Clinical and tomographic features associated with surgical management in adhesive small bowel obstruction patients.

Background The delay in surgical management of intestinal obstruction patients who did not respond to conservative management increases morbidity, mortality and days of hospital stay. Objective This study aimed to describe the clinical and tomographic features associated with surgical management in adhesive small bowel obstruction patients. Method We conducted a retrospective review of the electronic medical records during a 5-year period with the diagnosis of adhesive small bowel obstruction. We divided patients in two, those who responded to medical management and those who required surgery. Results A total of 162 patients were included, with a mean age of 61.5 years. It was the first case of intestinal obstruction in 63% of the patients and 65.4% underwent surgery: 52.8% (n = 56) open surgery and 47.2% (n = 50) laparoscopic surgery. Multivariate analysis showed the following predictors of surgical treatment: abdominal rebound (odds ratio [OR]: 8.8; 95% confidence interval [95% CI]: 1.09-71.6), tomographic free fluid (OR: 4.62; 95% CI: 1.50-14.20) and transition zone (OR: 5.4; 95% CI: 1.59-18.80). The history of previous obstruction was a protective factor (OR: 0.33; 95% CI: 0.17-0.67). Conclusions Abdominal rebound, free intrabdominal fluid and transition zone are related with the surgical management of adhesive small bowel obstruction.