Al-Wageeh Saleh, Alyhari Qasem, Ahmed Faisal, Mohammed Hanan, Dahan Noha, Almohtadi Abdullatif Mothanna, Al-Nuzili Sameer Taha Said, Badheeb Mohamed, Naji Abdulsattar
Department of General Surgery, School of Medicine, Ibb University, Ibb, Yemen.
Department of Urology, School of Medicine, Ibb University, Ibb, Yemen.
Ther Clin Risk Manag. 2024 Dec 25;20:893-906. doi: 10.2147/TCRM.S496629. eCollection 2024.
Recognizing factors that predict non-operative management (NOM) failure for patients with small bowel obstruction (SBO) aids in limiting surgical intervention when needed. This study investigated the predictive factors for NOM failure in SBO patients in a resource-limited setting.
A retrospective study included 165 patients who were diagnosed with SBO and were admitted and managed at Althora General Hospital, IBB, Yemen, from April 2022 to March 2024. Patients' baseline characteristics and profiles along with factors associated with failure of NOM were investigated and analyzed with univariate and multivariate analysis.
51 (30.4%) of included cohorts were managed non-operatively. The mean age was 47.7±16.9 years, and males were disproportionally presented (62.7%). The majority of patients presented with abdominal pain (96.1%). Failure of NOM was seen in 18 (35.3%) patients and intra-operative findings were adhesive bands, volvulus, intussusception, and mesenteric ischemia in 7 (38.9%), 5 (27.8%), 4 (22.2%), and 2 (11.1%) patients, respectively. Bowel resection was performed in 11 (61.1%), and 4 of them needed a colostomy diversion. Postoperative complications occurred in 13 (25.5%) patients, including fever, paralytic ileus, surgical site infection, and reoperation in 13 (25.5%), 5 (9.8%), 4 (7.8%), and 2 (3.9%) patients, respectively. Sixteen patients were discharged, and two patients died due to mesenteric ischemia. Among NOM successful patients, recurrence has occurred in 8 patients. In multivariate analysis, poor bowel wall enhancement (OR: 8.59; 95% CI: 1.14-64.59, p=0.037) and high level of obstruction (OR: 11.64; 95% CI: 1.34-100.85, p=0.026) in computed tomography (CT) scan were independently associated with NOM failure.
Poor bowel wall enhancement and significant obstruction on CT images are critical indicators for selecting SBO patients requiring urgent surgery. However, evaluating the advantages of surgical intervention versus NOM demands a comprehensive analysis of surgical risks, comorbidities, and the presence of bowel strangulation or ischemia.
识别预测小肠梗阻（SBO）患者非手术治疗（NOM）失败的因素有助于在必要时限制手术干预。本研究调查了资源有限环境下SBO患者NOM失败的预测因素。
一项回顾性研究纳入了2022年4月至2024年3月期间在也门伊卜省阿尔托拉综合医院确诊为SBO并入院治疗的165例患者。调查并分析了患者的基线特征和概况以及与NOM失败相关的因素，并进行单因素和多因素分析。
纳入队列中的51例（30.4%）患者接受了非手术治疗。平均年龄为47.7±16.9岁，男性占比过高（62.7%）。大多数患者表现为腹痛（96.1%）。18例（35.3%）患者出现NOM失败，术中发现分别有7例（38.9%）患者为粘连带、5例（27.8%）患者为肠扭转、4例（22.2%）患者为肠套叠、2例（11.1%）患者为肠系膜缺血。11例（61.1%）患者进行了肠切除，其中4例需要结肠造口改道。13例（25.5%）患者发生术后并发症，分别有13例（25.5%）患者出现发热、5例（9.8%）患者出现麻痹性肠梗阻、4例（7.8%）患者出现手术部位感染、2例（3.9%）患者需要再次手术。16例患者出院，2例患者因肠系膜缺血死亡。在NOM成功的患者中，有8例复发。多因素分析显示，计算机断层扫描（CT）中肠壁强化不佳（OR：8.59；95%CI：1.14 - 64.59，p = 0.037）和梗阻程度高（OR：11.64；95%CI：1.34 - 100.85，p = 0.026）与NOM失败独立相关。
CT图像上肠壁强化不佳和明显梗阻是选择需要紧急手术的SBO患者的关键指标。然而，评估手术干预与NOM的优势需要全面分析手术风险、合并症以及是否存在肠绞窄或缺血情况。
