Computed Tomography Scan Predictors of Intestinal Necrosis in Strangulated Small-Bowel Obstruction: A Retrospective Cohort Study

Abstract The preoperative diagnosis of intestinal necrosis in strangulated small-bowel obstruction (SBO) is clinically important because it is prognostically relevant. The current study assessed the predictors of preoperative intestinal necrosis in strangulated SBO. This retrospective single-center study included 75 consecutive patients undergoing surgery for strangulated SBO. Patients with inguinal, femoral, and obturator hernia were excluded from the analysis. The computed tomography (CT) scan value of the strangulated bowel was calculated as the average of the CT scan values ​​of the bowel contents measured at three different random points. The patients were divided into the intestinal necrosis and without necrosis groups. Clinical and CT scan findings were retrospectively analyzed, and univariate and multivariate analyses were performed. The cutoff CT scan value was the mean value. In total, 37 patients presented with intestinal necrosis in the strangulated SBO and 38 did not. In the univariate analysis, a CT scan value ≥ 20 HU for strangulated SBO, massive ascites, and mesenteric fluid were significant predictors of preoperative bowel necrosis in strangulated SBO. These factors were also independent predictors of preoperative intestinal necrosis in strangulated SBO in the multivariate analysis. Thus, these factors may help in predicting and managing necrosis in strangulated SBO.