The predictive factors for the necessity of operative treatment in adhesive small bowel obstruction cases

Background: The timely diagnosis of adhesive small bowel obstruction (SBO) can frequently be a clinical dilemma. The objective of this study was to evaluate the predictive factors for the necessity of operative treatment in adhesive SBO cases. Method : The records of hospitalized adhesive SBO patients at Dicle University Hospital (DUH) between January 1998 and December 2001 were prospectively reviewed. The patients divided into two groups as a non-operative group (NOG) and an operative group (OG). The epidemiological, clinical, and laboratory features were evaluated as probable predictive factors for the timing of the surgical treatment. Predictive factors associated with the timing of the surgical treatment were determined using logistic regression models. Results : A total of 180 patients [ 131(72.8%) male, 49(27.2%) female] with SBO were included in this study. One hundred and twenty patients (66.7%) were diagnosed with SBO and treated medically at the hospital. Sixty patients (33.3%) were diagnosed with SBO and underwent surgery. In univariate analyses, age (P = 0.008), length of period of symptoms (P < 0.001), high fever (P < 0.001), tachicardia (P < 0.001), tachypnea (P < 0.001), intractable pain (P < 0.001), hypoactive bowel sounds (P < 0.001), presence of rebound tenderness (P < 0.001), the persisting air-fluid levels in serial the plain abdominal radiographs (P < 0.001), leukocytosis (P < 0.001) and elevated CRP (P < 0.001) were found to be significantly associated with the predictive factors for the timing of operative treatment. In multivariate analyses, the presence of rebound tenderness [Odds Ratio (OR) = 57, 95% Confidence Interval (CI) = 3.5-922.4, p = 0.004], the persisting air-fluid levels (OR = 29, CI = 1.8-466.4, p = 0.018) were found significantly important as the predictive factors for the timing of operation. Conclusion : Presence of rebound tenderness and the persisting air-fluid levels at admission or in hospital should be considered as predictive factors for the timing of an operation in adhesive SBO cases.