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01.09.2005 | Original Contribution

Progressive Increase of Bowel Wall Thickness Is a Reliable Indicator for Surgery in Patients With Adhesive Small Bowel Obstruction

verfasst von: Shyr-Chyr Chen, M.D., Chien-Chang Lee, M.D., M.Sc., Chiung-Yuan Hsu, M.D., Zui-Shen Yen, M.D., M.P.H., Cheng-Chung Fang, M.D., Matthew H.-M. Ma, M.D., Ph.D., Wen-Jone Chen, M.D., Ph.D., Hong-Shiee Lai, M.D., Ph.D., Po-Huang Lee, M.D., Ph.D., Fang-Yue Lin, M.D., Ph.D., Wei-Jao Chen, M.D., Ph.D.

Erschienen in: Diseases of the Colon & Rectum | Ausgabe 9/2005

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PURPOSE

The aim of this study was to determine whether progressive increase of bowel wall thickness during nonoperative treatment is a reliable indicator for surgery in patients with adhesive small bowel obstruction.

METHODS

The study consisted of a prospective case series of 121 patients with adhesive small bowel obstruction who underwent an abdominal ultrasonographic examination. The results of ultrasonographic examinations were classified into two groups according to the presence (Group I) or absence (Group II) of bowel wall thickening. Bowel wall thickening was recognized as a visible small bowel wall ≥3 mm in width as seen by ultrasonographic examination. The findings of subsequent ultrasonographic examinations taken 24 hours later were compared with those taken at admission. Surgery was determined based on the presence of any toxic signs or the failure of nonoperative treatment. The number of patients who had successful nonoperative treatment, the number of patients who underwent surgeries, and the number of complications in each group were calculated to correlate with the ultrasonographic findings.

RESULTS

There are 49 and 72 patients in Groups I and II, respectively. The number of patients who had successful nonoperative treatment and number of patients who underwent surgeries in Group I are 40 (81.6 percent) and 9 (18.4 percent) and in Group II the numbers are 68 (94.4 percent) and four (5.6 percent), respectively (P = 0.036). All 12 (100 percent) patients with progressive increase of bowel wall thickness underwent surgery. Progressive increase of bowel wall thickness as an indicator for surgery has a sensitivity of 92.3 percent (95 percent confidence interval, 62.1–99.6 percent) and a specificity of 100 percent (95 percent confidence interval, 95.7–100 percent).

CONCLUSIONS

Patients with initial bowel wall thickening have a higher incidence of surgery, and progressive increase of bowel wall thickness that appears 24 hours later is a reliable indicator for surgery in patients with adhesive small bowel obstruction.
Literatur
1.
Zurück zum Zitat Ellis, H, Moran, BJ, Thompson, JN, et al. 1999Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort studyLancet353147680CrossRefPubMed Ellis, H, Moran, BJ, Thompson, JN,  et al. 1999Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort studyLancet353147680CrossRefPubMed
2.
Zurück zum Zitat Nieuwenhuijzen, M, Reijnen, MM, Kuijpers, JH, et al. 1998Small bowel obstruction after total or subtotal colectomy: a 10-year retrospective reviewBr J Surg8512425CrossRefPubMed Nieuwenhuijzen, M, Reijnen, MM, Kuijpers, JH,  et al. 1998Small bowel obstruction after total or subtotal colectomy: a 10-year retrospective reviewBr J Surg8512425CrossRefPubMed
3.
Zurück zum Zitat Wilson, MS, Hawkswell, J, McCloy, RF 1998Natural history of adhesional small bowel obstruction: counting the costBr J Surg8512948CrossRefPubMed Wilson, MS, Hawkswell, J, McCloy, RF 1998Natural history of adhesional small bowel obstruction: counting the costBr J Surg8512948CrossRefPubMed
4.
Zurück zum Zitat Seror, D, Feigin, E, Szold, A, et al. 1993How conservatively can postoperative small bowel obstruction be treated?Am J Surg1651216PubMed Seror, D, Feigin, E, Szold, A,  et al. 1993How conservatively can postoperative small bowel obstruction be treated?Am J Surg1651216PubMed
5.
Zurück zum Zitat Choi, HK, Chu, KW, Law, WL 2002Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trialAnn Surg23616CrossRefPubMed Choi, HK, Chu, KW, Law, WL 2002Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trialAnn Surg23616CrossRefPubMed
6.
Zurück zum Zitat Assalia, A, Schein, M, Kopelman, D, et al. 1994Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trialSurgery1154337PubMed Assalia, A, Schein, M, Kopelman, D,  et al. 1994Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trialSurgery1154337PubMed
7.
Zurück zum Zitat Ray, NF, Larsen, JW,Jr, Stillman, RJ, et al. 1993Economic impact of hospitalizations for lower abdominal adhesion-olysis in the United States in 1988Surg Gynecol Obstet1762716PubMed Ray, NF, Larsen, JW,Jr, Stillman, RJ,  et al. 1993Economic impact of hospitalizations for lower abdominal adhesion-olysis in the United States in 1988Surg Gynecol Obstet1762716PubMed
8.
Zurück zum Zitat Ellis, H 1997The clinical significance of adhesions: focus on intestinal obstructionEur J Surg57759 Ellis, H 1997The clinical significance of adhesions: focus on intestinal obstructionEur J Surg57759
9.
Zurück zum Zitat Menzies, D, Parker, M, Hoare, R, et al. 2001Small bowel obstruction due to postoperative adhesions: treatment patterns and associated costs in 110 hospital admissionsAnn R Coll Surg Engl83406PubMed Menzies, D, Parker, M, Hoare, R,  et al. 2001Small bowel obstruction due to postoperative adhesions: treatment patterns and associated costs in 110 hospital admissionsAnn R Coll Surg Engl83406PubMed
10.
Zurück zum Zitat Brolin, RE 1984Partial small bowel obstructionSurgery951459PubMed Brolin, RE 1984Partial small bowel obstructionSurgery951459PubMed
11.
Zurück zum Zitat Deutsch, AA, Eviatar, E, Gutman, H, et al. 1989Small bowel obstruction: a review of 264 cases and suggestions for managementPostgrad Med J654637PubMed Deutsch, AA, Eviatar, E, Gutman, H,  et al. 1989Small bowel obstruction: a review of 264 cases and suggestions for managementPostgrad Med J654637PubMed
12.
Zurück zum Zitat Chung, CC, Meng, WC, Yu, SC, et al. 1996A prospective study on the use of water-soluble contrast follow-through radiology in the management of small bowel obstructionANZ J Surg66598601 Chung, CC, Meng, WC, Yu, SC,  et al. 1996A prospective study on the use of water-soluble contrast follow-through radiology in the management of small bowel obstructionANZ J Surg66598601
13.
Zurück zum Zitat Shih, SC, Jeng, KS, Lin, SC, et al. 2003Adhesive small bowel obstruction: how long can patients tolerate conservative treatment?World J Gastroenterol96035PubMed Shih, SC, Jeng, KS, Lin, SC,  et al. 2003Adhesive small bowel obstruction: how long can patients tolerate conservative treatment?World J Gastroenterol96035PubMed
14.
Zurück zum Zitat Onoue, S, Katoh, T, Shibata, YM, et al. 2002The value of contrast radiology for postoperative adhesive small bowel obstructionHepatogastroenterology4915768PubMed Onoue, S, Katoh, T, Shibata, YM,  et al. 2002The value of contrast radiology for postoperative adhesive small bowel obstructionHepatogastroenterology4915768PubMed
15.
Zurück zum Zitat Chen, SC, Lin, FY, Lee, PH, et al. 1998Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstructionBr J Surg8516924CrossRefPubMed Chen, SC, Lin, FY, Lee, PH,  et al. 1998Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstructionBr J Surg8516924CrossRefPubMed
16.
Zurück zum Zitat Feigin, E, Seror, D, Szold, A, et al. 1996Water-soluble contrast medium has no therapeutic effect on postoperative small-bowel obstruction: results of a prospective, randomized clinical trialAm J Surg1712279CrossRefPubMed Feigin, E, Seror, D, Szold, A,  et al. 1996Water-soluble contrast medium has no therapeutic effect on postoperative small-bowel obstruction: results of a prospective, randomized clinical trialAm J Surg1712279CrossRefPubMed
17.
Zurück zum Zitat Chen, SC, Chang, KJ, Lee, PH, et al. 1999Oral Urografin in postoperative small bowel obstructionWorld J Surg2310514CrossRefPubMed Chen, SC, Chang, KJ, Lee, PH,  et al. 1999Oral Urografin in postoperative small bowel obstructionWorld J Surg2310514CrossRefPubMed
18.
Zurück zum Zitat Yen, ZS, Wang, HP, Ma, HM, et al. 2002Ultrasonographic screening of clinically suspected necrotizing fasciitisAcad Emerg Med9144851CrossRefPubMed Yen, ZS, Wang, HP, Ma, HM,  et al. 2002Ultrasonographic screening of clinically suspected necrotizing fasciitisAcad Emerg Med9144851CrossRefPubMed
19.
Zurück zum Zitat Puylaert, JB, Zant, FM, Rijke, AM 1997Sonography and the acute abdomen: practical considerationsAJR Am J Roentgenol16817986PubMed Puylaert, JB, Zant, FM, Rijke, AM 1997Sonography and the acute abdomen: practical considerationsAJR Am J Roentgenol16817986PubMed
20.
Zurück zum Zitat Chen, SC, Yen, ZS, Wang, HP, et al. 2002Ultrasonography is superior to plain radiography in the diagnosis of pneumoperitoneumBr J Surg893514CrossRefPubMed Chen, SC, Yen, ZS, Wang, HP,  et al. 2002Ultrasonography is superior to plain radiography in the diagnosis of pneumoperitoneumBr J Surg893514CrossRefPubMed
21.
Zurück zum Zitat Pattison, P, Jeffrey, RB, Mindelzum, RE, et al. 1997Sonography of intraabdominal gas collectionsAJR Am J Roentgenol169155964PubMed Pattison, P, Jeffrey, RB, Mindelzum, RE,  et al. 1997Sonography of intraabdominal gas collectionsAJR Am J Roentgenol169155964PubMed
22.
Zurück zum Zitat Chen, SC, Chen, KM, Wang, SM, et al. 1998Abdominal sonography screening of clinically diagnosed or suspected appendicitis before surgeryWorld J Surg2244952CrossRefPubMed Chen, SC, Chen, KM, Wang, SM,  et al. 1998Abdominal sonography screening of clinically diagnosed or suspected appendicitis before surgeryWorld J Surg2244952CrossRefPubMed
23.
Zurück zum Zitat Ogata, M, Mateer, JR, Condon, RE 1999Prospective evaluation of abdominal sonography for the diagnosis of bowel obstructionAnn Surg22323741CrossRef Ogata, M, Mateer, JR, Condon, RE 1999Prospective evaluation of abdominal sonography for the diagnosis of bowel obstructionAnn Surg22323741CrossRef
24.
Zurück zum Zitat Chen, SC, Lin, FY, Hsieh, YS, et al. 2000Accuracy of ultrasonography in the diagnosis of peritonitis compared with the clinical impression of the surgeonArch Surg1351703CrossRefPubMed Chen, SC, Lin, FY, Hsieh, YS,  et al. 2000Accuracy of ultrasonography in the diagnosis of peritonitis compared with the clinical impression of the surgeonArch Surg1351703CrossRefPubMed
25.
Zurück zum Zitat Sosa, J, Gardner, B 1993Management of patients diagnosed as acute intestinal obstruction secondary to adhesionsAm Surg591258PubMed Sosa, J, Gardner, B 1993Management of patients diagnosed as acute intestinal obstruction secondary to adhesionsAm Surg591258PubMed
26.
Zurück zum Zitat Brolin, RE, Krasna, MJ, Mast, BA 1987Use of tubes and radiographs in the management of small bowel obstructionAnn Surg20612633PubMed Brolin, RE, Krasna, MJ, Mast, BA 1987Use of tubes and radiographs in the management of small bowel obstructionAnn Surg20612633PubMed
27.
Zurück zum Zitat Hofstetter, SR 1981Acute adhesive obstruction of the small intestineSurg Gynecol Obstet1521414PubMed Hofstetter, SR 1981Acute adhesive obstruction of the small intestineSurg Gynecol Obstet1521414PubMed
28.
Zurück zum Zitat Bizer, LS, Liebling, RW, Delany, HM, et al. 1981Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstructionSurgery8940713PubMed Bizer, LS, Liebling, RW, Delany, HM,  et al. 1981Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstructionSurgery8940713PubMed
29.
Zurück zum Zitat Biondo, S, Pares, D, Mora, J, et al. 2003Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstructionBr J Surg905426CrossRefPubMed Biondo, S, Pares, D, Mora, J,  et al. 2003Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstructionBr J Surg905426CrossRefPubMed
30.
Zurück zum Zitat Ko, YT, Lim, JH, Lee, DH, et al. 1993Small bowel obstruction: sonographic evaluationRadiology18864953PubMed Ko, YT, Lim, JH, Lee, DH,  et al. 1993Small bowel obstruction: sonographic evaluationRadiology18864953PubMed
31.
Zurück zum Zitat Ogata, M, Imai, S, Hosotani, R, et al. 1994Abdominal ultrasonography for the diagnosis of strangulation in small bowel obstructionBr J Surg814214PubMed Ogata, M, Imai, S, Hosotani, R,  et al. 1994Abdominal ultrasonography for the diagnosis of strangulation in small bowel obstructionBr J Surg814214PubMed
32.
Zurück zum Zitat Okada, T, Yoshida, H, Iwai, J, et al. 2001Pulsed Doppler sonography for the diagnosis of strangulation in small bowel obstructionJ Pediatr Surg364305CrossRefPubMed Okada, T, Yoshida, H, Iwai, J,  et al. 2001Pulsed Doppler sonography for the diagnosis of strangulation in small bowel obstructionJ Pediatr Surg364305CrossRefPubMed
33.
Zurück zum Zitat Bland, KI 1996Abdominal sonography for the diagnosis of bowel obstructionAnn Surg2232356PubMed Bland, KI 1996Abdominal sonography for the diagnosis of bowel obstructionAnn Surg2232356PubMed
34.
Zurück zum Zitat Berlin, SC, Goske, MJ, Obuchowski, N, et al. 1998Small bowel obstruction in rats: diagnostic accuracy of sonography versus radiographyJ Ultrasound Med17497504PubMed Berlin, SC, Goske, MJ, Obuchowski, N,  et al. 1998Small bowel obstruction in rats: diagnostic accuracy of sonography versus radiographyJ Ultrasound Med17497504PubMed
35.
Zurück zum Zitat Snyder, JR 1989The pathophysiology of intestinal damage: effects of luminal distension and ischemiaVeter Clin North Am Equine Pract524770 Snyder, JR 1989The pathophysiology of intestinal damage: effects of luminal distension and ischemiaVeter Clin North Am Equine Pract524770
36.
Zurück zum Zitat Chappuis CW, Cohn I Jr. Intestinal obstruction. In: Fielding ML, Welch PJ, Moore FD, eds. Clinical surgery international. Vol 13. London: Churchill Livingstone, 1987:32 Chappuis CW, Cohn I Jr. Intestinal obstruction. In: Fielding ML, Welch PJ, Moore FD, eds. Clinical surgery international. Vol 13. London: Churchill Livingstone, 1987:32
37.
Zurück zum Zitat Gibo, M, Murayama, S, Murata, S, et al. 2002Small-bowel wall thickening related to a long intestinal tube: incidental CT finding mimicking a pathologic conditionJ Comput Assist Tomogr265059CrossRefPubMed Gibo, M, Murayama, S, Murata, S,  et al. 2002Small-bowel wall thickening related to a long intestinal tube: incidental CT finding mimicking a pathologic conditionJ Comput Assist Tomogr265059CrossRefPubMed
38.
Zurück zum Zitat Delabrousse, E, Destrumelle, N, Brunelle, S, et al. 2003CT of small bowel obstruction in adultsAbdom Imaging2825766CrossRefPubMed Delabrousse, E, Destrumelle, N, Brunelle, S,  et al. 2003CT of small bowel obstruction in adultsAbdom Imaging2825766CrossRefPubMed
39.
Zurück zum Zitat Torreggiani, WC, Harris, AC, Lyburn, ID, et al. 2003Computed tomography of acute small bowel obstruction: pictorial essayCan Assoc Radiol J54939PubMed Torreggiani, WC, Harris, AC, Lyburn, ID,  et al. 2003Computed tomography of acute small bowel obstruction: pictorial essayCan Assoc Radiol J54939PubMed
40.
41.
Zurück zum Zitat Matsuoka, H, Takahara, T, Masaki, T, et al. 2002Preoperative evaluation by magnetic resonance imaging in patients with bowel obstructionAm J Surg1836147CrossRefPubMed Matsuoka, H, Takahara, T, Masaki, T,  et al. 2002Preoperative evaluation by magnetic resonance imaging in patients with bowel obstructionAm J Surg1836147CrossRefPubMed
Metadaten
Titel
Progressive Increase of Bowel Wall Thickness Is a Reliable Indicator for Surgery in Patients With Adhesive Small Bowel Obstruction
verfasst von
Shyr-Chyr Chen, M.D.
Chien-Chang Lee, M.D., M.Sc.
Chiung-Yuan Hsu, M.D.
Zui-Shen Yen, M.D., M.P.H.
Cheng-Chung Fang, M.D.
Matthew H.-M. Ma, M.D., Ph.D.
Wen-Jone Chen, M.D., Ph.D.
Hong-Shiee Lai, M.D., Ph.D.
Po-Huang Lee, M.D., Ph.D.
Fang-Yue Lin, M.D., Ph.D.
Wei-Jao Chen, M.D., Ph.D.
Publikationsdatum
01.09.2005
Erschienen in
Diseases of the Colon & Rectum / Ausgabe 9/2005
Print ISSN: 0012-3706
Elektronische ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-005-0112-y

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