CT Features Predicting Failure of Conservative Treatment in Patients with Small Bowel Obstruction due to Adhesion without Evidence of Bowel Strangulation
Keywords:
Small bowel obstruction, conservative treatment, computed tomographyAbstract
Abstract
Objective: To determine CT features that predict failure of conservative treatment in patients with small bowel obstruction (SBO) due to adhesion without evidence of bowel strangulation.
Method: A retrospective review was performed. Patients diagnosed with SBO due to adhesion and underwent CT of the whole abdomen in Phra Nakhon Si Ayutthaya between June 2018 to June 2022 were enrolled. There were 107 patients with SBO due to adhesion who met our inclusion criteria. Medical records were reviewed. CT features were reviewed by one radiologist. The CT features were analyzed using multivariable logistic regression.
Results: There were 107 patients with SBO due to adhesion who met our inclusion criteria. The average age was 51.2 years (S.D. =20.8). The most frequent symptoms were abdominal pain (93.5%) and vomiting (62.6%). There are 55 patients (51.4 %) who failed respond to conservative treatment. There are 52 patients (48.6 %) who succeed with conservative treatment. Using multivariate logistic analysis, those patients had two significant CT features, mesenteric fat haziness (OR 0.5, 95%CI 0.3-0.8) and diameter of maximal small bowel dilatation (OR 0.5, 95%CI 0.3-0.9).
Conclusions: Mesenteric fat haziness and diameter of maximal small bowel dilatation are CT features associated with failed response to conservative treatment in patients with small bowel obstruction (SBO) due to adhesion without evidence of bowel strangulation.
Keywords: Small bowel obstruction, conservative treatment, computed tomography
References
Paulson EK, Thompson WM. Review of Small-bowel obstruction: The Diagnosis and When to Worry. RSNA 2015;275:332-42.
Rubesin SE, Gore RM. Small bowel obstruction. In: Gore RM, Levine MS, eds. Textbook of gastrointestinal radiology. 3rd ed. Vol 1. Philadelphia, Pa: Saunders Elsevier, 2008;871-99.
Jeffrey RB. Small bowel obstruction. In: Federle MP, Jeffrey RB, Woodward PJ, Borhani AA, eds. Diagnostic imaging: abdomen, 5nd ed. Salt Lake City, Utah: Amirsys, 2010;44-7.
Miller G, Boman J, Shrier I, Gordon PH. Etiology of small bowel obstruction. Am J Surg 2000;180(1):33-6.
Maglinte DD, Reyes BL, Harmon BH, et al. Reliability and role of film radiography and CT in the diagnosis of small bowel obstruction. AJR Am J Roentgenol 1996;167(6):1451-5.
Maglinte DD, Kelvin FM, Rowe MG, Bender GN, Rouch DM. Small-bowel obstruction: optimizing radiologic investigation and non-surgical management. Radiology 2001;218(1):39-46.
Maglinte DD, Heitkamp DE, Howard TJ, Kelvin FM, Lappas JC. Current concepts in imaging of small bowel obstruction. Radiol Clin North Am 2003;41(2):263-83.
Hwan JY, Lee JK, Lee JE, Back Sy. Value of multidetector CT in decision marking regarding surgery in patients with small-bowel obstruction due to adhesion. Eur Radiol 2009;19:2425-31.
Jone K, Mangram AJ, Lebron RA, Nadalo L, Dunn E. Can a computed tomography scoring system predict the need for surgery in small-bowel obstruction? Am J surg 2007;194:780-3.
Taourel PG, Fabre JM, Pradel JA, Seneterre EJ, Megibow AJ, et al. Value of CT in the diagnosis and management of patients with suspected acute small-bowel obstruction. Am J Roentgenol 1995;165:1187-92.
Chang WC, Ko KH, Lin CS, Hsu HH, Tsai SH, Fan HJ, et al. Features on MDCT That Predict Surgery in Patients with Adhesive-Related Small bowel obstruction, PLoS ONE 2014;9;e89804.
Foster NM, MCGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg 2006;203:170-6.
Petrovic B, Nikoliaidis P, Hammond NA, Grant TH, Miller FH. Identification of adhesions on CT in small-bowel obstruction. Emerg Radio 2006;12:88-93.
Silva AC, Pimenta M, Guimares LS. Small bowel obstruction: what to look for Radiograhics 2009;29:423-39.
Kim J, Lee Y, Yoon JH, Lee HJ, Lim YJ, Yi J, et al. Non-strangulated adhesive small bowel obstruction: CT findings predicting outcome of conservative treatment. European Radiology 2021;31:1597-1607.
McEntee G, Pender G, Mulvin D, et al. Current spectrum of intestinal obstruction. Br J Surg 1987;74:976-980.
Mosley JG, Shoaib A. Operative versus conservative management of adhesional intestinal obstruction. Br J Surg 2000;87:368.
Fevang BT, Fevang JM, Soreide O, Svanes K, Viste A. Delay in operative treatment amount patients with small bowel obstruction. Scand J Surg 2003;92:131-7.
Bender JS, Busuito MJ, Graham C, Allaben RD. Small bowel obstruction in the elderly. Am Surg 1989;55:385-8.
Miller I, Ruyer A, Alili C. et al. Adhesive small-bowel obstruction: value of CT in identifying findings associated with the effectiveness of nonsurgical treatment. Radiology 2014;273:425-32.
Komatsu I, Tokuda Y, Shimuda G, Jacobs JL, Onodera H. Development of a simple model for predicting need for surgery in patients who initially undergo conservative management for adhesive small bowel obstruction. Am J Surg 2010;200:212-23.
Deshmukh SD, Shin DS, Willmann JK, Rosenberg J, Shin L, Jeffrey RB. Non-emergency small bowel obstruction: assessment of CT findings that predict need for surgery. Eur Radiol. 2011;21:982-6.
Zielinski MD, Eliken PW, Bannon MP, et al. Small bowel obstruction-who needs an operation? World J Surg 2010;34:910-9.
Pricolo VE, Curley F. CT scan findings do not predict outcome of nonoperative management in small bowel obstruction: retrospective analysis of 108 conservative patients. Int J Surg 2016;27:88-91.
Zielinski MD, EIken PW, Bannon MP, Heller SF, Lohse CM, Huebner M, et al. Small bowel obstruction-who needs and operation? A multivariate prediction model. World J Surg 2010:34(5):910-9.
Zielinski MD, EIken PW, Heller SF, Lohse CM, Huebner M, Sarr MG, et al. Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. J Am Coll Surg 2011;212(6):1068-76
Lazarus DE, Slywotsky C, Bennett GL, Megibow AJ, Macari M. Frequency and relevance of the small-bowe feces sign on CT in patients with small-bowel obstruction. Am J Roentgenol 2004;183:1361-6.
Millet I, Boutot D, Faget C, et al. Assessment of strangulation in adhesive small bowel obstruction on the basis of combined CT findings: implications for clinical care. Radiology 2017;285:798-808.
Scrima A, Lubner MG, King S, Pankratz J, Kennerdy G, Pickhardt PJ. Value of MDCT and clinical and labarotory data for predicting the need for surgical intervention in suspected small bowel obstruction. AJR Am J Roentgenol 2017;208:785-93.
Makar RA, Nashir MR, Haystead CM, et al. Diagnostic performance of MDCT in identifying closed loop small bowel obstruction. Abdom Radiol(NY) 2016:41(7):1253-2560.
Rondenet C, Millet I, Corno L et al. CT diagnosis of closed loop bowel obstruction mechanism is not sufficient to indicate emergent surgery. Eur Radio 2020;30:1105-12.
Downloads
Published
Versions
- 2023-05-03 (2)
- 2023-04-24 (1)
How to Cite
Issue
Section
License
Copyright (c) 2023 Region 3 Medical and Public Health Journal - วารสารวิชาการแพทย์และสาธารณสุข เขตสุขภาพที่ 3
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
