Clinical and Radiological Factors Associated with Nonoperative Management Failure for Small Bowel Obstruction: A Retrospective Study from a Resource-Limited Setting

Saleh Al-Wageeh; Qasem Alyhari; Faisal Ahmed; Hanan Mohammed; Noha Dahan; Abdullatif Mothanna Almohtadi; Sameer Taha Said Al-Nuzili; Mohamed Badheeb; Abdulsattar Naji

doi:10.2147/TCRM.S496629

Clinical and Radiological Factors Associated with Nonoperative Management Failure for Small Bowel Obstruction: A Retrospective Study from a Resource-Limited Setting

Ther Clin Risk Manag. 2024 Dec 25:20:893-906. doi: 10.2147/TCRM.S496629. eCollection 2024.

Authors

Saleh Al-Wageeh¹, Qasem Alyhari¹, Faisal Ahmed², Hanan Mohammed¹, Noha Dahan¹, Abdullatif Mothanna Almohtadi³, Sameer Taha Said Al-Nuzili⁴, Mohamed Badheeb⁵, Abdulsattar Naji¹

Affiliations

¹ Department of General Surgery, School of Medicine, Ibb University, Ibb, Yemen.
² Department of Urology, School of Medicine, Ibb University, Ibb, Yemen.
³ Department of Radiology, School of Medicine, Ibb University, Ibb, Yemen.
⁴ Department of Vascular Surgery, School of Medicine, Ibb University, Ibb, Yemen.
⁵ Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, USA.

Abstract

Background: 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.

Material and method: 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.

Results: 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.

Conclusion: 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.

Keywords: computed tomography scan; failure; nonoperative management; predictive factors; small bowel obstruction.

Grants and funding

There is no funding to report.