Small bowel obstruction: early parameters predicting the need for surgical intervention

Background: Surgical training has long been to "never let the sun set on a bowel obstruction" without an operation to rule out and/or treat compromised bowel. However, advances in diagnostics have called into question the appropriate timing of non-emergent operations and expectant management is increasingly used. We performed a systematic review to evaluate the safety and effectiveness of expectant management for adhesive small bowel obstruction (aSBO) compared to early, non-emergent operation. Materials & Methods: We queried PubMed, EMBASE, and Cochrane databases for studies (1990-present) comparing early, nonemergent operations and expectant management for aSBO (PROSPERO #CRD42017057676). Results: Of 4873 studies, 29 cohort studies were included for full-text review. Four studies directly compared early surgery with expectant management, but none excluded patients who underwent emergent operations from those having early non-emergent surgery, precluding a direct comparison of the two treatment types of interest. When aggregated, the rate of bowel resection was 29% in patients undergoing early operation vs. 10% in those undergoing expectant management. The rate of successful, nonoperative management in the expectant group was 58%. There was a 1.3-day difference in LOS favoring expectant management (LOS 9.7 vs. 8.4 days), and the rate of death was 2% in both groups. Conclusion: Despite the shift towards expectant management of aSBO, no published studies have yet compared early, nonemergent operation and expectant management. A major limitation in evaluating the outcomes of these approaches using existing studies is confounding by indication related to including patients with emergent indications for surgery on admission in the early

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The Safety of Expectant Management for Adhesive Small Bowel Obstruction: A Systematic Review

Thornblade

Verdial

Bartek

et al. 2019

Journal of Gastrointestinal Surgery

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Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Pal¹,

Ansari²,

Islam³

2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Introduction: Serum C-reactive protein (CRP) and D-lactate have been proposed as markers of intestinal ischemia. The purpose of this prospective observational study is to find whether serum CRP and serum D-lactate can help in predicting strangulation in cases of acute intestinal obstruction. Materials and methods:A total of 50 consecutive patients were included in the study after excluding patients of comorbid medical illness and patients with findings other than obstruction or strangulation. The serum values of CRP and D-lactate were measured and compared between obstruction with strangulation and obstruction without strangulation. Receiver operating characteristic (ROC) curve was drawn and cutoff values for the diagnosis of strangulation were calculated along with calculation of sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs).Results: A total of 14 patients who were diagnosed with strangulated bowel obstruction had significantly higher values of serum CRP and D-lactate when compared with 36 patients with simple bowel obstruction (116 vs 40 mg/L and 5.4 vs 2.7 mmol/L respectively, p < 0.05). Using ROC analysis, the area under the curve of serum CRP and D-lactate was found to be 0.785 and 0.775 respectively, for bowel strangulation. Using a cutoff value of 60 mg/L for CRP, the sensitivity, specificity, PPV, and NPV were 87.5, 58.3, 48.3, 91.3% respectively. Using a cutoff value of 4.5 mmol/L for D-lactate, the sensitivity, specificity, PPV, and NPV were 75.0, 69.4, 52.7, 86.2% respectively. Conclusion:Serum CRP and D-lactate can be useful and reasonable markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.

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Small bowel obstruction: early parameters predicting the need for surgical intervention

Abstract: The presence of two or more early predictive factors as defined above, available at admission, significantly correlates with a likelihood of complete obstruction and the need of surgical intervention.

Cited by 2 publications

References 16 publications

The Safety of Expectant Management for Adhesive Small Bowel Obstruction: A Systematic Review

The Safety of Expectant Management for Adhesive Small Bowel Obstruction: A Systematic Review

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

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