Prognostic Factors to Identify Resolution of Small Bowel Obstruction Without Need for Operative Management: Systematic Review

Overview

Journal Eur Radiol

Specialty Radiology

Date 2023 Nov 8

PMID 37938387

Authors

Vivienne N Eze

Tom Parry

Darren Boone

Sue Mallett

Steve Halligan

Affiliations

Soon will be listed here.

Abstract

Objectives: To identify imaging, clinical, and laboratory variables potentially prognostic for surgical management of small bowel obstruction.

Methods: Two researchers systematically reviewed indexed literature 2001-2021 inclusive for imaging, clinical, and laboratory variables potentially predictive of surgical management of small bowl obstruction and/or ischaemia at surgery, where performed. Risk of bias was assessed. Contingency tables for variables reported in at least 5 studies were extracted and meta-analysed to identify strong evidence of association with clinical outcomes, across studies.

Results: Thirty-one studies were ultimately included, reporting 4638 patients (44 to 313 per study). 11 (35%) studies raised no risk of bias concerns. CT was the modality reported most (29 studies, 94%). Meta-analysis of 21 predictors identified 5 strongly associated with surgical intervention, 3 derived from CT (peritoneal free fluid, odds ratio [OR] 3.24, 95%CI 2.45 to 4.29; high grade obstruction, OR 3.58, 95%CI 2.46 to 5.20; mesenteric inflammation, OR 2.61, 95%CI 1.94 to 3.50; abdominal distension, OR 2.43, 95%CI 1.34 to 4.42; peritonism, OR 3.97, 95%CI 2.67 to 5.90) and one with conservative management (previous abdominopelvic surgery, OR 0.58, 95%CI 0.40 to 0.85). Meta-analysis of 10 predictors identified 3 strongly associated with ischaemia at surgery, 2 derived from CT (peritoneal free fluid, OR 3.49, 95%CI 2.28 to 5.35; bowel thickening, OR 3.26 95%CI 1.91 to 5.55; white cell count, OR 4.76, 95%CI 2.71 to 8.36).

Conclusions: Systematic review of patients with small bowel obstruction identified four imaging, three clinical, and one laboratory predictors associated strongly with surgical intervention and/or ischaemia at surgery.

Clinical Relevance Statement: Via systematic review and meta-analysis, we identified imaging, clinical, and laboratory predictors strongly associated with surgical management of small bowel obstruction and/or ischaemia. Multivariable model development to guide management should incorporate these since they display strong evidence of potential utility.

Key Points: • While multivariable models incorporating clinical, laboratory, and imaging factors could predict surgical management of small bowel obstruction, none are used widely. • Via systematic review and meta-analysis we identified imaging, clinical, and laboratory variables strongly associated with surgical management and/or ischaemia at surgery. • Development of multivariable models to guide management should incorporate these predictors, notably CT scanning, since they display strong evidence of potential utility.

Citing Articles

Clinical and Radiological Factors Associated with Nonoperative Management Failure for Small Bowel Obstruction: A Retrospective Study from a Resource-Limited Setting.

Al-Wageeh S, Alyhari Q, Ahmed F, Mohammed H, Dahan N, Almohtadi A Ther Clin Risk Manag. 2024; 20:893-906.

PMID: 39734746 PMC: 11682671. DOI: 10.2147/TCRM.S496629.

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