Predictive factors for surgical indication in adhesive small bowel obstruction.
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 (>or=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.
Tanaka
Shogo
S
Department of Surgery, Ishikiriseiki Hospital, 18-28 Yayoicho, Higashiosaka 579-8026, Osaka, Japan. m8827074@msic.med.osaka-cu.ac.jp
Yamamoto
Takatsugu
T
Kubota
Daisuke
D
Matsuyama
Mitsuharu
M
Uenishi
Takahiro
T
Kubo
Shoji
S
Ono
Koichi
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D007421:Intestine, Small / Q000601:surgery*; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D000267:Tissue Adhesions / Q000150:complications / Q000601:surgery*