World J Gastrointest Surg. Nov 27, 2026; 18(11): 122899 Published online Nov 27, 2026. doi: 10.4240/wjgs.122899
Early identification of reversible strangulating ischemia in adhesive small bowel obstruction using non-contrast computed tomography and routine laboratory parameters
Long-Chun Dong, Department of Radiology, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Nankai University, Tianjin 300121, China
Long-Chun Dong, Tianjin Medical University, Tianjin 300070, China
Ju-Dong Zhang, Shi-Chao Xu, Department of General Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Nankai University, Tianjin 300121, China
Yi-Fang Hsieh, School of Medicine, Nankai University, Tianjin 300071, China
Co-first authors: Long-Chun Dong and Ju-Dong Zhang.
Author contributions: Dong LC designed research; Zhang JD performed research; Hsieh YF and Xu SC contributed new reagents or analytic tools; Dong LC analyzed data; Dong LC wrote the paper. Dong LC and Zhang JD contributed equally to this work as co-first authors.
AI contribution statement: Not using AI tools.
Supported by Natural Science Foundation of Tianjin, No. 24JCZDJC01350; Tianjin Health Technology Project, No. TJWJ2025MS014; and Tianjin Key Medical Discipline Construction Project, No. TJYXZDXK-3-009B.
Institutional review board statement: The study was reviewed and approved by Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Nankai University.
Informed consent statement: This study is a retrospective one, analyzing medical records and/or data obtained from previous clinical diagnoses and treatments. It does not involve any intervention measures imposed on the study participants, does not interfere with routine diagnosis and treatment, and does not increase the risks for the study participants additionally.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at zjd_06221@163.com. Participants gave informed consent for data sharing.
Corresponding author: Ju-Dong Zhang, Department of General Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Nankai University, No. 190 Jieyuan Road, Tianjin 300121, China. zjd_06221@163.com
Received: May 22, 2026 Revised: June 18, 2026 Accepted: July 13, 2026 Published online: November 27, 2026 Processing time: 173 Days and 18.6 Hours
Abstract
BACKGROUND
Early identification of reversible strangulating ischemia in patients with adhesive small bowel obstruction (ASBO) remains challenging.
AIM
To develop a preliminary predictive model for strangulating ischemia based on risk factors, non-contrast computed tomography (CT) findings, and routine laboratory parameters.
METHODS
This retrospective study included data from 103 patients with surgically confirmed ASBO. Patients were classified into two groups based on the ischemia type: Non-strangulating (n = 74) and strangulating ischemia (n = 29). Clinical variables, laboratory results, and CT features were analyzed using multivariate logistic regression and receiver operating characteristic (ROC) curve analyses.
RESULTS
Shorter symptom duration before admission [odds ratio (OR) = 0.972, 95% confidence interval (CI): 0.953-0.992], mesenteric haziness (OR = 4.723, 95%CI: 1.099-20.294), closed-loop obstruction (OR = 7.181, 95%CI: 1.494-34.526), and lower base excess (OR = 0.604, 95%CI: 0.420-0.869) were independently associated with strangulating ischemia. The combined model yielded an area under the ROC curve of 0.897 (95%CI: 0.822-0.948), with a sensitivity of 82.76% and a specificity of 93.24%.
CONCLUSION
A preliminary model combining non-contrast CT findings and routine laboratory parameters helps identify strangulating ischemia at a potentially reversible stage of ASBO and supports early surgical decision-making.
Core Tip: This retrospective study of 103 patients with adhesive small bowel obstruction identified four independent predictors of strangulating ischemia: Shorter symptom duration, mesenteric haziness, closed-loop obstruction, and lower base excess. A combined model incorporating non-contrast computed tomography findings and routine laboratory parameters achieved excellent discrimination (area under the curve 0.897). The model aids early identification of potentially reversible strangulating ischemia and supports timely surgical decision-making.
