Bertona Sofía, Casas María A, Principe Josefina, Aramburu Sofía, Angeramo Cristian A, Zanfardini Andrés, Schlottmann Francisco
Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, C1118AAT, Buenos Aires, Argentina.
Department of Radiology, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
Updates Surg. 2025 Jul 12. doi: 10.1007/s13304-025-02311-0.
Small bowel obstruction (SBO) is a common cause of hospitalization worldwide with approximately 80% of cases resulting from surgical adhesions. While medical treatment is often advocated for SBO, some patients require surgical intervention. The aim of this study was to evaluate predictors of medical treatment failure in patients with adhesive SBO (ASBO).
We performed a retrospective analysis of a consecutive series of patients with ASBO between 2014 and 2024. The sample was divided into two groups; patients who resolved with conservative treatment (G1) and those who required surgical intervention after initial conservative management (G2). Demographic and preoperative variables were compared between groups. A multivariable logistic regression analysis was performed to identify independent factors associated with medical treatment failure.
A total of 225 patients were included; 125 (55.5%) belonged to G1 and 100 (45.5%) to G2. Demographic and laboratory variables were similar between groups, except for mean lactate levels, which were higher in G2 (G1: 0.5 vs G2: 1.1 mmol/L), p = 0.001). Patients in G1 had higher number of previous ASBO episodes (G1: 47 (37.6%) vs. G2: 20 (20.0%), p = 0.004). Previous open surgery (G1: 89 (71.2%) vs. G2: 86 (86%), p = 0.007) and open appendectomy (G1: 16 (12.8%) vs. G2: 24 (24%), p = 0.02) as surgical history were more frequent in G2. Time elapsed since symptoms onset was longer in G2 (G1: 2.2 vs. G2: 2.7 days, p = 0.001). An abrupt transition point (G1:86 (71%) vs. G2: 85 (86.7%), p = 0.005) and a beak sign (G1: 48 (39.6%) vs. G2: 52 (53%), p = 0.04) on CT scan were more frequently observed in G2. In the multivariate analysis, the presence of a transition point on CT (OR 2.25, IC 95% 1.07-4.71, p < 0.03), higher lactic acid levels (OR 1.37, IC 95% 1.07-1.77, p < 0.01), and history of previous open surgery (OR 2.55, IC 95% 1.23-5.30, p < 0.01) were independent predictors of treatment failure. History of multiple previous episodes of ASBO treated successfully with medical treatment (OR 0.43, IC 95% 0.23-0.84, p < 0.01) was associated with medical treatment success. After 50.8 months of follow-up, recurrence of ASBO was higher in G1 (G1: 16 (12.8%) vs G2: 1 (5%), p = 0.04).
ASBO in patients with a transition point on CT, high lactic acid levels, and/or history of previous open operation is significantly less likely to respond to medical treatment. Closer monitoring and early consideration of surgical intervention in these patients might be reasonable to reduce potential morbidity and mortality associated with delayed surgery.
小肠梗阻（SBO）是全球范围内住院治疗的常见病因，约80%的病例由手术粘连引起。虽然对于SBO通常提倡药物治疗，但一些患者需要手术干预。本研究的目的是评估粘连性小肠梗阻（ASBO）患者药物治疗失败的预测因素。
我们对2014年至2024年间一系列连续的ASBO患者进行了回顾性分析。样本分为两组；经保守治疗缓解的患者（G1组）和初始保守治疗后需要手术干预的患者（G2组）。比较两组之间的人口统计学和术前变量。进行多变量逻辑回归分析以确定与药物治疗失败相关的独立因素。
共纳入225例患者；125例（55.5%）属于G1组，100例（45.5%）属于G2组。两组之间的人口统计学和实验室变量相似，但平均乳酸水平除外，G2组更高（G1组：0.5 vs G2组：1.1 mmol/L），p = 0.001）。G1组既往ASBO发作次数更多（G1组：47例（37.6%） vs G2组：20例（20.0%），p = 0.004）。既往开腹手术（G1组：89例（71.2%） vs G2组：86例（86%），p = 0.007）和开腹阑尾切除术（G1组：16例（12.8%） vs G2组：24例（24%），p = 0.02）作为手术史在G2组中更常见。G2组自症状发作以来经过的时间更长（G1组：2.2天 vs G2组：2.7天，p = 0.001）。CT扫描上的突然转变点（G1组：86例（71%） vs G2组：85例（86.7%），p = 0.005）和鸟嘴征（G1组：48例（39.6%） vs G2组：52例（53%），p = 0.04）在G2组中更频繁观察到。在多变量分析中，CT上存在转变点（OR 2.25，95%CI 1.07 - 4.71，p < 0.03）、较高的乳酸水平（OR 1.37，95%CI 1.07 - 1.77，p < 0.01）和既往开腹手术史（OR 2.55，95%CI 1.23 - 5.30，p < 0.01）是治疗失败的独立预测因素。既往多次ASBO发作经药物治疗成功的病史（OR 0.43，95%CI 0.23 - 0.84，p < 0.01）与药物治疗成功相关。经过50.8个月的随访，G1组ASBO复发率更高（G1组：16例（12.8%） vs G2组：1例（5%），p = 0.04）。
CT上有转变点、乳酸水平高和/或有既往开腹手术史的患者发生的ASBO对药物治疗的反应明显较差。对这些患者进行更密切的监测并尽早考虑手术干预可能是合理的，以降低与延迟手术相关的潜在发病率和死亡率。
