Predictive factors with intestinal strangulation and operative intervention for recurrence in adhesive small bowel obstruction / 中国实用外科杂志

ABSTRACT

OBJECTIVE: To analyze the predictive factors for intestinal strangulation and to identify the surgical intervention for recurrence of adhesive small bowel obstruction(aSBO).METHODS: A retrospective study was conducted according the database in Department of Gastric and Colorectal Surgery, the First Hospital of Jilin University. Patients with aSBO from January 2013 to April 2016 were included in the study and were subject to follow-up. The clinical factors associated with strangulating obstruction and recurrences after treatment were analyzed by using univariate and multivariate logistic regression model.RESULTS: Total of 288 aSBO patients were included. Thirty-seven(12.9%)patients hadoccurredstrangulatingobstructions,and 251(87.1%)patients had simple obstructions.Increasing heart rate[>100/min;OR(95%CI)4.14(1.31-13.07),P=0.015],increasing WBC count[>15×10~9∕L;OR(95%CI)4.31(1.31-14.16),P=0.016],CT findings of thickening or swelling of the mesentery[OR(95%CI)11.04(2.18-55.92),P=0.004],and CT showing seroperitoneum [OR(95%CI)28.36(9.85-81.66),P<0.01] were detected as independent predictive factors for intestinal strangulation. During the follow-up,84 cases(29.2%)experienced recurrence of obstruction. The recurrence rates were reduced in the operation groups compared with non-operative groups[21.3%(26/122)vs.34.9%(58/166),P =0.01].CONCLUSION: Tachycardia,leukocytosis,CT findings of thickening or swelling of the mesentery,and CT showing seroperitoneum are considered as the predictive factors with intestinal strangulation in aSBO. Meanwhile,surgical treatments can reduce recurrence rate of aSBO patients significantly.