SURGICAL TREATMENT OF ACUTE SMALL BOWEL OBSTRUCTION: CLINICAL AND LABORATORY PARAMETERS ASSOCIATED WITH STRANGULATION AND EARLY MORTALITY AFTER SURGERY

Abstract

The aim: The study aimed to evaluate some criteria for preoperative diagnosis of strangulation and significant indicators of the prognosis of short-term outcomes in patients with small bowel obstruction. Materials and methods: The results of the treatment of 123 patients aged 18–70 years with SBO were evaluated. Results: All of these patients underwent emergency surgery, and 22 patients (17.9%) have died. It has been shown that four lab parameters (blood leukocytes, lactate, intestinal fatty acid-binding protein, and C-reactive protein levels) and one instrumental (involving the mesentery of the small intestine, free fluid in the abdomen during CT) with 80% probability or more were associated with the strangulation type of SBO (Λ=0.276, p = 0.000). Three lab indicators (WBC count, serum lactate, and intestinal fatty acid-binding protein levels) and two clinical parameters (abdominal perfusion pressure level and the presence of abdominal sepsis) were associated with early mortality after surgery (Λ=0.626, p = 0.000) with the same probability. Immediate results of the treatment in these patients depended on the development of intra-abdominal complications after surgery (P = 0.024) and the need for early reoperation (P = 0.006) as well as the development of cardiovascular dysfunction (P = 0.000) and respiratory dysfunction (P = 0.000). Conclusions: There were confirmed parameters that were significantly associated with strangulation before surgery and short-term in-hospital mortality with an 80% probability or more. This made it possible to develop new mathematical models for the diagnosis of strangulated bowel obstruction and early postoperative mortality with an accuracy of 84.5% and 84.2%, respectively.