Clinical and tomographic features associated with surgical management in adhesive small bowel obstruction patients

Abstract

Background: The delay in surgical management of intestinal obstruction patients who did not respond to conservative management increases morbidity, mortality and days of hospital stay. Objective: This study aimed to describe the clinical and tomographic features associated with surgical management in adhesive small bowel obstruction patients. Method: We conducted a retrospective review of the electronic medical records during a 5-year period with the diagnosis of adhesive small bowel obstruction. We divided patients in two, those who responded to medical management and those who required surgery. Results: A total of 162 patients were included, with a mean age of 61.5 years. It was the first case of intestinal obstruction in 63% of the patients and 65.4% underwent surgery: 52.8% (n = 56) open surgery and 47.2% (n = 50) laparoscopic surgery. Multivariate analysis showed the following predictors of surgical treatment: abdominal rebound (odds ratio [OR]: 8.8; 95% confidence interval [95%CI]: 1.09-71.6), tomographic free fluid (OR: 4.62; 95%CI: 1.50-14.20) and transition zone (OR: 5.4; 95%CI: 1.59-18.80). The history of previous obstruction was a protective factor (OR: 0.33; 95%CI: 0.17-0.67). Conclusions: Abdominal rebound, free intrabdominal fluid and transition zone are related with the surgical management of adhesive small bowel obstruction.