Clinical Factors to Predict the Need of Operation in Patients with Small Bowel Obstruction
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Abstract
Background: Small bowel obstruction (SBO) is a common surgical emergency. Delay of operative treatment increase the risk of small bowel ischemia leading to a major cause of death. The proper decision-making process by surgeon is crucial. There is no clear conclusion about clinical factors for prediction the need of operation.
Objective: The aim of this study is to identify clinical factors to predict the need of operation within 72 hour in patients with small bowel obstruction.
Methods: This is a prognostic factor research, retrospective cohort design. A database of 478 patients with SBO from September 2016 to September 2020 were reviewed. Symptoms, laboratory and radiological findings of patients were collected after admission and 24 hour. The clinical factors were analyzed using multivariable logistic regression.
Results: Two hundred and six patients required surgery. Male to female ratio was 2:1. Mean age was 60 year. Most of etiology was adhesive disease in 76.2%. On multivariate analysis, persistent abdominal pain within 24 hour (Odds ratio (OR) 6.7 95%CI 3.6-78.5, p<0.001), obstipation within 24 hour (OR 7.2 95%CI 2.1-24.4, p=0.002), fixed bowel loop on plain film abdomen (OR 9.2 95%CI 2.7-31.9, p<0.001) were significantly predictors for the need of operation. In addition, the peritoneal irritant sign on admission is a clinical significance factor (OR 13.3, 95%CI 0.7-237.6, p=0.078). The predictive factors were correlated with an area under the curve of 0.893.
Conclusion: Patients with SBO presented with peritoneal irritant sign on admission or after conservative treatment within 24 hour but continue persistent abdominal pain, obstipation and fixed bowel loop on X-ray may be require surgical operation.
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