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Kryvoruchko IA, Boyko VV, Sartelli M, Coccolini F, Catena F, Olefir OS. SURGICAL TREATMENT OF ACUTE SMALL BOWEL OBSTRUCTION: CLINICAL AND LABORATORY PARAMETERS ASSOCIATED WITH STRANGULATION AND EARLY MORTALITY AFTER SURGERY. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 75:2891-2900. [PMID: 36723300 DOI: 10.36740/wlek202212101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim: The study aimed to evaluate some criteria for preoperative diagnosis of strangulation and significant indicators of the prognosis of short-term outcomes in patients with small bowel obstruction. PATIENTS AND METHODS Materials and methods: The results of the treatment of 123 patients aged 18-70 years with SBO were evaluated. RESULTS Results: All of these patients underwent emergency surgery, and 22 patients (17.9%) have died. It has been shown that four lab parameters (blood leukocytes, lactate, intestinal fatty acid-binding protein, and C-reactive protein levels) and one instrumental (involving the mesentery of the small intestine, free fluid in the abdomen during CT) with 80% probability or more were associated with the strangulation type of SBO (Λ=0.276, p = 0.000). Three lab indicators (WBC count, serum lactate, and intestinal fatty acid-binding protein levels) and two clinical parameters (abdominal perfusion pressure level and the presence of abdominal sepsis) were associated with early mortality after surgery (Λ=0.626, p = 0.000) with the same probability. Immediate results of the treatment in these patients depended on the development of intra-abdominal complications after surgery (P = 0.024) and the need for early reoperation (P = 0.006) as well as the development of cardiovascular dysfunction (P = 0.000) and respiratory dysfunction (P = 0.000). CONCLUSION Conclusions: There were confirmed parameters that were significantly associated with strangulation before surgery and short-term in-hospital mortality with an 80% probability or more. This made it possible to develop new mathematical models for the diagnosis of strangulated bowel obstruction and early postoperative mortality with an accuracy of 84.5% and 84.2%, respectively.
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Demessence R, Lyoubi Y, Feuerstoss F, Hamy A, Aubé C, Paisant A, Venara A. Surgical management of adhesive small bowel obstruction: Is it still mandatory to wait? - An update. J Visc Surg 2022; 159:309-319. [PMID: 35272958 DOI: 10.1016/j.jviscsurg.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Small bowel obstruction syndromes (SBO) represent one of the main causes of emergency admission for surgical abdominal pain. The 2018 Bologna Guidelines (Ten Broek et al. 2018) recommend non-operative management at the outset if there are no signs of severity; surgery is proposed after 72h for the 20-30% of patients who fail medical management. However, these recommendations were based on old studies published at a time when laparoscopic surgery was not commonplace and when diagnostic capabilities (particularly for establishing etiology) were less developed than they are today. Additionally, the advent and development of laparoscopy and enhanced rehabilitation after surgery have led to a decrease in surgical morbidity. These guidelines are therefore now debated and several recent publications have encouraged urgent or semi-urgent surgical management for patients presenting for SBO in order to reduce morbidity, mortality, duration of hospitalization and costs, and to improve the feasibility of therapeutic laparoscopy. Prompt surgical management could also reduce the risk of recurrent small bowel obstructions. This model for early surgical management probably cannot be applied to all patients. It therefore seems important to select those patients at risk for failure of medical treatment and to identify those in whom the probability of successful laparoscopy is high. New radiological tools should allow better selection in the future. At the present time, the indications for early surgery "within 24h" should be emphasized.
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Affiliation(s)
- R Demessence
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France
| | - Y Lyoubi
- Faculty of Health of Angers, Department of Medicine, Angers, France; Urology Department, CHU d'Angers, 49933 Angers Cedex 9, France
| | - F Feuerstoss
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France
| | - A Hamy
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France
| | - C Aubé
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France
| | - A Paisant
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France
| | - A Venara
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France.
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Amara Y, Leppaniemi A, Catena F, Ansaloni L, Sugrue M, Fraga GP, Coccolini F, Biffl WL, Peitzman AB, Kluger Y, Sartelli M, Moore EE, Di Saverio S, Darwish E, Endo C, van Goor H, Ten Broek RP. Diagnosis and management of small bowel obstruction in virgin abdomen: a WSES position paper. World J Emerg Surg 2021; 16:36. [PMID: 34217331 PMCID: PMC8254282 DOI: 10.1186/s13017-021-00379-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Background Small bowel obstruction (SBO) is a common surgical emergency, causing high morbidity and healthcare costs. The majority of SBOs are caused by adhesions that result from previous surgeries. Bowel obstruction, however, also occurs in patients without previous operation or known pathology, a so called virgin abdomen. It is unknown if small bowel obstruction in the virgin abdomen (SBO-VA) can be managed according to the same principles as other cases of small bowel obstruction. The aim of this position paper is to evaluate the available evidence on etiology and management of small bowel obstruction in the virgin abdomen. Methods This is a narrative review with scoping aspects. Clinical topics covered in this review include epidemiology and etiology of SBO-VA, diagnosis and imaging, initial assessment, the role of surgical management in SBO-VA, and the role of non-operative management in SBO-VA. Results Our scoping search revealed seven original studies reporting original patient data related to SBO-VA. All the included studies are retrospective cohorts, with populations ranging between 44 and 103 patients with SBO-VA. Adhesions were found to be the cause of the obstruction in approximately half of the reported cases of SBO-VA. A relatively high number of cases of SBO-VA were managed surgically with studies reporting 39–83%. However, in cases where a trial of non-operative management was started, this was generally successful. Conclusion The data available suggest that etiology and treatment results for patients with SBO-VA are largely comparable to the results in patients with SBO after previous abdominal surgery. We therefore propose that patients with a virgin abdomen could be treated according to existing guidelines for SBO and adhesive small bowel obstruction.
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Affiliation(s)
- Yousef Amara
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of General Surgery, The Baruch Padeh Medical Centre, Poriya, Israel
| | - Ari Leppaniemi
- Second Department of Surgery, Meilahti Hospital, Helsinki, Finland
| | - Fausto Catena
- Department of General Surgery, Parma University Hospital, Parma, Italy
| | - Luca Ansaloni
- General Emergency And Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Michael Sugrue
- General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland
| | - Gustavo P Fraga
- Faculdade de Ciências Médicas (FCM), Unicamp Campinas, São Paulo, Brazil
| | | | - Walter L Biffl
- Acute Care Surgery, The Queen's Medical Center, Honolulu, Hawaii, USA
| | - Andrew B Peitzman
- Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus Haifa, Haifa, Israel
| | | | | | | | - Esfo Darwish
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Chikako Endo
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Richard P Ten Broek
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Inoue A, Furukawa A, Takaki K, Imai Y, Ota S, Nitta N, Watanabe Y. Noncontrast MRI of acute abdominal pain caused by gastrointestinal lesions: indications, protocol, and image interpretation. Jpn J Radiol 2020; 39:209-224. [PMID: 33034849 DOI: 10.1007/s11604-020-01053-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
Gastrointestinal tract lesions are major causes of acute abdominal pain. A rapid, accurate, and reliable diagnosis is required to manage patients. Magnetic resonance imaging (MRI) is a nonionizing modality that is beneficial for pregnant women, children, and young adults who are sensitive to ionizing radiation. For patients with renal impairment who are not accurately diagnosed with noncontrast computed tomography, noncontrast MRI can serve as an alternative diagnostic modality. MRI protocols used for acute abdominal pain are supposed to be optimized and prioritized to shorten scanning times. Single-shot T2-weighted and fat-suppressed T2-weighted imaging are important pulse sequences that are used to reveal pathology and inflammation in the gastrointestinal tract. Diffusion-weighted imaging clearly depicts inflammation and abscesses as hyperintense lesions. Most acute gastrointestinal tract lesions, including inflammation, ischemia, obstruction, and perforation, demonstrate bowel wall thickening. Bowel obstruction and adynamic ileus present bowel dilatation, and perforation and penetration show bowel wall defects. MRI can be used to reveal these pathological findings with some characteristics depending on their underlying pathophysiology. This review article discusses imaging modalities for acute abdominal pain, describes a noncontrast MRI protocol for acute abdominal pain caused by gastrointestinal tract lesions, and reviews MRI findings of acute gastrointestinal tract lesions.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, National Hospital Organization, Higashi-ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-8505, Japan.
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Akira Furukawa
- Department of Radiological Science, Tokyo Metropolitan University, 7-2-10, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Kai Takaki
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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