Ng ZQ, Hsu V, Tee WWH, Tan JH, Wijesuriya R. Predictors for success of non-operative management of adhesive small bowel obstruction. World J Gastrointest Surg 2023; 15(6): 1116-1124 [PMID: 37405103 DOI: 10.4240/wjgs.v15.i6.1116]
Corresponding Author of This Article
Zi Qin Ng, MBBS (Hons), FRACS Senior Researcher, Surgeon, Department of General Surgery, St John of God Midland Hospital, 1 Clayton Street, Midland 6056, Western Australia, Australia. kentng@hotmail.co.uk
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
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/
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1116-1124 Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1116
Predictors for success of non-operative management of adhesive small bowel obstruction
Zi Qin Ng, Vivien Hsu, William Wei Han Tee, Jih Huei Tan, Ruwan Wijesuriya
Zi Qin Ng, Vivien Hsu, Ruwan Wijesuriya, Department of General Surgery, St John of God Midland Hospital, Midland 6056, Western Australia, Australia
William Wei Han Tee, Department of Radiology, St John of God Midland Hospital, Midland 6056, Western Australia, Australia
Jih Huei Tan, Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru 80000, Johor, Malaysia
Author contributions: Ng ZQ contributed to the data analysis and drafting of manuscript; Hsu V collected the data; Tee WWH collected the radiological data collection, review of manuscript; Tan JH contributed to the statistical data analysis; Hsu V, Tee WWH, and Tan JH involved in the review of the manuscript; Ng ZQ and Wijesuriya R designed the study; Wijesuriya R contributed to critical review of manuscript and supervision of study; and all authors approved the final version of this manuscript for submission and publication.
Institutional review board statement: Ethical approval was obtained from the St John of God Healthcare’s ethics committee (Ref: 1358).
Informed consent statement: The consent was waived from the institute’s ethics committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. Dr Zi Qin Ng received the General Surgeons Australia Junior Doctor Research Grant in 2018 for this study.
Data sharing statement: Data is available upon reasonable request grounds.
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: Zi Qin Ng, MBBS (Hons), FRACS Senior Researcher, Surgeon, Department of General Surgery, St John of God Midland Hospital, 1 Clayton Street, Midland 6056, Western Australia, Australia. kentng@hotmail.co.uk
Received: December 27, 2022 Peer-review started: December 27, 2022 First decision: January 20, 2023 Revised: January 21, 2023 Accepted: April 13, 2023 Article in press: April 13, 2023 Published online: June 27, 2023 Processing time: 170 Days and 4.8 Hours
Abstract
BACKGROUND
Majority of adhesive small bowel obstruction (SBO) cases can be managed non-operatively. However, a proportion of patients failed non-operative management.
AIM
To evaluate the predictors of successful non-operative management in adhesive SBO.
METHODS
A retrospective study was performed for all consecutive cases of adhesive SBO from November 2015 to May 2018. Data collated included basic demographics, clinical presentation, biochemistry and imaging results and management outcomes. The imaging studies were independently analyzed by a radiologist who was blinded to the clinical outcomes. The patients were divided into group A operative (including those that failed initial non-operative management) and group B non-operative for analysis.
RESULTS
Of 252 patients were included in the final analysis; group A (n = 90) (35.7%) and group B (n = 162) (64.3%). There were no differences in the clinical features between both groups. Laboratory tests of inflammatory markers and lactate levels were similar in both groups. From the imaging findings, the presence of a definitive transition point [odds ratio (OR) = 2.67, 95% confidence interval (CI): 0.98-7.32, P = 0.048], presence of free fluid (OR = 2.11, 95%CI: 1.15-3.89, P = 0.015) and absence of small bowel faecal signs (OR = 1.70, 95%CI: 1.01-2.88, P = 0.047) were predictive of the need of surgical intervention. In patients that received water soluble contrast medium, the evidence of contrast in colon was 3.83 times predictive of successful non-operative management (95%CI: 1.79-8.21, P = 0.001).
CONCLUSION
The computed tomography findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.
Core Tip: Adhesive small bowel obstruction (SBO) is a common acute surgical presentation. Majority of the cases can be managed successfully with non-operative management. The findings on computed tomography abdomen/pelvis are useful in predicting patients that are unlikely to resolve with conservative management for adhesive SBO and therefore guide decision-making in early surgical intervention to prevent morbidities associated with it.
