• Eur J Trauma Emerg Surg · Feb 2022

    Diagnosis of single adhesive bands versus matted adhesions in small bowel obstructions: a radiological predictive score.

    • Pierre Berge, Maxime Delestre, Anita Paisant, Antoine Hamy, Christophe Aubé, HamelJean-FrançoisJFDepartment of Medicine, University of Health- Angers, Angers, France.Department of Biostatistics, Maison de la Recherche, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France., and Aurélien Venara.
    • Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
    • Eur J Trauma Emerg Surg. 2022 Feb 1; 48 (1): 13-22.

    PurposeThe objective was to develop a radiological score obtained from multi-detector computed tomography (MDCT) to differentiate between single band adhesion (SBA) and matted adhesions (MA) as the etiology of small bowel obstruction (SBO).MethodsAll consecutive patients who underwent surgery from January 2013 to June 2018 for adhesion-induced SBO were retrospectively included.ResultsAmong the 193 patients having surgery for SBO, 119 (61.6%) had SBA and 74 (38.4%) had MA surgically proven. In multivariate analysis, the presence of a beak sign (OR = 3.47, CI [1.26; 9.53], p = 0.02), a closed loop (OR = 11.37, CI [1.84; 70.39], p = 0.009), focal mesenteric haziness (OR = 3.71, CI [1.33; 10.34], p = 0.01) and focal and diffuse peritoneal fluid (OR = 4.30, CI [1.45; 12.73], p = 0.009 and OR = 6.34, CI [1.77; 22.59], p = 0.004, respectively) were significantly associated with SBA. Conversely, the presence of diffuse mesenteric fluid without focal fluid (OR = 0.23, CI [0.06; 0.92], p = 0.04) and an increase of the diameter of the most dilated loop (OR = 0.94, CI [0.90; 0.99], p = 0.02) were inversely associated with SBA. Using the significant predictive factors of SBA, we built a composite score to radiologically predict the etiology of SBO. The area under the receiver operating characteristic (ROC) curve of the score was 0.8274. For a cut-off score of -0.523, sensitivity, specificity and the percentage of patients correctly classified were 78.4%, 84.6% and 80%, respectively. If the score is ≥ 7, the probability that the mechanism of SBO is not SBA was 100%.ConclusionsThe present score, validated in a different population, could be a significant tool in the decision for surgical management.© 2021. Springer-Verlag GmbH, DE part of Springer Nature.

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