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Predicting the outcome of closed-loop small bowel obstruction by preoperative characteristics

World Journal of Gastrointestinal Surgery 2022年第6期14卷 556-566页

作者： Masja K Toneman Bente M de Kok Frank M Zijta Stanley Oei Gijs J D van Acker marinke westerterp Anne E M van der Pool Department of Surgery Haaglanden Medical CentreThe Hague 2512 VANetherlands Department of Radiology Haaglanden Medical CentreThe Hague 2512 VANetherlands

BACKGROUND Closed-loop small bowel obstruction(CL-SBO)can threaten the viability of the intestine by obstructing a bowel segment at two adjacent *** recognition and surgery are *** To analyze the outcomes of patients who underwent surgery for CL-SBO and to evaluate clinical *** Patients who underwent surgery for suspected CL-BSO on computed tomography(CT)at a single center between 2013 and 2019 were evaluated *** were divided into three groups by perioperative outcome,including viable bowel,reversible ischemia,and irreversible *** and laboratorial variables at presentation were compared and postoperative outcomes were *** Of 148 patients with CL-SBO,28(19%)had a perioperative viable small bowel,86(58%)had reversible ischemia,and 34(23%)had irreversible *** with a higher age had higher risk for perioperative irreversible ischemia[odds ratio(OR):1.03,95%confidence interval(CI):0.99-1.06].Patients with American Society of Anaesthesiologists(ASA)classification≥3 had higher risk of perioperative irreversible ischemia compared to lower ASA classifications(OR:3.76,95%CI:1.31-10.81).Eighty-six patients(58%)did not have elevated C-reactive protein(>10 mg/L),and between-group differences were *** in-hospital stay was significantly longer for patients with irreversible ischemia(median 8 d,P=0.001)than for those with reversible ischemia(median 6 d)or a viable bowel(median 5 d).Postoperative morbidity was significantly higher in patients with perioperative irreversible ischemia(45%,P=0.043)compared with reversible ischemia(20%)and viable bowel(4%).CONCLUSION Older patients or those with higher ASA classification had an increased risk of irreversible ischemia in case of *** irreversible ischemia,postoperative morbidity was increased.

关键词： General surgery Laparoscopy Laparotomy Critical care Intestinal obstruction Morbidity

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