The Journal of emergency medicine
July 10, 2026 · via Europe PMC
A Retrospective Multicenter Study Examining Clinical and Imaging Predictors of Emergent Surgery in Small Bowel Obstruction.
Brower CH, Karam A, Schulwolf S, +9 more, Goldsmith A.
AI summary — for doctors, generated from the abstract only
In 4,478 patients with small bowel obstruction, CT findings like closed loop and swirl and exam findings like rebound and guarding predicted emergent surgery, while prior SBO or surgery predicted lower risk.
What was studied
A multicenter retrospective review of SBO patients modeling clinical and CT predictors of emergent surgery within 24 hours.
Key findings
- 10.3% had emergent surgery.
- CT predictors: closed loop (OR 9.64), internal hernia (OR 7.72), mesenteric swirl (OR 6.91).
- Clinical predictors: rebound (OR 6.13), tap/shake tenderness (OR 5.44), guarding (OR 4.28).
- Prior SBO (OR 0.29) and prior abdominal surgery (OR 0.42) decreased likelihood.
Clinical relevance
This suggests clinical features may identify some SBO patients needing emergent surgery and raises the hypothesis of CT-avoidance pathways for low-risk patients, which requires prospective study.
Who should care
Limitations
Retrospective design; models not externally validated.
Peritoneal signs and CT findings like closed loop flag SBO needing urgent surgery.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Operative management for small bowel obstruction (SBO) is indicated for patients with concerns about bowel ischemia or failure of conservative therapy; however, most patients respond to nonoperative management.
Objective
Our primary objective was to identify clinical and imaging predictors of operative management in SBO, stratified by the timing of intervention, with an emphasis on emergent operative management within 24 h of presentation. Secondarily, we sought to explore which patient populations may be candidates for future prospective evaluation of computed tomography (CT)-avoidance pathways, generating hypotheses regarding patients who may safely undergo an initial trial of nonoperative management without emergent CT imaging.
Methods
This was a multicenter retrospective review of patients with SBO. We performed univariate and multivariate explanatory modeling of clinical and CT imaging variables to calculate odds ratios for operative management. We generated receiver operating characteristic curves to compare the performance of clinical and imaging variables in predicting emergent surgical intervention.
Results
A total of 4478 patients with SBO were included, with 10.3% (n = 463) undergoing emergent surgical intervention within 24 h of presentation. The CT variables (odds ratio; 95% confidence interval) most predictive of emergent operative management were closed-loop obstruction (9.64; 6.13-15.2), internal hernia (7.72; 5.77-10.3), and mesenteric swirl (6.91; 5.12-9.29). Among non-CT clinical variables, rebound tenderness (6.13; 4.04-9.21), tap/shake tenderness (5.44; 3.89-7.54), and abdominal guarding (4.28; 3.29-5.54) increased the likelihood of emergent surgery. In contrast, a history of prior SBO (0.29; 0.23-0.36) and prior abdominal surgery (0.42; 0.33-0.53) decreased the likelihood of emergent surgery. Receiver operating characteristic curves demonstrated that a model using clinical features alone was outperformed by a model including clinical and imaging variables in predicting emergent operative management, although with similar performance when optimizing for higher sensitivity.
Conclusion
Clinical features alone may be predictive in identifying a subset of patients with SBO who require emergent operative management. Future research is needed to refine these predictive models and develop scoring systems that incorporate other diagnostic modalities, such as ultrasound, to both diagnose SBO and identify low-risk patient populations. Patients identified as low risk based on clinical variables alone may then be able to avoid initial CT imaging and proceed directly to a trial of nonoperative management. © 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
DOI
10.1016/j.jemermed.2026.07.009
PMID
42636790
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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