Our Summary

This research paper looks at how effective computed tomography (CT) scans are in determining whether or not a patient suffering from a small bowel obstruction (SBO) needs surgery. Currently, CT scans are used by doctors to decide if surgery is the best course of action. This study suggests that a combination of signs of bowel ischemia (a lack of blood flow to the bowels) on a CT scan, represented by a score called the Bowel Ischemia Score (BIS), can help predict if a patient needs surgery.

The researchers looked at data from patients with SBO over a six-year period. They found that most patients with a low BIS score (0 or 1) could be treated successfully without surgery. However, most of those with a high BIS score (3) did need surgery. This suggests that the BIS score, based on the cumulative signs of bowel ischemia seen on a CT scan, could be a good indicator of whether or not a patient needs surgery.

FAQs

  1. What is the Bowel Ischemia Score (BIS) and how is it used in determining the need for surgery in patients with small bowel obstruction?
  2. How effective are CT scans in identifying signs of bowel ischemia and predicting the need for surgery in small bowel obstruction cases?
  3. What does the study suggest about the correlation between the BIS score and the need for surgery in patients suffering from a small bowel obstruction?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bowel resection is to follow post-operative care instructions carefully, including taking prescribed pain medications, eating a healthy diet, staying hydrated, and avoiding strenuous activities until cleared by your healthcare provider. It is also important to attend follow-up appointments to monitor your recovery progress and address any concerns or complications that may arise.

Suitable For

Patients who are typically recommended bowel resection are those with severe small bowel obstructions that do not improve with conservative treatment, such as bowel rest and nasogastric decompression. These patients may have signs of bowel ischemia on CT scans, such as thickening of the bowel wall, lack of bowel wall enhancement, or free fluid in the abdomen. Patients with signs of bowel perforation or necrosis may also require surgery. Additionally, patients with recurrent or complicated SBO, such as those with a history of abdominal surgery or adhesive disease, may be candidates for bowel resection. Ultimately, the decision to recommend bowel resection depends on the individual patient’s clinical presentation and imaging findings.

Timeline

Before bowel resection:

  • Patient experiences symptoms of small bowel obstruction, such as abdominal pain, bloating, nausea, and vomiting.
  • Patient undergoes diagnostic tests, such as physical examination, blood tests, and imaging studies like CT scans to confirm the diagnosis of SBO.
  • Based on the results of the CT scan, the Bowel Ischemia Score (BIS) is calculated to determine the severity of bowel ischemia.
  • Treatment options, including conservative management with bowel rest and nasogastric tube decompression or surgical intervention, are discussed with the patient.

After bowel resection:

  • If surgery is deemed necessary, the patient undergoes bowel resection, a procedure where the affected portion of the small intestine is removed and the healthy ends are reconnected.
  • Recovery from bowel resection surgery involves a hospital stay, pain management, monitoring for complications like infection or bowel leakage, and gradually resuming normal activities and diet.
  • Follow-up appointments with the surgeon and possibly other healthcare providers are scheduled to monitor the patient’s progress and address any concerns or complications that may arise post-surgery.
  • Long-term management may involve dietary changes, medications, and regular monitoring to prevent recurrence of small bowel obstruction or other complications related to the surgery.

What to Ask Your Doctor

  1. What is a bowel resection and why is it necessary in my case?
  2. What are the risks and potential complications associated with bowel resection surgery?
  3. How long is the recovery process after bowel resection surgery?
  4. Are there any alternative treatments or procedures that could be considered instead of bowel resection?
  5. What is the success rate of bowel resection surgery in treating my condition?
  6. How will bowel resection surgery affect my quality of life in the long term?
  7. Will I need to make any changes to my diet or lifestyle after bowel resection surgery?
  8. How often will I need follow-up appointments or monitoring after bowel resection surgery?
  9. What is the experience of the surgical team in performing bowel resection surgeries?
  10. Are there any specific tests or assessments that need to be done before deciding on bowel resection surgery, such as a CT scan to determine bowel ischemia?

Reference

Authors: Morris RS, Murphy P, Boyle K, Somberg L, Webb T, Milia D, Tignanelli CJ, de Moya M, Trevino C. Journal: Am Surg. 2022 Feb;88(2):205-211. doi: 10.1177/0003134820988820. Epub 2021 Jan 27. PMID: 33502222