Predicting of intestinal ischemia in patients with adhesive small bowel obstruction

Abstract

Aim. To detect intestinal ischemia promptly in patients with acute adhesive small bowel obstruction.Methods. A total of 124 patients with acute adhesive small bowel obstruction were studied. Logistic regression analysis was performed to determine the most significant prognostic factors for intestinal ischemia. The derived regression coefficient indicators were utilized in a scoring system.Results. Six independent prognostic factors of intestinal ischemia were identified: age, duration of pain, body temperature, white blood cell count, reduced intestinal wall contrast, and localized mesenteric edema visible on a CT scan. Regression coefficient scores were attributed to each variable associated with intestinal ischemia. The predicted occurrence of bowel ischemia was computed as a sum of scores ranging from 0 to 24. A threshold of 6 points was used to define the low-probability group (risk of bowel ischemia was 1.13%). A score between 7 and 15 determined the intermediate-probability group (the risk of intestinal ischemia was 44%). A score of ≥16 defined the high-probability group (all patients in this group had intestinal ischemia).Conclusions. The risk prediction assessment of bowel ischemia was performed with high accuracy (above 90%). This evaluation is reliable and reproducible, hence it may aid the surgeon to differentiate patients with intestinal ischemia for surgical intervention. Since ischemic disorders may be reversible, this could prevent the development of intestinal necrosis.