Strangulated Small Bowel Obstruction Research Articles

Ischemia prediction score (IsPS) in patients with strangulated small bowel obstruction: a retrospective cohort study

BackgroundsIntestinal ischemia of strangulated small bowel obstruction (SSBO) requires prompt identification and early intervention. This study aimed to evaluate the risk factors and develop a prediction model of intestinal ischemia requiring bowel resection in SSBO.MethodsThis was a single-center, retrospective cohort study of consecutive patients underwent emergency surgery for SSBO from April 2007 to December 2021. Univariate analysis was performed to identify the risk factors for bowel resection in these patients. Two clinical scores (with contrasted computed tomography [CT] and without contrasted CT) were developed to predict intestinal ischemia. The scores were validated in an independent cohort.ResultsA total of 127 patients were included, 100 in the development cohort (DC) and 27 in the validation cohort (VC). Univariate analysis showed that high white blood cell count (WBC), low base excess (BE), ascites and reduced bowel enhancement were significantly associated with bowel resection. The ischemia prediction score (IsPS) comprised 1 point each for WBC ≥ 10,000/L, BE ≤ -1.0 mmol/L, ascites, and 2 points for reduced bowel enhancement. The simple IsPS (s-IsPS, without contrasted CT) of 2 or more had a sensitivity of 69.4%, specificity of 65.4%. The modified IsPS (m-IsPS, with contrasted CT) of 3 or more had a sensitivity of 86.7%, specificity of 76.0%. AUC of s-IsPS was 0.716 in DC and 0.812 in VC, and AUC of m-IsPS was 0.838 and 0.814.ConclusionIsPS predicted possibility of ischemic intestinal resection with high accuracy and can help in the early identification of intestinal ischemia in SSBO.

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

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.

Comprehensively evaluate the short outcome of small bowel obstruction: A novel medical-economic score system.

Small bowel obstruction (SBO) still imposes a substantial burden on the health care system. Traditional evaluation systems for SBO outcomes only focus on a single element. The comprehensive evaluation of outcomes for patients with SBO remains poorly studied. Early intensive clinical care would effectively improve the short-term outcomes for SBO, however, the full spectrum of the potential risk status regarding the high complication-cost burden is undetermined. We aim to construct a novel system for the evaluation of SBO outcomes and the identification of potential risk status. Patients who were diagnosed with SBO were enrolled and stratified into the simple SBO (SiBO) group and the strangulated SBO (StBO) group. A principal component (PC) analysis was applied for data simplification and the extraction of patient characteristics, followed by separation of the high PC score group and the low PC score group. We identified independent risk status on admission via a binary logistic regression and then constructed predictive models for worsened management outcomes. Receiver operating characteristic curves were drawn, and the areas under the curve (AUCs) were calculated to assess the effectiveness of the predictive models. Of the 281 patients, 45 patients (16.0%) were found to have StBO, whereas 236 patients (84.0%) had SiBO. Regarding standardized length of stay (LOS), total hospital cost and the presence of severe adverse events (SAEs), a novel principal component was extracted (PC score = 0.429 × LOS + 0.444 × total hospital cost + 0.291 × SAE). In the multivariate analysis, risk statuses related to poor results for SiBO patients, including a low lymphocyte to monocyte ratio (OR = 0.656), radiological features of a lack of small bowel feces signs (OR = 0.316) and mural thickening (OR = 1.338), were identified as risk factors. For the StBO group, higher BUN levels (OR = 1.478) and lower lymphocytes levels (OR = 0.071) were observed. The AUCs of the predictive models for poor outcomes were 0.715 (95%CI: 0.635-0.795) and 0.874 (95%CI: 0.762-0.986) for SiBO and StBO stratification, respectively. The novel PC indicator provided a comprehensive scoring system for evaluating SBO outcomes on the foundation of complication-cost burden. According to the relative risk factors, early tailored intervention would improve the short-term outcomes.

Strangulated small bowel obstruction caused by isolated obturator nerve and pelvic vessels after pelvic lymphadenectomy in gynecologic surgery: two case reports

BackgroundAlthough small bowel obstruction (SBO) is a major complication occurring after abdominal surgery, few reports have described strangulated SBO after pelvic lymphadenectomy (PL). This report describes two cases of strangulated SBO caused by a skeletonized obturator nerve and pelvic vessels after laparoscopic PL during gynecologic surgery.Case presentationCase 1: A 57-year-old woman with endometrial cancer underwent a laparoscopic semi-radical total hysterectomy with PL. Nine months after the operation, she visited our emergency room complaining about subacute pain spreading in the right groin, right buttock, and dorsal part of the right thigh. She had no abdominal pain. Although her symptoms were not typical, computed tomography (CT) revealed strangulated SBO in the right pelvis. Laparoscopic surgery revealed that the small bowel was ischemic. Then we converted to open surgery. We transected the right obturator nerve and umbilical artery, which constructed an internal hernia orifice in the right pelvis, followed by resection of the ischemic small bowel. Fortunately, during 6-month follow-up, she showed only slight difficulty in walking as a postoperative complication. Case 2: A 62-year-old woman with cervical cancer underwent laparoscopic radical hysterectomy with PL. Six months after the operation, she visited our hospital emergently because of sudden onset of abdominal pain and vomiting. CT showed strangulated SBO. Urgent laparoscopic surgery exhibited the incarcerated small bowel at the right pelvis. Consequently, we converted to open surgery. The terminal ileum was detained into the space constructed by the right umbilical artery. We cut the umbilical artery and performed ileocecal resection. After the surgery, she was discharged with no complication or sequela.ConclusionWhen examining a patient after PL who complains of severe pain or symptoms, one should consider the possibility of PL-related SBO, even if the pain is apparently atypical for SBO.

Value of the ultrasound research in the diagnostic of acute strangulated small bowel obstruction

Purpose. To identify and evaluate the effectiveness of sonographic signs of intestinal ischemia in patients with strangulated small bowel obstruction.Materials and methods. For the period 2017–2019, 115 patients with SIO were treated at the N.V. Sklifosovsky Federal Research Institute of Emergency Medicine. There were 64 women (55.6%) and 51 men (44.4%). The mean age was 62 ± 15 years. In all patients, the diagnosis was verified intraoperatively. All patients underwent ultrasound examination of the abdominal cavity in B-mode with the assessment of blood flow of the intestinal wall in the mode of CDI. Patients were divided on the basis of intraoperative data into 2 groups. The first group: 63 (54.8%) patients with signs of ischemia of the strangulated loop of the intestine. The second group consisted of 21 (18.1%) patients in whom intestinal necrosis was detected. The comparison group included 31 (26.7%) patients with adhesive small bowel obstruction without intestinal strangulation.Results. The most informative signs of ischemia of the strangulated intestine of the loop are infiltrative changes of its mesentery. In the second and third groups 9 (14.3%) and 12 (57.1%) participants, respectively, showed severity of intestinal ischemia, compared with 1 participant (3.2%) in the first group. The next informative criterion is the thickening of more than 0.4 cm and edema of the intestinal wall. In the second and third groups 30 (47.6%) and 14 (66.6%), in the comparison group 4 (12.9%), akinesis of the strangulated loop and paresis of the entire small intestine also directly correlated with intestinal ischemia. The absence of differentiation of intestinal wall layers occurs in (23.8%), the absence of blood flow in the intestinal wall in the CDI mode (19%), gas inclusions in the intestinal wall (4.3%).Conclusion. The assessment of sonographic symptoms allows to diagnose the presence of ischemic changes in the intestinal wall and perform surgery before the development of necrosis in the early period. In cases of late admission of the patient to the hospital, with the onset of intestinal necrosis and the associated erased clinical picture, ultrasound allows to establish indications for surgery before the development of peritonitis.

Age, blood urea nitrogen, and lactate: Preoperative risk factors of laparotomy for strangulated small bowel obstruction.

Despite increasing reports of laparoscopy for strangulated small bowel obstruction (SSBO), there is no consensus on outcomes in patients with SSBO. We evaluated the safety and utility of laparoscopy for SSBO and investigated the preoperative risk factors for laparotomy. This retrospective study included 107 patients who underwent emergency surgery for SSBO over a period of 6 years. Patients' characteristics and surgical parameters were compared between 27 patients undergoing laparoscopy alone (group L) and 80 patients undergoing laparotomy (group O, including conversion). Univariate and multivariate analyses were performed to determine risk factors for laparotomy. Compared with group L, group O had significantly shorter operation time (59 vs 115 minutes, P < .001), shorter postoperative hospital stay (6 vs 10 days, P < .001), and fewer complications (3 vs 40 cases, P < .001). Age ≥ 68 years (odds ratio [OR] 3.970, P=.021), blood urea nitrogen (BUN) ≥ 14.6mg/dL (OR 4.360, P=.012), and lactate ≥2.80 mmol/L (OR 12.90, P=.023) were independent risk factors for laparotomy. Prognosis was better in patients with SSBO undergoing complete laparoscopy than in patients undergoing laparotomy; however, age, BUN, and lactate were independent preoperative risk factors for laparotomy.

A Case of Torsion of Meckel’s Diverticulum with Strangulated Small Bowel Obstruction Caused by a Mesodiverticular Band

A Case of Torsion of Meckel’s Diverticulum with Strangulated Small Bowel Obstruction Caused by a Mesodiverticular Band

A Case of Strangulated Small Bowel Obstruction Probably Caused by a Slipped-down Staple After Laparoscopic Sigmoidectomy

A Case of Strangulated Small Bowel Obstruction Probably Caused by a Slipped-down Staple After Laparoscopic Sigmoidectomy

Intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae: a case report

BackgroundAnisakiasis is a parasitic infection caused by Anisakis worms found in raw fish. Most cases of anisakiasis occur in the stomach and rarely occur in the intestine. It is extremely rare for live larvae to break through the intestine into the mesentery and cause severe intestinal ischemia. Anisakiasis can be treated conservatively, because the larvae will die in approximately 1 week, but, sometimes, a serious condition can arise, as in this case. We report the first case of extraluminal anisakiasis in which a live Anisakis worm caused severe intestinal ischemia.Case presentationThe patient was a 26-year-old woman who ate squid a week prior. She had abdominal pain and was admitted to our emergency department. On physical examination, abdominal guarding and rebound tenderness were present in her lower abdomen. Contrast-enhanced computed tomography showed ascites, the whirl sign, localized submucosal edema of the intestinal wall, and a dilated small bowel segment with edema. We suspected the strangulated small bowel obstruction based on the CT-scan findings. To rule out the strangulated small bowel obstruction, laparoscopic exploration was performed. Bloody ascites in the pouch of Douglas and severe inflammation in 20 cm of the ileum were observed. An Anisakis larva had perforated the intestinal wall and was found alive in the mesentery. The ileum had developed a high degree of ischemia, so the affected section was resected. Histopathological examination revealed that the Anisakis worm body was in the inflamed mesentery and caused a high degree of ischemia in the intestinal tract. The patient was discharged 9 days after surgery.ConclusionsA living Anisakis larva punctured the mesentery of the small intestine, resulting in severe intestinal ischemia. As seen in this case, intestinal anisakiasis may cause serious symptoms, and a low threshold for performing diagnostic laparoscopy for the early diagnosis of bowel ischemia secondary to anisakiasis can be useful in determining the definite diagnosis and indications for resection.

Multisection spiral CT in the diagnosis of adhesive small bowel obstruction: the value of CT signs in strangulation

Small bowel obstruction (SBO) is usually caused by mechanical obstruction or by irreversible changes in the normal position of the small bowel, with obstruction of bowel contents. According to the blood supply of the intestinal wall, SBO can be divided into simple and strangulated small bowel obstruction. Strangulated small bowel obstruction is one of the most serious acute abdominal diseases in general surgery. The most common aetiology is intraperitoneal adhesions.1,2 Delayed treatment can cause serious complications, such as peritonitis, intestinal perforation, infection, shock, and systemic failure.

Laparoscopic vs open surgery for patients with strangulated small bowel obstruction.

Recent reports revealed that laparoscopic adhesiolysis is a feasible procedure for patients with adhesive small bowel obstruction (SBO). However, the feasibility of laparoscopic surgery for strangulated SBO has not been investigated in detail. Ninety-six patients who underwent surgery for strangulated SBO between April 2008 and September 2019 were included. Of these, 49 patients were intended to undergo laparoscopic surgery, while the other 47 underwent open surgery from the first. Comparisons were made between the patients who underwent laparoscopic and open surgery in the patients with intestinal resection and without resection, respectively. In the resection group, eight patients (50.0%) who underwent laparoscopic surgery required conversion to open surgery. Perioperative outcomes were not statistically different between laparoscopic and open surgery except for postoperative use of continuous infusion of an analgesic agent or epidural anesthesia (P = .008). In the non-resection group, five patients (15.1%) who underwent laparoscopic surgery required conversion. Time from surgery to ingestion (P = .025) and postoperative use of continuous infusion of an analgesic agent or epidural anesthesia (P < .001) were significantly favorable in the laparoscopic group. In the patients who underwent laparoscopic surgery, white blood cell count was >12 000/μL (P = .024, odds ratio = 7.569) and intestinal resection (P = .026, odds ratio = 5.19) were found by logistic regression analysis to be independent risk factors for conversion to open. Laparoscopic surgery yields superior outcomes in patients without a requirement of intestinal resection. Laparoscopic surgery was considered as a first-choice strategy in selected patients with strangulated SBO.

Transmural Bowel Necrosis From Acute Mesenteric Ischemia and Strangulated Small-Bowel Obstruction: Distinctive CT Features.

OBJECTIVE. The purpose of this study was to assess whether transmural bowel necrosis has distinct CT features based on the three main causes: occlusive acute mesenteric ischemia (AMI), nonocclusive AMI, and strangulated small-bowel obstruction (SBO). MATERIALS AND METHODS. From January 2010 to December 2017, the records of all patients with a pathologic diagnosis of transmural bowel necrosis were extracted from the pathology department database of a university hospital. The inclusion criteria for the study were presence of transmural bowel necrosis at pathologic examination and available contrast-enhanced CT images obtained within the 24 hours before surgery. Seventy-seven patients were finally included. The CT scans were retrospectively independently reviewed by two abdominal radiologists to identify the classic CT findings of transmural bowel necrosis. Statistical analyses were performed. RESULTS. Pneumatosis intestinalis was statistically more frequent in nonocclusive AMI (59%) than in occlusive AMI (29%) and strangulated SBO (7%) (p < 0.01), as were superior mesenteric venous gas (55%, 29%, and 0%; p < 0.01) and portal venous gas (48%, 10%, and 0%; p < 0.01). Decreased or absent bowel wall enhancement was more frequent in AMI than in SBO (nonocclusive AMI, 83%; occlusive AMI, 81%; SBO, 56%; p = 0.02), as was thinned bowel wall (nonocclusive AMI, 52%; occlusive AMI, 48%; SBO, 18%; p = 0.02). Spontaneous hyperattenuation of the bowel wall was more frequent in strangulated SBO (41%) than in nonocclusive AMI (10%) and occlusive AMI (14%) (p < 0.01). CONCLUSION. Transmural bowel necrosis has distinct CT findings according to its three main causes. Occlusive AMI is characterized by an absence of bowel wall enhancement and less mesenteric fat stranding, nonocclusive AMI by a high prevalence of pneumatosis intestinalis and portal venous gas, and strangulated SBO by spontaneous hyperattenuation of the bowel wall and an absence of pneumatosis intestinalis and portal venous gas.

MR Imaging-based Evaluation of Mesenteric Ischemia Caused by Strangulated Small Bowel Obstruction and Mesenteric Venous Occlusion: An Experimental Study Using Rabbits.

Purpose:This study assessed the MRI findings of strangulated small bowel obstruction (SBO) and mesenteric venous occlusion (MVO) in a rabbit model using 3T MRI.Materials and Methods:Twenty rabbits were included in this study. The strangulated SBO and MVO models were generated via surgical procedures in nine rabbits, and sham surgery was performed in two rabbits. The success of generating the models was confirmed via angiographic, macroscopic, and microscopic findings after the surgical procedure. MRI was performed before and 30 min after inducing mesenteric ischemia. T1-weighted images (T1WIs), T2-weighted images (T2WIs), and fat-suppressed T2WIs (FS-T2WIs) were obtained using the BLADE technique, and fat-suppressed T1WIs (FS-T1WIs) were obtained. The signal intensities of the affected bowel before and after the surgical procedures were visually categorized as high, iso, and low intense compared with the findings for the normal bowel wall on all sequences. Bowel wall thickness was measured, and the signal intensity ratio (SI ratio) was calculated using the signal intensities of the bowel wall and psoas muscle.Results:Angiographic, macroscopic, and microscopic findings confirmed that all surgical procedures were successful. The ischemic bowel wall was thicker than the normal bowel. The bowel wall was thicker in the MVO model (3.17 ± 0.55 mm) than in the strangulated SBO model (2.26 ± 0.46 mm). The signal intensity and SI ratio of the bowel wall were significantly higher after the procedure than before the procedure on all sequences in both models. The mesentery adjacent to the ischemic bowel loop exhibited a high signal intensity in all animals on FS-T2WIs.Conclusion:Non-contrast MRI can be used to evaluate mesenteric ischemia caused by strangulated SBO and MVO. FS-T2WIs represented the best modality for depicting the high signal intensity in the bowel wall and mesentery caused by ischemia.

Reduced Port Surgery for a Pregnant Woman With Strangulated Small Bowel Obstruction: A Case Report

Introduction Intestinal obstruction in pregnancy is very rare, but the maternal mortality rate and the fetal loss rate are high. Therefore, an early diagnosis and appropriate treatments for small bowel obstructions (SBOs) during pregnancy are crucial for the mothers and fetuses. On the other hand, laparoscopic surgeries are widely used in pregnant patients, although laparoscopic surgeries for SBOs can have higher risks of complications. Then, reduced port surgery (RPS) can reduce the risk of intestinal injury by minimizing the number of ports the operator could not control alone. There is no previous report of RPS for SBOs in pregnant patients. We report on a pregnant patient with a strangulated SBO treated with RPS without complications. Case presentation A 37-year-old Japanese pregnant woman complaining of severe abdominal pain was admitted by ambulance. Her gestational age was 9 weeks. Her medical history included surgery for acute perforated appendicitis and deep vein thrombosis due to anti-thrombin III deficiency. Abdominal computed tomography revealed a strangulated SBO. We performed RPS and the cause of strangulated SBO was a string at the postoperative site of the appendectomy. The ischemic region of the small bowel recovered after we cut the string and released the adhesion. The patient's postoperative course was uneventful and the fetus was not harmed. Conclusion This is the first report of RPS performed for the pregnant patient with the strangulated SBO. Our findings indicate that RPS is a feasible treatment for strangulated SBOs in pregnant women.

Internal hernia beneath the left external iliac artery after robotic-assisted laparoscopic prostatectomy with extended pelvic lymph node dissection: a case report

BackgroundFormation of an internal hernia beneath a skeletonized pelvic vessel after pelvic lymph node dissection is extremely rare. We report a case of an internal hernia formation beneath the left external iliac artery after a robotic-assisted laparoscopic prostatectomy with extended pelvic lymph node dissection.Case presentationA 72-year-old man visited our hospital complaining of severe lower abdominal pain. On physical examinations, his abdomen was distended and tympanitic with rebound tenderness and muscular defense. Abdominal non-enhanced computed tomography showed a small bowel obstruction with marked ascites. A coronal non-enhanced computed tomography image revealed thickened loops of small bowel with surrounding mesenteric edema in the left lower quadrant. Enhanced computed tomography was not performed because we decided to perform urgent surgery with a diagnosis of strangulated small bowel obstruction based on physical examination and the computed tomography findings. The patient underwent urgent laparotomy at which time bloody ascites was seen in the peritoneal cavity. The ileum, which was approximately 60 cm proximal to the ileocecal junction, formed a closed loop beneath the left external iliac artery. The incarcerated ileum, 120 cm in length, appeared non-viable with a color change of the ileum to black. We therefore resected the strangulated ileum for a length of 120 cm and performed a functional end-to-end anastomosis. The orifice beneath the left external iliac artery was about 4 cm in diameter. We did not close the orifice because of the risk of injuring the left iliac artery. The postoperative course was uneventful, and the patient was discharged from our hospital 10 days after surgery. Presently, the patient is doing well 5 months after surgery without recurrent disease.ConclusionWe report an extremely rare case of internal hernia formation beneath the left external iliac artery after a robotic-assisted laparoscopic prostatectomy with extended pelvic lymphadenectomy. Awareness of such complication and early surgical treatment are important when treating patients with this rare occurrence.

Diagnostic value of a simple scoring system for the diagnosis and treatment of non-emergency small bowel obstruction

In order to improve the diagnostic accuracy and treatment strategy for small bowel obstruction, we developed a non-emergency small bowel obstruction scoring system (0-4). We performed a retrospective analysis on 94 patients diagnosed with mechanical small bowel obstruction at our hospital. Anterior adhesion, small bowel feces sign, scoring system, and the usefulness of small bowel feces subtypes were examined. When the non-emergency small bowel obstruction scores 3-4, 99% were non-emergency obstructions, with the exclusion of strangulated small bowel obstruction. On the contrary, when the non-emergency small bowel obstruction scores 0-1, 47.5% were strangulated small bowel obstruction. As the effectiveness of withholding food and fluids (NPO) or short tube is high (about 70%) when small bowel feces are dry, placing a long tube may not be needed.

Analysis of Related Factors in Elderly Patients with Strangulated Small Bowel Obstruction

Objective To investigate the surgery-related factors of strangulated small bowel obstruction in the elderly patients. Methods The clinical data of 261 elderly patients with acute small bowel obstruction treated between July 2010 and September 2016 were analyzed retrospectively. Differences of clinical data,laboratory Results ,and CT findings were compared between the elderly strangulation group(ESt group,n=139)and the elderly simple group (ESi group,n=122). The surgery-related factors of strangulated small bowel obstruction in the elderly were analyzed by univariate and multivariate Logistic regression analysis. Results The ESt group and the ESi group showed significant differences in factors including muscle guarding (χ2=102.331,P=0.000),American Society of Anesthesiologists(ASA) score≥3 (χ2=69.748,P=0.000),leukocyte count (t=7.453,P=0.000),C-reactive protein (t=2.128,P=0.034),segmental mesenteric fluid (χ2=78.655,P=0.000),thick-walled small bowel (χ2=100.806,P=0.000),intestinal wall of hyperattenuation (χ2=69.068,P=0.000),ascites (χ2=89.299,P=0.000),mesenteric fat stranding (χ2=80.255,P=0.000),bird's beak sign (χ2=84.451,P=0.000),and stranding sign (χ2=98.635,P=0.000). Univariate regression analysis indicated the above 11 factors were the surgery-related factors in elderly patients with strangulated small bowel obstruction. Multivariate Logistic regression analysis showed that the surgery-related factors included segmental mesenteric fluid (OR=3.576,95%CI:1.043-12.261,P=0.043),ASA score≥3 (OR=3.463,95%CI:1.149-10.441,P=0.027),muscle guarding (OR=3.288,95%CI:1.010-10.707,P=0.048),thick-walled small bowel (OR=3.046,95%CI:1.074-8.638,P=0.036),and increased leukocyte count (OR=1.307,95%CI:1.170-1.458,P=0.000). Conclusion Muscle guarding,ASA score≥3,segmental mesenteric fluid,thick-walled small bowel,and increased leukocyte count are the surgery-related factors of strangulated small bowel obstruction in the elderly patients.

A Prediction Model for Recognizing Strangulated Small Bowel Obstruction.

Introduction Early and accurate diagnosis of strangulated small bowel obstruction (SSBO) is difficult. This study aimed to devise a prediction model for predicting the risk of SSBO. Materials and Methods A database of 417 patients who had clinical symptoms of intestinal obstruction confirmed by computed tomography (CT) were evaluated for inclusion in this study. Symptoms and laboratory and radiologic findings of these patients were collected after admission. These clinical factors were analyzed using logistic regression. A logistic regression model was applied to identify determinant variables and construct a clinical score that would predict SSBO. Results Seventy-six patients were confirmed to have SSBO, 169 patients required surgery but had no evidence of intestinal ischemia, and 172 patients were successfully managed conservatively. In multivariate logistic regression analysis, body temperature ≥ 38.0°C, positive peritoneal irritation sign, white blood cell (WBC) count > 10.0 × 10^9/L, thick-walled small bowel ≥3 mm, and ascites were significantly associated with SSBO. A new prediction model with total scores ranging from 0 to 481 was developed with these five variables. The area under the curve (AUC) of the new prediction model was 0.935. Conclusions Our prediction model is a good predictive model to evaluate the severity of SBO.

Significance of Diagnostic Paracentesis in the Preoperative Diagnosis of Strangulated Small Bowel Obstruction

Objective: This study aimed to clarify the significance of diagnostic paracentesis (DPC) and ascites analysis in the preoperative diagnosis of strangulated small bowel obstruction (SBO). Methods: Between June 2008 and May 2018, 38 patients underwent DPC and ascites analysis based on a preoperative diagnosis of strangulated SBO. The patients were divided into two groups based on the intraoperative macroscopic bowel condition: the strangulated (26 patients) and simple (12 patients) groups. The following factors were investigated and compared between the two groups: patient characteristics, preoperative vital signs, blood test results, ascites analysis results white blood cell [WBC] and red blood cell [RBC] counts, and lactate dehydrogenase and creatinine phosphokinase levels), and computed tomography (CT) findings. Results: No procedure-related complications were noted. The vital signs did not differ significantly between the two groups. The arterial base excess (BE) level was significantly lower in the strangulated group than in the simple group, and a BE level of ≤ -1.1 mmol/L had a sensitivity of 65%, specificity of 92%, and overall accuracy of 74% for differentiating the two groups. The ascites RBC count was significantly higher in the strangulated group than in the simple group, and an ascites RBC count of ≥ 20,000/mm3 had a sensitivity of 81%, specificity of 83%, and overall accuracy of 82% for differentiating the two groups. Regarding the distribution of the patients, 24 (92%) patients of the strangulated group were present in the area of BE level of ≤ -1.1 mmol/L or ascites RBC count of ≥ 20,000/mm3. Strangulation sign on CT, besides accumulation of ascites, was more frequently and significantly detected in the strangulated group than in the simple group. Conclusion: Our results suggest that DPC and ascites analysis, particularly ascites RBC count, are significant in the preoperative diagnosis of strangulated SBO when combined with CT findings and BE level.

Strangulated small bowel obstruction in children

BackgroundDiagnosing intestinal strangulation as a complication of small bowel obstruction (SBO) remains a considerable challenge in children. We evaluated the clinicoradiological parameters for predicting the presence of a strangulated intestine. MethodsWe reviewed the medical records of 69 pediatric patients who underwent operation for acute SBO. Regression analysis was used to identify the parameters for predicting strangulated SBO. ResultsOf the 69 patients with SBO, 27 patients had intestinal strangulation and were awarded one point each towards the overall clinical score: intractable continuous abdominal pain, tachycardia, white blood cell count >13,600/mm3, and abdominal distention. Patients with a clinical score ≥2 combined with the presence of ascites in ultrasound (US) results or with wall thickness and reduced wall contrast enhancement in abdominal computed tomography (CT) scans showed strong evidence for intestinal strangulation. ConclusionThe combination of two or more clinical parameters, including intractable continuous abdominal pain, tachycardia, leukocytosis, and abdominal distention with the presence of ascites in US or wall thickness and reduced wall contrast enhancement in, is useful for the identification of strangulated SBO. The type of study and level of evidencePrognosis study; Level III.