Frontiers in medicine · 2026
Clinical features of failure of conservative management in adult patients with adhesive small bowel obstruction: a retrospective cohort study.
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Shen Jie, Chen Bin, Xie Hongyang, Wang Yiping
Аннотация
BACKGROUND: Adhesive small bowel obstruction (ASBO) is a common cause of acute abdominal pain in adults. Most patients with ASBO without strangulation are successfully managed conservatively. However, some patients fail nonoperative treatment, develop intestinal ischemia and undergo surgical management. The clinical features of these patients require further investigation.
METHODS: Patients who received conservative management as the initial treatment for ASBO between January 2017 and December 2025 were selected from the electronic medical records of a single institution. The patients were categorized into a successful conservative treatment group (group A) and a surgery group (group B). Demographic and clinical variables were compared between the two groups.
RESULTS: A total of 510 patients were included in this retrospective study. Groups A and B comprised 456 and 54 patients, respectively. Univariable analysis demonstrated a significant difference in five factors: age, multiple previous operations, C-reactive protein (CRP) level, body temperature, and maximum diameter of the dilated small bowel (MDSB) (P < 0.05). Multivariable logistic regression analysis indicated that older age (OR 1.035, P = 0.019), higher CRP level (OR 1.024, P = 0.003), elevated body temperature (OR 9.812, P < 0.001), and larger MDSB (OR 4.860, P < 0.001) were independent risk factors for failure of conservative management of ASBO. Receiver operating characteristic curves were plotted to evaluate the predictive age, CRP level, body temperature, and MDSB values, yielding areas under the curve of 0.6122, 0.6337, 0.8193, and 0.7052, respectively. Patients in group B had longer hospital stays, higher hospitalization costs, and more intensive care unit admissions than those in group A. However, no statistical difference was observed in the post-discharge recurrence rate.
CONCLUSION: Our study established older age, higher CRP level, fever, and larger MDSB on admission as risk factors for failure of conservative ASBO management. The risk of ASBO recurrence was not increased by surgical intervention. Although these results should be interpreted with caution, these findings might assist clinical practice. Conversion to operation increases the length of hospital stay, hospitalization costs, and intensive care unit admission.
METHODS: Patients who received conservative management as the initial treatment for ASBO between January 2017 and December 2025 were selected from the electronic medical records of a single institution. The patients were categorized into a successful conservative treatment group (group A) and a surgery group (group B). Demographic and clinical variables were compared between the two groups.
RESULTS: A total of 510 patients were included in this retrospective study. Groups A and B comprised 456 and 54 patients, respectively. Univariable analysis demonstrated a significant difference in five factors: age, multiple previous operations, C-reactive protein (CRP) level, body temperature, and maximum diameter of the dilated small bowel (MDSB) (P < 0.05). Multivariable logistic regression analysis indicated that older age (OR 1.035, P = 0.019), higher CRP level (OR 1.024, P = 0.003), elevated body temperature (OR 9.812, P < 0.001), and larger MDSB (OR 4.860, P < 0.001) were independent risk factors for failure of conservative management of ASBO. Receiver operating characteristic curves were plotted to evaluate the predictive age, CRP level, body temperature, and MDSB values, yielding areas under the curve of 0.6122, 0.6337, 0.8193, and 0.7052, respectively. Patients in group B had longer hospital stays, higher hospitalization costs, and more intensive care unit admissions than those in group A. However, no statistical difference was observed in the post-discharge recurrence rate.
CONCLUSION: Our study established older age, higher CRP level, fever, and larger MDSB on admission as risk factors for failure of conservative ASBO management. The risk of ASBO recurrence was not increased by surgical intervention. Although these results should be interpreted with caution, these findings might assist clinical practice. Conversion to operation increases the length of hospital stay, hospitalization costs, and intensive care unit admission.