Preoperative prediction of inadvertent enterotomy during adhesive small bowel obstruction surgery using combination of CT features

Objectives The purpose of this study was to identify the preoperative CT features that are associated with inadvertent enterotomy (IE) during adhesive small bowel obstruction (ASBO) surgery. Methods From January 2015 to December 2019, all patients with ASBO who underwent an abdominal CT were reviewed. Abdominal CT were retrospectively reviewed by two radiologists with a consensus read in case of disagreement. IE during ASBO surgery was retrospectively recorded. Univariate and multivariate analyses of CT features associated with IE were performed and a simple CT score was built to stratify the risk of IE. This score was validated in an independent retrospective cohort. Abdominal CT of the validation cohort was reviewed by a third independent reader. Results Among the 368 patients with ASBO during the study period, 169 were surgically treated, including 129 ASBO for single adhesive band and 40 for matted adhesions. Among these, there were 47 IE. By multivariate analysis, angulation of the transitional zone (OR = 4.19, 95% CI [1.10–18.09]), diffuse intestinal adhesions (OR = 4.87, 95% CI [1.37–19.76]), a fat notch sign (OR = 0.32, 95% CI [0.12–0.85]), and mesenteric haziness (OR = 0.13, 95% CI [0.03–0.48]) were independently associated with inadvertent enterotomy occurrence. The simple CT score built to stratify risk of IE displayed an AUC of 0.85 (95% CI [0.80–0.90]) in the study sample and 0.88 (95% CI [0.80–0.96]) in the validation cohort. Conclusion A simple preoperative CT score is able to inform the surgeon about a high risk of IE and therefore influence the surgical procedure. Key Points • In this retrospective study of 169 patients undergoing abdominal surgery for adhesive small bowel obstruction, 47 (28%) inadvertent enterotomy occurred . • A simple preoperative CT score enables accurate stratification of inadvertent enterotomy risk (area under the curve 0.85) . • By multivariable analysis, diffuse intestinal adhesions and angulation of the transitional zone were predictive of inadvertent enterotomy occurrence .