Early identification of reversible strangulating ischemia in adhesive small bowel obstruction using non-contrast computed tomography and routine laboratory parameters

doi:10.4240/wjgs.122899

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Publication Name

World Journal of Gastrointestinal Surgery

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1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

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, Ju-Dong Zhang, Yi-Fang Hsieh, Shi-Chao Xu

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

Core Tip

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.