Abstract
BackgroundThe level of intestinal fatty acid-binding protein (I-FABP) is considered to be useful diagnostic markers of small bowel ischemia. The purpose of this retrospective study was to investigate whether the serum I-FABP level is a predictive marker of strangulation in patients with small bowel obstruction (SBO).MethodsA total of 37 patients diagnosed with SBO were included in this study. The serum I-FABP levels were retrospectively compared between the patients with strangulation and those with simple obstruction, and cut-off values for the diagnosis of strangulation were calculated using a receiver operating characteristic curve. In addition, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.ResultsTwenty-one patients were diagnosed with strangulated SBO. The serum I-FABP levels were significantly higher in the patients with strangulation compared with those observed in the patients with simple obstruction (18.5 vs. 1.6 ng/ml p<0.001). Using a cut-off value of 6.5 ng/ml, the sensitivity, specificity, PPV and NPV were 71.4%, 93.8%, 93.8% and 71.4%, respectively. An I-FABP level greater than 6.5 ng/ml was found to be the only independent significant factor for a higher likelihood of strangulated SBO (P = 0.02; odds ratio: 19.826; 95% confidence interval: 2.1560 – 488.300).ConclusionsThe I-FABP level is a useful marker for discriminating between strangulated SBO and simple SBO in patients with SBO.
Highlights
Small bowel obstruction (SBO) is commonly encountered in the field of gastroenterology, the leading cause of which is adhesion in patients with a history of abdominal surgery, accounting for over 70% of cases of small bowel obstruction (SBO) [1,2]
Patient characteristics Forty-seven patients were suspected of having bowel obstruction, 10 of whom were excluded from the study because they were diagnosed with large bowel obstruction
The remaining 37 patients were included in this study, 21 of whom were diagnosed with strangulated SBO and 16 of whom were diagnosed with simple SBO based on their computed tomography (CT) findings (Figure 1)
Summary
Small bowel obstruction (SBO) is commonly encountered in the field of gastroenterology, the leading cause of which is adhesion in patients with a history of abdominal surgery, accounting for over 70% of cases of SBO [1,2]. Reduced enhancement of the bowel wall, a serrated beak, thickening of the bowel wall, mesenteric engorgement and ascites have been reported to be useful CT findings enabling the detection of strangulated SBO, with a sensitivity of 33–48%, 32–47%, 38– 52%, 19–58% and 64–75% and a specificity of 100%, 100%, 59– 95% and 38–86%, respectively [11,12,13,14] Detecting these findings remains difficult, even for physicians who specialize in digestive surgery or radiology. The level of intestinal fatty acid-binding protein (I-FABP) is considered to be useful diagnostic markers of small bowel ischemia The purpose of this retrospective study was to investigate whether the serum I-FABP level is a predictive marker of strangulation in patients with small bowel obstruction (SBO)
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