Clinical variables related to small bowel obstruction: comparison of patients with and without Crohn’s disease

Abstract

Small bowel obstruction is a known complication of Crohn's disease. Determining need for operation is a demanding task. The aim of this study was to fine tune the decision-making process by evaluating standard clinical and laboratory parameters in small bowel obstruction of any cause and compare etiologies. Consecutive patients with Crohn's disease and small bowel obstruction were selected retrospectively and compared to a randomly selected group of non Crohn's patients with obstruction over a 9 year period. Twenty-two clinical, laboratory and radiological variables were assessed for the following outcomes: i) diagnosis of Crohn's; ii) operative or non operative treatment in Crohn's; iii) operative or non operative treatment without Crohn's; iv) exacerbation or adhesions causing obstruction among Crohn's patients. Multivariable models were developed for each outcome using logistic regression. Age less than 50, history of smoking, Jewish ethnicity, white count >11¥10 9 , neutrophils >7.5¥10 9 and platelet volume <9.9 fL, supported the diagnosis of Crohn's disease. Operation in Crohn's disease within the same admission was associated with a history of smoking, temperature >38˚, high pulse >100, leukocytosis (>11¥10 9 ) and obstruction on abdominal scan, while operation in patients without Crohn's in the sentinel admission, was associated with temperature >38˚, tachycardia, leukocytosis (>11¥10 9 ) and previous operation. Confirmation of these predictive patterns in a validation group could help in clinical decisions regarding therapeutic options in an emergency setting.