Journal of Clinical and Diagnostic Research (Nov 2021)
Small Bowel Obstruction in the Virgin Abdomen: A Retrospective Study for a New Management Pathway
Abstract
Introduction: Adhesions are the main cause of Small Bowel Obstruction (SBO) for patients with previous abdominal surgery. In this case, conservative management has traditionally been efficient. However, aetiologies and therapeutic decisions are less obvious to determine for patients without previous abdominal surgery. Aim: To identify the accuracy of the results of clinical findings, laboratory investigations and Computed Tomography (CT) scan as tools to suggest a management pathway to deal with SBO in the virgin abdomen. Materials and Methods: This retrospective study included 59 patients that had been admitted for SBO with a virgin abdomen between January 2008 and December 2016. Clinical, laboratory and radiological findings were assessed to determine the difference between the urgent surgical versus the non operative management groups. Statistical analyses were performed using SPSS version 24.0. Logistic regression was used to determine the independent predictive factor of an urgent surgery. Results: Overall, 59 patients with no prior abdominal surgery were admitted to Department. There were 37 males and 22 females. The median age was 52 years. The CT scan performed in 52 cases, revealed the cause of obstruction in 35 cases (67.30%). The most common cause of obstruction was Crohn’s disease present in 13 cases (22.03%). Twenty-nine patients (49.15%) underwent surgery. A rate of C-Reactive Protein (CRP) >135 mg/L was an independent predictor of an urgent surgery {p-value=0.010; OR=1.009 ; IC=95% (1.001-1.018)}. Conclusion: Although there was compelling evidence that the CT scan was essential in the management pathway, it was not accurate in the present study in terms of determining the causes of obstruction and predicting the need for performing urgent surgery. A rate of CRP ≥135 mg/L was a predictive factor of urgent surgery.
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