title: Surgical indicators for the operative treatment of acute mechanical intestinal obstruction due to adhesions.
abstract: OBJECTIVE
  Our aim was to investigate the predictive factors indicating strangulation, and the requirement for surgery in patients with acute mechanical intestinal obstruction due to adhesions.
  
  
  METHODS
  This study retrospectively evaluated the records of patients with adhesive acute mechanical intestinal obstruction. The surgical treatment (group S), conservative treatment (group C), intraoperative bowel ischemia (group I), and intraoperative adhesion only (group A) groups were statistically evaluated according to the diagnostic and surgical parameters.
  
  
  RESULTS
  The study group of 252 patients consisted of 113 women (44.8%), and 139 men (55.2%). The mean age was 62.79 ± 18.08 years (range, 20-98 years). Group S consisted of 50 patients (19.8%), and 202 (80.2%) were in group C. Group I consisted of 19 patients (38%), where as 31 (62%) were in group A. In group S, the prehospital symptomatic period was longer, incidence of fever was increased, and elevated CRP levels were significant (P < 0.05). Plain abdominal radiography, and abdominal computerized tomography were significantly sensitive for strangulation (P < 0.05). The elderly were more prone to strangulation (P < 0.05). Fever, rebound tendernes, and urea & creatinine levels were significantly higher in the presence of strangulation (P < 0.05, P < 0.05, and P < 0.05, consecutively).
  
  
  CONCLUSIONS
  Fever, rebound tenderness, urea & creatinine levels, plain abdominal radiography, and abdominal computerized tomography images were important indicators of bowel ischemia. Longer prehospital symptomatic period was related with a tendency for surgical treatment, and the elderly were more prone to strangulation. CRP detection was considered to be useful for the decision of surgery, but not significantly predictive for strangulation.
authors.affiliation: Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
authors.forename: Tunc
authors.initials: T
authors.lastname: Eren
authors.affiliation: Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
authors.forename: Salih
authors.initials: S
authors.lastname: Boluk
authors.affiliation: Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
authors.forename: Baris
authors.initials: B
authors.lastname: Bayraktar
authors.affiliation: Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
authors.forename: Ibrahim Ali
authors.initials: IA
authors.lastname: Ozemir
authors.affiliation: Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
authors.forename: Sumeyra
authors.initials: S
authors.lastname: Yildirim Boluk
authors.affiliation: Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
authors.forename: Ercument
authors.initials: E
authors.lastname: Tombalak
authors.affiliation: Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Alimoglu
keywords: Intestinal obstruction; Surgery; Tissue adhesions