Evaluation of the findings affecting the treatment decision in cases of adhesive intestinal obstruction

Abstract

To establish a standard approach in patient management by determining the parameters that affect the decision of surgical or conservative treatment in adhesive small bowel obstructions. 94 patients who were admitted to the emergency department with symptoms of ileus and were diagnosed with adhesive intestinal obstruction according to clinical, examination and imaging findings were grouped as patients who were followed up with conservative methods (Group 1) and patients who underwent surgery (Group 2). All patients' laboratory values (hemoglobin, white blood cell (WBC), C- reactive protein (CRP), Blodd urea nitrogen (BUN)/creatinin, sodium, potassium, Lactate dehydrogenase (LDH), lactate and amylase) and imaging findings (air-fluid level in direct abdominal X-ray, increase in small intestine diameter (≥3.95 cm) in computerized tomography), wall thickness increase (>3mm), transition zone, fecal sign, and presence of contrast in the colon) were evaluated, and criteria for early surgery and non-operative follow-up-treatment criteria were determined. 72% (n:68) of the patients were classified as Group 1 and 28% (n:26) as Group 2, and no significant difference was found between the groups according to age and gender. Surgical treatment with increased lactate (r:0.326, p=0.001), diameter increase in the small intestine (r:0.299, p=0.003) and wall thickness increase (r:0.540, p<0.001), change in air-fluid levels on direct X-ray ( A significant correlation was found between r:-0.291, p=0.004) and contrast transfer to the colon on tomography (r:-0.668, p<0.001) and the decision for conservative treatment. Although adhesive intestinal obstruction is a condition that can mostly be managed non-operatively, the early surgical decision significantly reduces mortality and morbidity in cases with an operation indication. It was concluded that the standard approach protocol based on laboratory and imaging findings determined in the non-operative or operative treatment management helps in the differential diagnosis and early surgical decision and reduces the length of stay of the patient.