Potential role of abdominal symptoms as decision making tools for management of adhesive bowel obstruction in low-income center

Abstract

Predicting successful nonoperative management(NOM) based on clinical presentation in Adhesive Bowel Obstruction (ABO) is a major challenge. To overcome this challenge, new guidelines centered on expensive radiologic investigations beyond the reach of low-income centers are emerging. This study aimed to describe the potential role of clinical features to select patients who require surgical intervention and as screening tool for utilization of expensive imaging investigations.

ABO patients managed between January 2014 and January 2016 were enrolled. The variables of interest were constipation, passage of flatus, tenderness and fever recorded after 24 hours resuscitation. Patient who required immediate surgical intervention were excluded. Statistical analysis and graphical presentations were by SPSS v16.

Forty-three patients were eligible over the 25 months period. There were 18 males and 25 females. Age range was 18-80 years (38.0 ± 14.6). NOM was successful in 24 patients(55.8%), no mortality was recorded. Abdominal pain was present in all patients, the symptom with highest sensitivity were constipation(84.2%)  and localized tenderness(85.2%). Fever(81.8%) and combination of fever and tenderness had the highest sensitivity(86.5%). The discriminant ability was low for all the variables of interest; the highest was constipation(55.7%).

In conclusion, no clinical feature was diagnostic of the need for surgical intervention because of low discriminant ability. Fever, tenderness or combination of the two had high specificity hence they may be used as screening tools to select patient who require more expensive radiologic investigations.

Keywords: Adhesive obstruction, Clinical features, Decision