“Clinicoradiological Score – Valuable Tool to Assess the Risk of Strangulated Small Bowel Obstruction in Tertiary Care Center”

Abstract

Background Small bowel obstruction accounts for about 3% of the emergency laparotomies, hence there is a need for early recognition of the risk associated with strangulated small bowel obstruction. However, there is no single reliable tool for evaluating the bowel strangulation risk precisely and quickly, hence we sought to assess the specificity and sensitivity of a scoring system named “Clinicoradiological score” as a tool to assess the risk of strangulated small bowel obstruction in tertiary care center for early intervention. Methods The study was an observational study conducted on 50 patients with clinical symptoms of small intestinal obstruction, diagnosed by CT and admitted in-patient basis at the general surgery department in the hospitals attached to Bangalore Medical College and Research Institute, Bengaluru from November 2017 to May 2019. In this scoring system, one point was given to each factor which includes pain duration (4 or more days), guarding, leucocyte count at least 10 ×109/L, C-reactive protein 75 mg/L or more, free fluid at least 500 mL (CT criteria), reduced wall contrast enhancement (CT criteria) leading to a maximum score of 6. Statistics Based on standard treatment outcome, patients were grouped into three categories (conservative management, laparotomy without resection and anastomosis, and laparotomy with resection and anastomosis). Data was analyzed by descriptive statistics. The risk factors were compared between three patient groups and Chi-square test used for hypothesis testing. Sensitivity and specificity were evaluated for accuracy of score. Results Out of the six factors of Clinicoradiological score, five factors were found to be predictors (p-value <0.01), while history of pain more than 3 days did not have a significant p-value. In our study all 18 patients with score more than 3 had gangrenous changes and underwent resection. The p-value of the score was found to be significant. Conclusion Clinicoradiological score has been proved to be a valuable tool in predicting the risk of strangulated small bowel obstruction and ascertained the need for subsequent intestinal resection.