CT scan findings do not predict outcome of nonoperative management in small bowel obstruction: Retrospective analysis of 108 consecutive patients

• Small bowel obstruction, likely secondary to adhesions from previous abdominal surgery, is a very common occurrence and a relevant acute care problem.
• Computed tomography is routinely used in the diagnostic evaluation of small bowel obstruction.
• Certain CT scan findings have been proposed as indicative of need for surgical intervention in adhesive small bowel obstruction.
• Our experience does not show that CT scan findings alone can reliably predict failure of nonoperative management in adhesive small bowel obstruction.

ObjectivesThe study purpose was to investigate the ability of Emergency Department CT scan to predict the need for operative intervention in patients hospitalized for small bowel obstruction (SBO) likely secondary to adhesions (ASBO) and initially managed nonoperatively.DesignRetrospective case series. Statistical analysis was done with independent-samples t-test and chi-square to identify correlation between variables and outcome of nonoperative management.SettingTertiary care academic medical center.Patients and MethodsOf 200 consecutive patients hospitalized for SBO, 108 were included in the study with a diagnosis of ASBO and received initial nonoperative management. Exclusion criteria were need for emergency surgery (e.g. peritonitis) or other diagnoses (e.g. neoplasms, hernias, Crohn's disease). CT findings such as transition point, small bowel faeces, high grade obstruction, and abnormal vascular course were correlated with failure of nonoperative management.ResultsOnly 18 patients (16.7%) required operative intervention, while the other 90 (83.3%) were successfully discharged after nonoperative care. There was no correlation between CT scan findings and treatment outcome.ConclusionsEmergency Department CT scan findings do not significantly alter management decisions in patients admitted for ASBO and managed initially with nonoperative care.