Pavlidis ET, Pavlidis TE. Prediction factors for ischemia of closed-loop small intestinal obstruction. World J Gastrointest Surg 2022; 14(9): 1086-1088 [PMID: 36185555 DOI: 10.4240/wjgs.v14.i9.1086]
Corresponding Author of This Article
Theodoros Efstathios Pavlidis, Doctor, PhD, Chief Doctor, Full Professor, Surgeon, The Second Propedeutic Department of Surgery, Hippocration Hospital, Aristotle University of Thessaloniki, School of Medicine, Konstantinoupoleos 49, Thessaloniki 54642, Greece. pavlidth@auth.gr
Research Domain of This Article
Surgery
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Efstathios Theodoros Pavlidis, Theodoros Efstathios Pavlidis, The Second Propedeutic Department of Surgery, Hippocration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54642, Greece
Author contributions: Pavlidis TE designed research, analyzed data and revised the paper; Pavlidis ET performed research, analyzed data and wrote the paper.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Theodoros Efstathios Pavlidis, Doctor, PhD, Chief Doctor, Full Professor, Surgeon, The Second Propedeutic Department of Surgery, Hippocration Hospital, Aristotle University of Thessaloniki, School of Medicine, Konstantinoupoleos 49, Thessaloniki 54642, Greece. pavlidth@auth.gr
Received: July 21, 2022 Peer-review started: July 21, 2022 First decision: August 7, 2022 Revised: August 8, 2022 Accepted: September 2, 2022 Article in press: September 2, 2022 Published online: September 27, 2022 Processing time: 62 Days and 22.5 Hours
Abstract
A closed-loop type of intestinal obstruction leads to ischemic necrosis. There have been indicators that may predict ischemia and its severity, such as biomarkers and computed tomography scans. In addition to the usual inflammation markers, such as white blood count-neutrophil count and c-reactive protein (CRP), the most accurate predictors that have been proposed are the CRP-to-albumin ratio, the neutrophil/lymphocyte ratio and the platelet/lymphocyte ratio. Endothelin 1 is another promising biomarker of ischemia that must be assessed in daily clinical practice. Advanced age and frailty status were assessed as predictors of mortality. A timely operative procedure without any delay ensures a better outcome.
Core Tip: Early recognition of closed loops is important to interrupt ongoing ischemia by prompt surgical intervention, especially for older age patients. In such a case, we achieve avoidance of bowel necrosis and enterectomy as well as septic complications, which ultimately resulted in an improved outcome. Endothelin 1, c-reactive protein and leukocyte-neutrophil count must be more often used in daily practice as a severity marker of small bowel ischemia.
