Can Plain Abdominal X-Ray Predict the Need for Operation in Patients with Adhesive Small Bowel Obstruction?
Nathan M. Novotny*1, Daniel a. Liesen2, Anthony Senagore3, Thomas Z. Hayward1, Don J. Selzer1, Robert E. Pennington1, Imtiaz a. Munshi1, Nicholas J. Zyromski1
1General Surgery, Indiana University, Indianapolis, IN; 2General Surgery, Medical University of Ohio, Toledo, OH; 3General Surgery, Michigan State University, Grand Rapids, MI
Background: The decision to operate on a patient with adhesive small bowel obstruction (SBO) is multifactorial. However, in an age of ubiquitous computed tomography scans, our hypothesis was that plain abdominal x-ray (AXR) alone can predict whether or not patients would eventually need laparotomy for definitive management of SBO.
Methods: Thirty patients’ acute abdominal series were selected for inclusion. All patients had adhesive SBO; patients with SBO due to cancer or hernia were excluded. Half of these patients underwent laparotomy, with intraoperative findings or pathology confirming the need for operative intervention. The others half were successfully managed conservatively. Long-term (>1 year) follow-up confirmed no subsequent readmission or operation for SBO. Sixteen general surgeons of varying experience were asked to predict need for laparotomy based solely on AXR findings.
Results: Surgeons’ overall accuracy in predicting the need for operation was 50%. (Table) Surgeons with 0-10, 11-20, and 21+ years post-residency had an accuracy of 37%, 50%, and 56% respectively. Compared to surgeons with 0-5 years experience, surgeons with 11-20 and 21+ years of experience were significantly more accurate (p=0.029 and p=0.003 respectively). Three patients needing laparotomy had high agreement among all surgeons with 88-94% accuracy. In each of these patients, surgeons identified degree of small bowel distention as the primary reason for predicting need for laparotomy.
Conclusion: These data show that plain abdominal x-ray alone is still important in deciding which patient with adhesive SBO will require operative intervention. Experienced gastrointestinal surgeons (>11 years) are significantly more likely than junior surgeons (0-5 years) to predict the need for surgery based on AXR alone.
| N | Percent Correct (Mean, range in parentheses) | Specificity | Sensitivity | |
| All Surgeons | 16 | 50% (30-63%) | 51% | 49% |
| Experience | ||||
| 0-5 years | 3 | 37% (30-43%) | 36% | 37% |
| 11-20 years | 7 | 50%* (43-63%) | 62% | 43% |
| 21+ years | 6 | 56%* (47-63%) | 46% | 63% |
Table I: Summary of surgeons responses with breakdown by experience (years post training).
*p<0.05 when compared to experience of 0-5 years
