Diagnostic nomogram for closed-loop small bowel obstruction requiring emergency surgery

Purpose: This study aimed to build a diagnostic model of closed-loop small bowel obstruction (CL-SBO) using clinical information, blood test results, and computed tomography (CT) findings.Methods: All patients who were diagnosed with small bowel obstruction (SBO) and underwent surgery between January 1, 2018, and October 31, 2021, in the affiliated hospital of Qingdao university were reviewed, and their relevant preoperative information was collected. All variables were selected using univariate analysis and back-ward stepwise regression to build a diagnostic nomogram model. K-fold cross-validation and bootstrap resam-pling techniques were used for internal validation, and data from Qingdao Central Hospital were used for external validation. We also evaluated the diagnostic performance of each CT finding and performed subgroup analysis according to bowel ischemia in the closed-loop small bowel obstruction (CL-SBO) group.Results: A total of 219 patients (95 in the CL-SBO group and 124 in the open-loop small bowel obstruction [OL-SBO] group) were included in our research. D-dimers (median 1085 vs. 690, P = 0.019), tenderness (77.9% vs. 59.7%, P = 0.004), more than one beak sign (65.3% vs. 30.6%, P < 0.001), radial distribution (18.9% vs. 6.5%, P = 0.005), whirl sign (35.8% vs. 8.9%, P < 0.001), and ascites (71.6% vs. 53.2%, P = 0.006) were selected as the predictive variables of the nomogram. This model's Harrell's C statistic was 0.786 (95% confidence interval (CI), 0.724-0.848), and the Brier score was 0.182. The Harrell's C statistic of external validation was 0.784 (95%CI, 0.664-0.905); the Brier score was 0.190. Regarding the CT findings, radial distribution, U/C-shaped loop, and whirl sign had high specificity (93.5%, 96.0%, and 91.1%, respectively), but low sensitivity (18.9%, 8.4%, and 35.8%, respectively). D-dimer levels and tenderness were also associated with bowel ischemia.Conclusion: The nomogram accurately predicted CL-SBO in patients with SBO, and surgery should be considered when patients have a high risk for developing CL-SBO.(c) 2022 Published by Elsevier Inc.