Small Bowel Obstruction

 3/25/02 (Bhasin)

Question: What is an efficient method for diagnosing acute small bowel obstruction?

[ 

<5>

Unique Identifier:9129407

Authors: Maglinte DD. Balthazar EJ. Kelvin FM. Megibow AJ.

Institution: Department of Radiology, Methodist Hospital of Indiana, Indianapolis, USA.

Title: The role of radiology in the diagnosis of small-bowel obstruction. [Review] [71 refs]

Source: AJR. American Journal of Roentgenology. 168(5):1171-80, 1997 May.

<7>

Unique Identifier:7973431

Authors: Eskelinen M. Ikonen J. Lipponen P.

Institution: Dept. of Surgery, University of Kuopio, Finland.

Title: Contributions of history-taking, physical examination, and computer assistance to diagnosis of acute small-bowel obstruction. A prospective study of 1333 patients with acute abdominal pain.

Source: Scandinavian Journal of Gastroenterology. 29(8):715-21, 1994 Aug.

Abstract: BACKGROUND: The accuracy of clinical diagnosis of acute small-bowel studied in connection with the survey of acute abdominal pain by the Research Committee of the World Organization of Gastroenterology (OMGE). Criteria for inclusion and the diagnostic criteria of this prospective study were those set out by the OMGE Research Committee. METHODS: The clinical findings in each patient were recorded in detail on a pre-defined structured data collection sheet, and the collected data were compared with the final diagnosis of patients. RESULTS: The most efficient symptoms in the diagnosis of acute small-bowel obstruction were previous abdominal surgery (relative risk (RR) = 12.1) and type of pain (colic/intermittent versus steady) (RR = 2.4). The most efficient clinical tests were abdominal distension (yes versus no) (RR = 13.1) and bowel sounds (abnormal versus normal) (RR = 9.0). The sensitivity of the clinical decision was 0.75, with a specificity of 0.99 and an efficiency of 0.98. The computer-based diagnostic score reached a sensitivity of 0.87 with a specificity of 0.95 and an efficiency of 0.95. CONCLUSIONS: Acute abdominal pain with distension, abnormal bowel sounds, and previous abdominal surgery are indicative of a small-bowel obstruction. A computer-based diagnostic score increases the sensitivity and usefulness index of the diagnosis of acute small-bowel obstruction in comparison with clinical decision alone.

<8>

Unique Identifier:2695291

Authors: Argov S. Itzkovitz D. Wiener F.

Title: A new method for differentiating simple intra-abdominal from strangulated small-intestinal obstruction.

Source: Current Surgery. 46(6):456-60, 1989 Nov-Dec.

Abstract: We developed a model that aids in the differentiation of simple from strangulated intra-abdominal small-intestinal obstruction and reached an accuracy rate of 97 percent in predicting strangulated obstruction. Fifty-three criteria were analyzed from the records of 229 patients and by the Bayes statistical mode; five statistically significant criteria were identified. Using these, and another 16 criteria that indicated trends, we were able to predict strangulated obstruction with a 97 percent accuracy. Neither laboratory tests nor abdominal roentgenography aided in the diagnosis.