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 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, chi(2)). 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).


CONCLUSIONS
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.
O'Daly
Brendan J
BJ
Surgical Professorial Unit, St Vincent'sUniversity Hospital, Elm Park, Dublin, Ireland.
Ridgway
Paul F
PF
Keenan
Niamh
N
Sweeney
Karl J
KJ
Brophy
David P
DP
Hill
Arnold D K
AD
Evoy
Denis
D
O'Higgins
Niall J
NJ
McDermott
Enda W M
EW
D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome