Computed Tomography Features Associated with Operative Management for Nonstrangulating Small Bowel Obstruction
Rakesh R. Suri*1, Parag Vora2, John M. Kirby2, Kevin Chan1, Stephen Smith1, Leyo Ruo1
1General Surgery, McMaster University, Hamilton, ON, Canada; 2Radiology, McMaster University, Hamilton, ON, Canada
Purpose: There is limited data regarding the usefulness of computed tomography (CT) to predict operative management for patients with nonstrangulating small bowel obstruction (SBO). This study aims to determine whether specific features on CT scans in patients with nonstrangulating SBO are associated with the need for surgical intervention.Methods: We performed a retrospective review of all patients with SBO admitted to a tertiary care centre within a two year period (2004-2006). We excluded patients with a history of intraabdominal cancer, inflammatory bowel disease, abdominal or pelvic radiation, recent surgery, those with a clinical indication for immediate surgery or comorbidities precluding them from surgery. All patients had CT scans performed within 48 hours of admission. All scans were independently reviewed by two staff gastrointestinal radiologists blinded to clinical outcomes. Concordance between CT observers was calculated by the kappa test. The primary outcome evaluated was whether SBO required surgical intervention or resolved with nonoperative management. Variables were examined by univariate analysis using the chi-square or Fisher’s exact test. Independent predictive features were derived from a multivariable stepwise logistic regression analysis.Results: A total of 229 patients were identified of whom 125 met inclusion criteria; CT scans were available for 63 patients. Of these, 27 patients (43%) underwent surgical intervention and 36 patients (57%) were managed nonoperatively. There were five CT features frequently associated with surgery on univariate analysis; of these, transition point, complete bowel obstruction, and small bowel dilation greater than 4 cm had good concordance between radiologists. Only transition point remained significant (OR = 19, 95% CI [1.8 - 201], p=0.014) on multivariable logistic regression analysis.Conclusion: The presence of a transition point on CT scan in patients with a clinical diagnosis of nonstrangulating SBO was significantly associated with the need for surgical intervention.
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