Clinical factors associated with intestinal strangulating obstruction and recurrence in adhesive small bowel obstruction

Abstract

Postoperative adhesions are a common cause of adhesive small bowel obstruction (ASBO), and recognition of intestinal strangulation is important. The aim of this study is to analyze the clinical factors for strangulating obstruction and to identify the predictors for recurrence of ASBO.A retrospective study was conducted using the database in our department. Patients with ASBO from January 2013 to April 2016 were included in the study and were subject to follow-up. The clinical factors associated with strangulating obstruction and recurrence after treatment were analyzed by using univariate and multivariate logistic regression model.In total, 288 ASBO patients were included in the study. Of these, 37 (12.9%) patients had occurred strangulating obstructions, and 251 (87.1%) patients had simple obstructions. Four clinical parameters, including increasing heart rate (>100 bpm), increasing WBC count (>15 × 109/L), CT findings of thickening or swelling of the mesentery, and CT showing seroperitoneum were detected as independent clinical factors for intestinal strangulation. Eighty-four (29.2%) patients experienced recurrence of obstruction during the median 24 months of follow-up. Recurrence rates were reduced in patients who underwent surgical treatment compared with those who received conservative management [21.3% (26/122) vs 34.9% (58/166) (P = .010)]. Nevertheless, the recurrence rates were not significantly increased in patients with strangulating obstructions compared with those with simple ASBO [34.3% (12/35) vs 27.7% (72/253) (P = .186)].Four clinical parameters including tachycardia, leukocytosis, along with CT findings of thickening or swelling of the mesentery and CT showing seroperitoneum, associated with occurrence of intestinal strangulation in ASBO. ASBO patients who underwent surgical treatment had a reduced recurrence rate, but ASBO patients with strangulating obstructions had not increase the recurrence rates than those of patients with simple ASBO.

Prediction model for irreversible intestinal ischemia in strangulated bowel obstruction

“…Systemic inflammatory response syndrome is reportedly associated with SBO [6,[8][9][10][11][12]. Particularly, only high WBC counts have been associated with irreversible II, reflecting the severity of inflammation due to the irreversible ischemic changes found in SBO [10].…”

Non-Emergent Early Surgical Management for Adhesive Small Bowel Obstruction

“…If fibrinolysis does not take place within a week of peritoneal injury, the temporary fibrin matrix becomes a scaffold and peritoneal adhesions form [5,6]. Postoperative adhesions instigate 60-75% of small bowel obstructions [2][3][4]7]. This risk is highest following colorectal, oncologic, gynecologic, and pediatric operations [2,7].…”

“…Postoperative adhesions instigate 60-75% of small bowel obstructions [2][3][4]7]. This risk is highest following colorectal, oncologic, gynecologic, and pediatric operations [2,7]. Although NOM can ameliorate symptoms, relieve obstruction, and restore function, it does not eliminate the offending adhesions, which can provoke the recurrence of ASBO [5].…”

“…Although NOM can ameliorate symptoms, relieve obstruction, and restore function, it does not eliminate the offending adhesions, which can provoke the recurrence of ASBO [5]. While NOM is effective in 70-90% of cases, it is associated with high readmission rates (20-35%) [2,4,7]. A longitudinal population-based study comparing ESM and NOM for recurrence rates revealed a significant difference of 13 versus 21.3%.…”

Clinical benefit of oral lactulose for postoperative care of pateints with complicated appendicitis using propensity score matching analysis

“…Core accelerated care pathways included no perioperative fasting, optimal nutrition and fluid management, decreased use of tubes, optimizing pain control, and early mobilization have been used in some specialized centers to facilitate gastrointestinal (GI) recovery [4, 5]. Furthermore, postoperative adhesive small bowel obstruction (ASBO), is the most common surgical causes for hospital readmission, bowel resection [6], but until now, no specific treatment currently exists for the treatment or prevention of POI and ASBO. Alvimopan has been suggested with possible therapeutic effect in accelerated the recovery of bowel function [7].…”