Predictive factors for surgical indication in adhesive small bowel obstruction

Tanaka, Shogo; Yamamoto, Takatsugu; Kubota, Daisuke; Matsuyama, Mitsuharu; Uenishi, Takahiro; Kubo, Shoji; Ono, Koichi

doi:10.1016/j.amjsurg.2007.05.048

« Previous Next »The American Journal of Surgery
Volume 196, Issue 1 , Pages 23-27, July 2008

Predictive factors for surgical indication in adhesive small bowel obstruction

Shogo Tanaka, M.D.
- Department of Surgery, Ishikiriseiki Hospital, 18-28 Yayoicho, Higashiosaka 579-8026, Osaka, Japan
- Corresponding author. Tel.: +81-72-988-3121; fax: +81-72-988-3119.
Takatsugu Yamamoto, M.D.
- Department of Surgery, Ishikiriseiki Hospital, 18-28 Yayoicho, Higashiosaka 579-8026, Osaka, Japan
Daisuke Kubota, M.D.
- Department of Surgery, Joto Central Hospital, Osaka, Japan
Mitsuharu Matsuyama, M.D.
- Department of Surgery, Joto Central Hospital, Osaka, Japan
Takahiro Uenishi, M.D.
- Department of Surgery, Ishikiriseiki Hospital, 18-28 Yayoicho, Higashiosaka 579-8026, Osaka, Japan
Shoji Kubo, M.D.
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
Koichi Ono, M.D.
- Department of Surgery, Ishikiriseiki Hospital, 18-28 Yayoicho, Higashiosaka 579-8026, Osaka, Japan

published online 27 March 2008.

Abstract

Background

Small bowel obstruction (SBO) after abdominal surgery is usually treated successfully with intestinal decompression using a long nasointestinal tube (LT), but some cases fail to respond.

Methods

Clinical background and laboratory data on admission were evaluated retrospectively for 53 patients with adhesive SBO to determine predictive factors for failure of LT decompression, and the appropriate timing of laparotomy was investigated.

Results

Complete SBO (no evidence of air within the large bowel) and increased serum creatine phosphokinase (≥130 IU/L) were independent predictive factors for LT decompression failure. Laparotomy was indicated in 14 patients (9 and 5 with complete and partial SBO, respectively), whereas successful LT decompression occurred in 39 patients (9 and 30, respectively). Resolution of SBO took significantly longer for complete SBO (6.3 days) than for partial SBO (2.6 days).

Conclusions

Patients with complete SBO or high serum creatine phosphokinase (CPK) may not respond to LT decompression. Laparotomy is appropriate after non-response for 7 and 3 days for complete and partial SBO, respectively.

Keywords: Ileus, Strangulation, Timing of surgery