Detected peritoneal fluid in small bowel obstruction is associated with the need for surgical intervention
Background Predicting the clinical course in adhesional small bowel obstruction is difficult. There are no validated clinical or radiologic features that allow early identification of patients likely to require surgical intervention. Methods We conducted a retrospective review of 100 patients consec...
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Published in | Canadian Journal of Surgery Vol. 52; no. 3; pp. 201 - 206 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | French English |
Published |
Canada
CMA Impact Inc
01.06.2009
CMA Impact, Inc Canadian Medical Association |
Subjects | |
Online Access | Get full text |
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Summary: | Background Predicting the clinical course in adhesional small bowel obstruction is difficult. There are no validated clinical or radiologic features that allow early identification of patients likely to require surgical intervention. Methods We conducted a retrospective review of 100 patients consecutively admitted to a tertiary level teaching hospital over a 3-year period (2002–2004) who had acute adhesional small bowel obstruction and underwent computed tomography (CT). The primary outcomes that we assessed were conservative management or the need for surgical intervention. We investigated time to physiologic gastrointestinal function recovery as a secondary outcome. We examined independent predictors of surgical intervention in a bivariate analysis using a stepwise logistic regression analysis. Results Of the 100 patients investigated, we excluded 12. Of the 88 remaining patients, 58 (66%) were managed conservatively and 30 (34%) underwent surgery. Peritoneal fluid detected on a CT scan ( n = 37) was associated more frequently with surgery than conservative management (46% v. 29%, p = 0.046, χ2 ). Logistical regression identified peritoneal fluid detected on a CT scan as an independent predictor of surgical intervention (odds ratio 3.0, 95% confidence interval 1.15–7.84). Conclusion The presence of peritoneal fluid on a CT scan in patients with adhesional small bowel obstruction is an independent predictor of surgical intervention and should alert the clinician that the patient is 3 times more likely to require surgery. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0008-428X 1488-2310 |