Ng ZQ, Hsu V, Tee WWH, Tan JH, Wijesuriya R. Predictors for success of non-operative management of adhesive small bowel obstruction. World J Gastrointest Surg 2023; 15(6): 1116-1124 [PMID: 37405103 DOI: 10.4240/wjgs.v15.i6.1116]
Corresponding Author of This Article
Zi Qin Ng, MBBS (Hons), FRACS Senior Researcher, Surgeon, Department of General Surgery, St John of God Midland Hospital, 1 Clayton Street, Midland 6056, Western Australia, Australia. kentng@hotmail.co.uk
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1116-1124 Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1116
Predictors for success of non-operative management of adhesive small bowel obstruction
Zi Qin Ng, Vivien Hsu, William Wei Han Tee, Jih Huei Tan, Ruwan Wijesuriya
Zi Qin Ng, Vivien Hsu, Ruwan Wijesuriya, Department of General Surgery, St John of God Midland Hospital, Midland 6056, Western Australia, Australia
William Wei Han Tee, Department of Radiology, St John of God Midland Hospital, Midland 6056, Western Australia, Australia
Jih Huei Tan, Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru 80000, Johor, Malaysia
Author contributions: Ng ZQ contributed to the data analysis and drafting of manuscript; Hsu V collected the data; Tee WWH collected the radiological data collection, review of manuscript; Tan JH contributed to the statistical data analysis; Hsu V, Tee WWH, and Tan JH involved in the review of the manuscript; Ng ZQ and Wijesuriya R designed the study; Wijesuriya R contributed to critical review of manuscript and supervision of study; and all authors approved the final version of this manuscript for submission and publication.
Institutional review board statement: Ethical approval was obtained from the St John of God Healthcare’s ethics committee (Ref: 1358).
Informed consent statement: The consent was waived from the institute’s ethics committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. Dr Zi Qin Ng received the General Surgeons Australia Junior Doctor Research Grant in 2018 for this study.
Data sharing statement: Data is available upon reasonable request grounds.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zi Qin Ng, MBBS (Hons), FRACS Senior Researcher, Surgeon, Department of General Surgery, St John of God Midland Hospital, 1 Clayton Street, Midland 6056, Western Australia, Australia. kentng@hotmail.co.uk
Received: December 27, 2022 Peer-review started: December 27, 2022 First decision: January 20, 2023 Revised: January 21, 2023 Accepted: April 13, 2023 Article in press: April 13, 2023 Published online: June 27, 2023
ARTICLE HIGHLIGHTS
Research background
Adhesive small bowel obstruction (SBO) is a common presentation in acute care surgery. Majority of cases are managed with non-operative approach successfully. Nevertheless, there is a small proportion of patients will fail non-operative management and require surgical intervention.
Research motivation
The delay surgical intervention in patients that fail non-operative management in adhesive SBO may result in small bowel ischemia requiring resection. This may lead to further morbidity and mortality.
Research objectives
The aim of this study was to identify predictors from clinical presentation, laboratory tests and imaging results that may help identify cases of adhesive SBO that are unlikely to resolve with non-operative management.
Research methods
A retrospective analysis of all cases of SBO in our institute were undertaken. The cases of SBO secondary to causes such as incarceration, tumour, volvulus, inflammatory bowel disease etc were excluded. The computed tomography (CT) scans were independently reviewed by a consultant radiologist who was blinded to the outcomes for specific signs that may determine the success of non-operative management of adhesive SBO.
Research results
Clinical presentation and laboratory results were not predictive of the success of non-operative management of SBO. Only the CT findings of a definitive transition point, presence of free fluid and absence of small bowel faecal sign were predictive of the need of surgical intervention in adhesive SBO.
Research conclusions
The CT findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.
Research perspectives
Future studies should focus on universal definitions of the CT findings and outcomes to allow accurate comparison of the efficacy of the therapeutic options.
