Predicting Intestinal Ischaemia in Patients with Adhesive Small Bowel Obstruction: A Simple Score

Predicting Intestinal Ischaemia in Patients with Adhesive Small Bowel Obstruction: A Simple Score

Background/aims Intestinal ischaemia (II) is the most critical factor to determine in patients with adhesive small bowel obstruction (ASBO) because intestinal ischaemia could be reversible. The aim of this study was to create a clinicoradiological score to predict II in patients with ASBO. Methods W...

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Bibliographic Details
Published in:World journal of surgery Vol. 44; no. 5; pp. 1444 - 1449
Main Authors: Bouassida, Mahdi, Laamiri, Ghazi, Zribi, Slim, Slama, Helmi, Mroua, Bassem, Sassi, Selim, Aboudi, Rania, Mighri, Mohamed Mongi, Bouzeidi, Khaled, Touinsi, Hassen
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01-05-2020
Springer Nature B.V
Subjects:
Abdominal Surgery
Adult
Aged
Aged, 80 and over
Body temperature
Cardiac Surgery
Clinical Decision Rules
Computed tomography
Female
General Surgery
Humans
Intestinal obstruction
Intestinal Obstruction - etiology
Intestinal Obstruction - pathology
Intestinal Obstruction - surgery
Intestine, Small - blood supply
Intestine, Small - pathology
Intestine, Small - surgery
Ischemia
Logistic Models
Male
Mathematical analysis
Medicine
Medicine & Public Health
Mesenteric Ischemia - diagnosis
Mesenteric Ischemia - etiology
Mesenteric Ischemia - pathology
Mesenteric Ischemia - surgery
Mesentery
Middle Aged
Necrosis
Original Scientific Report
Pain
Postoperative Complications - diagnosis
Postoperative Complications - pathology
Postoperative Complications - surgery
Radiography
Regression analysis
Regression coefficients
Retrospective Studies
Risk
Risk Assessment
Risk Factors
ROC Curve
Small intestine
Statistical analysis
Surgery
Thoracic Surgery
Vascular Surgery
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Summary:Background/aims Intestinal ischaemia (II) is the most critical factor to determine in patients with adhesive small bowel obstruction (ASBO) because intestinal ischaemia could be reversible. The aim of this study was to create a clinicoradiological score to predict II in patients with ASBO. Methods We conducted a retrospective study including 124 patients with ASBO. Logistic regression analysis was used to identify predictive factors of II. We assigned points for the score according to the regression coefficient. The area under the curve (AUC) was determined using receiver operating characteristic curves. Results Six independent predictive factors of II were identified: age, pain duration, body temperature, WBC, reduced wall enhancement and segmental mesenteric fluid at CT scan. According to the regression, coefficient points were assigned to each of the variables associated with II. The estimated rates of II were calculated for the total scores ranging from 0 to 24. The AUC of this clinicoradiological score was 0.92. A cut-off score of 6 was used for the low-probability group (the risk of II was 1.13%). A score ranging from 7 to 15 defined intermediate-probability group (the risk of II was 44%). A score ≥16 defined high-probability group (100% of patients in this group had II). Conclusions We performed a score to predict the risk of intestinal II with a good accuracy (the AUC of our score exceeded 0.90). This score is reliable and reproducible, so it can help surgeon to prioritize patients with II for surgery because ischaemia could be reversible, avoiding thus intestinal necrosis.
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ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-020-05377-6