostic performance of each CT finding and performed subgroup analysis according to bowel ischemia in the closed-loop small bowel obstruction (CL-SBO) group. RESULTS A total of 219 patients (95 in the CL-SBO group and 124 in the open-loop small bowel obstruction [OL-SBO] group) were included in our research. D-dimers (median 1085 vs. 690, P = 0.019), tenderness (77.9% vs. 59.7%, P = 0.004), more than one beak sign (65.3% vs. 30.6%, P < 0.001), radial distribution (18.9% vs. 6.5%, P = 0.005), whirl sign (35.8% vs. 8.9%, P < 0.001), and ascites (71.6% vs. 53.2%, P = 0.006) were selected as the predictive variables of the nomogram. This model's Harrell's C statistic was 0.786 (95% confidence interval (CI), 0.724-0.848), and the Brier score was 0.182. The Harrell's C statistic of external validation was 0.784 (95%CI, 0.664-0.905); the Brier score was 0.190. Regarding the CT findings, radial distribution, U/C-shaped loop, and whirl sign had high specificity (93.5%, 96.0%, and 91.1%, respectively), but low sensitivity (18.9%, 8.4%, and 35.8%, respectively). D-dimer levels and tenderness were also associated with bowel ischemia. CONCLUSION The nomogram accurately predicted CL-SBO in patients with SBO, and surgery should be considered when patients have a high risk for developing CL-SBO.
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11
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The value of MSCT in evaluating the passability of bezoar by conservative treatment for bezoars-induced small bowel obstruction. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:236-243. [PMID: 36242605 DOI: 10.1007/s00261-022-03700-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To explore the multi-slice spiral computed tomography (MSCT) imaging characteristics of patients with bezoars-induced small bowel obstruction (BI-SBO) to evaluate the risk of conservative treatment. MATERIALS AND METHODS This retrospective study included 72 patients with BI-SBO who underwent whole-abdominal MSCT scan within 1 day before treatment. The patients were classified as the non-pass group and pass group depending on whether bezoar can pass after conservative treatment. The CT images were observed and measured by two radiologists. Statistical analysis was performed by using Student's t test, Pearson's chi-squared test, Fisher's exact test, Logistic linear regression, and receiver operating characteristic curve (ROC). RESULTS The study population consisted of 72 patients with a mean age of 52.2 ± 16.2 years (32 men and 40 women with an age range of 13-81 years). There were statistical differences between the two groups in the bezoar appearance, maximum HU of bezoar, thickness of intestinal wall, mesenteric haziness, mesenteric fluid, and peritoneal fluid (P = 0.002, 0.024, 0.017, 0.006, 0.021, and 0.030). The appearance of bezoar and mesenteric haziness is independent risk factors affecting whether bezoar can be passed by the conservative treatment. Sensitivity (41.7%) was decreased, NPV (76.3%) was not significantly changed, specificity (93.8%) and PPV (76.9%) were improved when both parameters were met to assess failure of conservative treatment. CONCLUSION The observation of important signs by MSCT and its reconstruction technology is of great clinical value in evaluating the passability of bezoar by conservative treatment, and which can provide radiographic basis for clinical treatment selection.
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12
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Liu M, Cheng F, Liu X, Zheng B, Wang F, Qin C, Ding G, Fu T, Geng L. Diagnosis and surgical management strategy for pediatric small bowel obstruction: Experience from a single medical center. Front Surg 2023; 10:1043470. [PMID: 36896265 PMCID: PMC9989272 DOI: 10.3389/fsurg.2023.1043470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023] Open
Abstract
Identifying Bowel strangulation and the approach and timing of surgical intervention for pediatric SBO are still uncertain. In this study, 75 consecutive pediatric patients with surgically confirmed SBO were retrospectively reviewed. The patients were divided into group 1 (n = 48) and group 2 (n = 27) according to the presence of reversible or irreversible bowel ischemia, which was analyzed based on the degree of ischemia at the time of operation. The results demonstrated that the proportion of patients with no prior abdominopelvic surgery was higher, the serum albumin level was lower, and the proportion of patients in which ascites were detected by ultrasonography was higher in group 2 than that in group 1. The serum albumin level was negatively correlated with ultrasonographic findings of the fluid sonolucent area in group 2. There were significant differences in the choice of surgical approach between group 1 and group 2. A symptom duration of >48 h was associated with an increased bowel resection rate. The mean length of hospital stay was shorter in group 1 than that in group 2. In conclusion, immediate surgical intervention should be considered in patients with a symptom duration of >48 h or the presence of free ascites between dilated small bowel loops on ultrasonography. Laparoscopic exploration is recommended as first-line treatment in patients with stable status.
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Affiliation(s)
- Mingzhu Liu
- Binzhou Medical University Hospital, Binzhou, China
| | | | - Xijie Liu
- Binzhou Medical University Hospital, Binzhou, China
| | - Bufeng Zheng
- Binzhou Medical University Hospital, Binzhou, China
| | - Feifei Wang
- Binzhou Medical University Hospital, Binzhou, China
| | - Chengwei Qin
- Binzhou Medical University Hospital, Binzhou, China
| | - Guojian Ding
- Binzhou Medical University Hospital, Binzhou, China
| | - Tingliang Fu
- Binzhou Medical University Hospital, Binzhou, China
| | - Lei Geng
- Binzhou Medical University Hospital, Binzhou, China
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13
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Chen B, Sheng WY, Ma BQ, Mei BS, Xiao T, Zhang JX. Progress in diagnosis and treatment of surgery-related adhesive small intestinal obstruction. Shijie Huaren Xiaohua Zazhi 2022; 30:1016-1023. [DOI: 10.11569/wcjd.v30.i23.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
Adhesive small bowel obstruction is a relatively common surgical acute abdomen, which is caused by various factors that result in the contents of the small bowel failing to pass smoothly. The clinical symptoms include abdominal pain, distension, nausea and vomiting, and defecation disorder. The chance of adhesive small bowel obstruction to develop in patients with a history of abdominal surgery is around 2.4%. This paper discusses the most recent developments in the conservative and surgical management of adhesive small bowel obstruction based on clinical manifestation, laboratory analysis, and imaging examination.
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Affiliation(s)
- Biao Chen
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Wei-Yong Sheng
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Bing-Qing Ma
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Bo-Sheng Mei
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Tian Xiao
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Jin-Xiang Zhang
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Olausson M, Aerenlund MP, Azzam M, Bjerke T, Burcharth JFH, Dibbern CB, Jensen TK, Jordhøj JQ, Lolle I, Ngo-Stuyt L, Nielsen EØ, Nielsen LBJ, Skovsen AP, Tolver MA, Smith HG. Management and short-term outcomes of patients with small bowel obstruction in Denmark: a multicentre prospective cohort study. Eur J Trauma Emerg Surg 2022; 49:1121-1130. [PMID: 36357790 PMCID: PMC9648885 DOI: 10.1007/s00068-022-02171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022]
Abstract
AIMS The optimal management of small bowel obstruction (SBO) remains a matter of debate and treatment varies internationally. In Denmark, a more surgically aggressive strategy has traditionally been used, but to what extent patient outcomes differ from international reports is unknown. This study aimed to describe the current management and outcomes of patients admitted with SBO in Denmark. METHODS This was a prospective cohort study conducted at six acute hospitals in Denmark over a 4-month period. Patients aged ≥ 18 years with a clinical or radiological diagnosis of SBO were eligible. Primary outcomes were 30 day morbidity and mortality rates. RESULTS 316 patients were included during the study period. The median age was 72 years and 56% were female. Diagnosis was made by computed tomography (CT) in 313 patients (99.1%), with the remaining three diagnosed clinically. Non-operative management was the initial strategy in 152 patients (48.1%) and successful in 119 (78.3%). Urgent surgery was performed in the remaining 164 (51.9%), with a laparoscopic approach used in 84 patients (51.2%). The entire cohort had a 30 day mortality rate of 7.3% and a 30 day morbidity rate of 17.1%. CONCLUSIONS The management of SBO in Denmark differs markedly to previous international reports, with an almost ubiquitous use of CT for diagnosis and a high proportion of patients undergoing urgent surgery. Despite higher rates of surgery, patient outcomes are broadly similar to reports of more conservative strategies, perhaps due to a reduction in delayed operations. TRIAL REGISTRATION Trial registration number: NCT04750811. Trial registration date: 11/02/2021.
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Affiliation(s)
- M Olausson
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - M P Aerenlund
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Azzam
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - T Bjerke
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J F H Burcharth
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C B Dibbern
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T K Jensen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Q Jordhøj
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - I Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L Ngo-Stuyt
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - E Ø Nielsen
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L B J Nielsen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M A Tolver
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - H G Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
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Tam AJY, Ahmad SB, Yong C. A timely reminder that prognostication with Gastrograffin is not recommended with closed loop bowel obstruction. ANZ J Surg 2022; 92:3116. [DOI: 10.1111/ans.17958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022]
Affiliation(s)
| | - Saad Bilal Ahmad
- Department of Surgery Maroondah Hospital Melbourne Victoria Australia
| | - Charles Yong
- Department of Surgery Maroondah Hospital Melbourne Victoria Australia
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16
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Does Amount of Intra-abdominal Fluid on CT May Predict Failure of Non-operative Management in Patients with Small Bowel Obstruction? Indian J Surg 2022. [DOI: 10.1007/s12262-021-03052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1980371. [PMID: 35935303 PMCID: PMC9325346 DOI: 10.1155/2022/1980371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Abstract
We aimed to analyze the computed tomography (CT) imaging signs of bowel wall ischemia in patients with acute intestinal obstruction and construct an imaging prediction model to guide clinical treatment. The CT imaging signs of patients with acute intestinal obstruction diagnosed in our center in recent 6 years were collected for retrospective analysis. The etiology of intestinal obstruction and incidence rate of bowel wall ischemia were recorded, and the specific CT findings of bowel wall ischemia, including mesenteric edema, bowel wall thickening, and fish tooth sign, were analyzed. Among the 302 patients selected, 130 surgically treated patients were eligible for analysis. Bowel wall ischemia in acute intestinal obstruction showed an incidence rate of 14.90%, and the incidence rates of bowel wall ischemia in intra-abdominal hernia, intussusception, incarcerated external abdominal hernia, and volvulus were about 92.30%, 50%, 35.71%, 33.33%, and 12.59%, respectively. The incidence rate of bowel wall ischemia in simple adhesive intestinal obstruction was about 12.59%, and that in malignancy-induced intestinal obstruction was about 6.56%. Univariate analysis revealed 5 factors with statistical significance, including bowel wall thickening, mesenteric edema, bowel wall pneumatosis, ascites, and fish tooth sign. Multivariate logistic regression analysis indicated that fish tooth sign, bowel wall thickening, and mesenteric edema were able to predict bowel wall ischemia, and the corresponding partial regression coefficients were 2.164, 1.129, and 1.173, odds ratios (ORs) were 8.707, 3.093, and 3.232, sensitivity was 0.356, 0.400, and 0.844, and specificity was 0.859, 0.835, and 0.529, respectively. Imaging signs of bowel wall thickening, mesenteric edema, and fish tooth sign are valuable in predicting bowel wall ischemia, among which bowel wall thickening and mesenteric edema have relatively high specificity and fish tooth sign has a relatively high sensitivity. Furthermore, a fish tooth sign has the most favorable predictive value for bowel wall ischemia in acute intestinal obstruction, followed by bowel wall thickening and mesenteric edema.
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18
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Toneman MK, de Kok BM, Zijta FM, Oei S, van Acker GJD, Westerterp M, van der Pool AEM. Predicting the outcome of closed-loop small bowel obstruction by preoperative characteristics. World J Gastrointest Surg 2022; 14:556-566. [PMID: 35979424 PMCID: PMC9258239 DOI: 10.4240/wjgs.v14.i6.556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/24/2021] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Closed-loop small bowel obstruction (CL-SBO) can threaten the viability of the intestine by obstructing a bowel segment at two adjacent points. Prompt recognition and surgery are crucial.
AIM To analyze the outcomes of patients who underwent surgery for CL-SBO and to evaluate clinical predictors.
METHODS Patients who underwent surgery for suspected CL-BSO on computed tomography (CT) at a single center between 2013 and 2019 were evaluated retrospectively. Patients were divided into three groups by perioperative outcome, including viable bowel, reversible ischemia, and irreversible ischemia. Clinical and laboratorial variables at presentation were compared and postoperative outcomes were analyzed.
RESULTS Of 148 patients with CL-SBO, 28 (19%) had a perioperative viable small bowel, 86 (58%) had reversible ischemia, and 34 (23%) had irreversible ischemia. Patients with a higher age had higher risk for perioperative irreversible ischemia [odds ratio (OR): 1.03, 95% confidence interval (CI): 0.99-1.06]. Patients with American Society of Anaesthesiologists (ASA) classification ≥ 3 had higher risk of perioperative irreversible ischemia compared to lower ASA classifications (OR: 3.76, 95%CI: 1.31-10.81). Eighty-six patients (58%) did not have elevated C-reactive protein (> 10 mg/L), and between-group differences were insignificant. Postoperative in-hospital stay was significantly longer for patients with irreversible ischemia (median 8 d, P = 0.001) than for those with reversible ischemia (median 6 d) or a viable bowel (median 5 d). Postoperative morbidity was significantly higher in patients with perioperative irreversible ischemia (45%, P = 0.043) compared with reversible ischemia (20%) and viable bowel (4%).
CONCLUSION Older patients or those with higher ASA classification had an increased risk of irreversible ischemia in case of CL-SBO. After irreversible ischemia, postoperative morbidity was increased.
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Affiliation(s)
- Masja K Toneman
- Department of Surgery, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
| | - Bente M de Kok
- Department of Radiology, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
| | - Frank M Zijta
- Department of Radiology, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
| | - Stanley Oei
- Department of Radiology, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
| | - Gijs J D van Acker
- Department of Surgery, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
| | - Marinke Westerterp
- Department of Surgery, Haaglanden Medical Centre, The Hague 2512 VA, Netherlands
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Xu WX, Zhong QH, Cai Y, Zhan CH, Chen S, Wang H, Lin L, Geng YQ, Hou P, Chen XQ, Zhang JR. Prediction and management of strangulated bowel obstruction: a multi-dimensional model analysis. BMC Gastroenterol 2022; 22:304. [PMID: 35733109 PMCID: PMC9219133 DOI: 10.1186/s12876-022-02363-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Distinguishing strangulated bowel obstruction (StBO) from simple bowel obstruction (SiBO) still poses a challenge for emergency surgeons. We aimed to construct a predictive model that could distinctly discriminate StBO from SiBO based on the degree of bowel ischemia. METHODS The patients diagnosed with intestinal obstruction were enrolled and divided into SiBO group and StBO group. Binary logistic regression was applied to identify independent risk factors, and then predictive models based on radiological and multi-dimensional models were constructed. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were calculated to assess the accuracy of the predicted models. Via stratification analysis, we validated the multi-dimensional model in the prediction of transmural necrosis both in the training set and validation set. RESULTS Of the 281 patients with SBO, 45 (16.0%) were found to have StBO, while 236(84.0%) with SiBO. The AUC of the radiological model was 0.706 (95%CI, 0.617-0.795). In the multivariate analysis, seven risk factors including pain duration ≤ 3 days (OR = 3.775), rebound tenderness (OR = 5.201), low-to-absent bowel sounds (OR = 5.006), low levels of potassium (OR = 3.696) and sodium (OR = 3.753), high levels of BUN (OR = 4.349), high radiological score (OR = 11.264) were identified. The AUC of the multi-dimensional model was 0.857(95%CI, 0.793-0.920). In the stratification analysis, the proportion of patients with transmural necrosis was significantly greater in the high-risk group (24%) than in the medium-risk group (3%). No transmural necrosis was found in the low-risk group. The AUC of the validation set was 0.910 (95%CI, 0.843-0.976). None of patients in the low-risk and medium-risk score group suffered with StBO. However, all patients with bowel ischemia (12%) and necrosis (24%) were resorted into high-risk score group. CONCLUSION The novel multi-dimensional model offers a useful tool for predicting StBO. Clinical management could be performed according to the multivariate score.
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Affiliation(s)
- Wei-Xuan Xu
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Qi-Hong Zhong
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Yong Cai
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Can-Hong Zhan
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Shuai Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Hui Wang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Lin Lin
- Department of Radiology, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Ying-Qian Geng
- Department of Radiology, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Ping Hou
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China.,Immunotherapy Institute, Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Xian-Qiang Chen
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China. .,Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
| | - Jun-Rong Zhang
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China. .,Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
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Yamamoto Y, Kitazawa M, Otsubo T, Miyagawa Y, Tokumaru S, Nakamura S, Koyama M, Ehara T, Hondo N, Iijima Y, Soejima Y. Comparison of Clinical Outcomes and Safety Between Open and Laparoscopic Surgery for Adhesive Small Bowel Obstruction: A Propensity-Matched Analysis of a National Inpatient Database. J Laparoendosc Adv Surg Tech A 2022; 32:1064-1070. [PMID: 35446138 DOI: 10.1089/lap.2022.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The effectiveness of laparoscopic surgery for adhesive small bowel obstruction (ASBO) remains unclear. We aimed to compare the outcomes and safety of open and laparoscopic surgeries for ASBO. Methods: In this retrospective study, we analyzed an inpatient database of 42 national university hospitals in Japan. Patients who underwent surgery for the first episode of ASBO between April 2013 and March 2018 were identified. Using the propensity score method, patients who underwent laparoscopic surgery were matched one-to-one with those who underwent open surgery. We investigated postoperative clinical outcomes, including morbidity, mortality, length of hospital stay (LOS), and recurrence. Results: Overall, 306 and 96 patients underwent open and laparoscopic surgery, respectively (96 propensity score-matched pairs). The incidence rates of postoperative morbidity, mortality, and recurrence were comparable between the two groups. Cox regression analysis revealed a hazard ratio (HR) of 1.020 (P = .959) for readmission due to ASBO in the laparoscopic surgery group relative to the open surgery group. Postoperative hospital stay was longer for open surgery than for laparoscopic surgery (13.0 days versus 10.0 days, P < .001). Cox regression analysis revealed that laparoscopic surgery was associated with earlier postoperative discharge compared with open surgery (HR 1.641, P = .002). Conclusions: The postoperative LOS was shorter with laparoscopic surgery than with open surgery for ASBO, but there were no differences between the procedures in other clinical outcomes. Laparoscopic surgery is suitable to treat patients with ASBO.
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Affiliation(s)
- Yuta Yamamoto
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
| | - Masato Kitazawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
| | - Tetsuya Otsubo
- The Database Center of the National University Hospitals, The University of Tokyo Hospital, Tokyo, Japan.,Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Yusuke Miyagawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
| | - Shigeo Tokumaru
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
| | - Satoshi Nakamura
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
| | - Makoto Koyama
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
| | - Takehito Ehara
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
| | - Nao Hondo
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
| | - Yasuhiro Iijima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
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21
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Rosano N, Gallo L, Mercogliano G, Quassone P, Picascia O, Catalano M, Pesce A, Fiorini V, Pelella I, Vespere G, Romano M, Tammaro P, Marra E, Oliva G, Lugarà M, Scuderi M, Tamburrini S, Marano I. Ultrasound of Small Bowel Obstruction: A Pictorial Review. Diagnostics (Basel) 2021; 11:diagnostics11040617. [PMID: 33808245 PMCID: PMC8065936 DOI: 10.3390/diagnostics11040617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 12/29/2022] Open
Abstract
Small bowel obstruction (SBO) is a common condition requiring urgent attention that may involve surgical treatment. Imaging is essential for the diagnosis and characterization of SBO because the clinical presentation and results of laboratory tests may be nonspecific. Ultrasound is an excellent initial imaging modality for assisting physicians in the rapid and accurate diagnosis of a variety of pathologies to expedite management. In the case of SBO diagnosis, ultrasound has an overall sensitivity of 92% (95% CI: 89–95%) and specificity of 93% (95% CI: 85–97%); the aim of this review is to examine the criteria for the diagnosis of SBO by ultrasound, which can be divided into diagnostic and staging criteria. The diagnostic criteria include the presence of dilated loops and abnormal peristalsis, while the staging criteria are represented by parietal and valvulae conniventes alterations and by the presence of free extraluminal fluid. Ultrasound has reasonably high accuracy compared to computed tomography (CT) scanning and may substantially decrease the time to diagnosis; moreover, ultrasound is also widely used in the monitoring and follow-up of patients undergoing conservative treatment, allowing the assessment of loop distension and the resumption of peristalsis.
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Affiliation(s)
- Nicola Rosano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
- Correspondence: (N.R.); (S.T.)
| | - Luigi Gallo
- Department of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (L.G.); (P.Q.); (O.P.)
| | - Giuseppe Mercogliano
- Department of Radiology, University of Naples “Federico II”, 80131 Napoli, Italy;
| | - Pasquale Quassone
- Department of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (L.G.); (P.Q.); (O.P.)
| | - Ornella Picascia
- Department of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (L.G.); (P.Q.); (O.P.)
| | - Marco Catalano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
| | - Antonella Pesce
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
| | - Valeria Fiorini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
| | - Ida Pelella
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
| | - Giuliana Vespere
- Department of Gastroenterology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy;
| | - Marina Romano
- Department of Surgery, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.R.); (P.T.)
| | - Pasquale Tammaro
- Department of Surgery, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.R.); (P.T.)
| | - Ester Marra
- Department of Surgery, University of Naples “Federico II”, 80131 Napoli, Italy;
| | - Gabriella Oliva
- Department of Internal Medicine, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (G.O.); (M.L.)
| | - Marina Lugarà
- Department of Internal Medicine, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (G.O.); (M.L.)
| | - Mario Scuderi
- Department of Emergency A.O.E. Cannizzaro, 95126 Catania, Italy;
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
- Correspondence: (N.R.); (S.T.)
| | - Ines Marano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
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