Progressive increase of bowel wall thickness is a reliable indicator for surgery in patients with adhesive small bowel obstruction.
OBJECTIVE
The aim of this study was to determine whether progressive increase of bowel wall thickness during nonoperative treatment is a reliable indicator for surgery in patients with adhesive small bowel obstruction.


METHODS
The study consisted of a prospective case series of 121 patients with adhesive small bowel obstruction who underwent an abdominal ultrasonographic examination. The results of ultrasonographic examinations were classified into two groups according to the presence (Group I) or absence (Group II) of bowel wall thickening. Bowel wall thickening was recognized as a visible small bowel wall > or =3 mm in width as seen by ultrasonographic examination. The findings of subsequent ultrasonographic examinations taken 24 hours later were compared with those taken at admission. Surgery was determined based on the presence of any toxic signs or the failure of nonoperative treatment. The number of patients who had successful nonoperative treatment, the number of patients who underwent surgeries, and the number of complications in each group were calculated to correlate with the ultrasonographic findings.


RESULTS
There are 49 and 72 patients in Groups I and II, respectively. The number of patients who had successful nonoperative treatment and number of patients who underwent surgeries in Group I are 40 (81.6 percent) and 9 (18.4 percent) and in Group II the numbers are 68 (94.4 percent) and four (5.6 percent), respectively (P = 0.036). All 12 (100 percent) patients with progressive increase of bowel wall thickness underwent surgery. Progressive increase of bowel wall thickness as an indicator for surgery has a sensitivity of 92.3 percent (95 percent confidence interval, 62.1-99.6 percent) and a specificity of 100 percent (95 percent confidence interval, 95.7-100 percent).


CONCLUSIONS
Patients with initial bowel wall thickening have a higher incidence of surgery, and progressive increase of bowel wall thickness that appears 24 hours later is a reliable indicator for surgery in patients with adhesive small bowel obstruction.
Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.
Shyr-Chyr
SC
Chen
Chien-Chang
CC
Lee
Chiung-Yuan
CY
Hsu
Zui-Shen
ZS
Yen
Cheng-Chung
CC
Fang
Matthew H-M
MH
Ma
Wen-Jone
WJ
Chen
Hong-Shiee
HS
Lai
Po-Huang
PH
Lee
Fang-Yue
FY
Lin
Wei-Jao
WJ
Chen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D000267:Tissue Adhesions / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014463:Ultrasonography