A Prospective Study of Clinicoradiological Scores in Predicting risk of Strangulation in Bowel Obstruction

Introduction: Acute intestinal obstruction is one of the common surgical emergencies leading to variable amount of morbidity and mortality. Strangulation is the most important factor in influencing the outcome and it is critical to accurately and promptly identify the existence of intestinal strangulation. The objective of the study was to assess the clinicoradiological scores in predicting risk of strangulation in bowel obstruction.

Methods: A prospective study of 50 patients with clinical diagnosis of acute intestinal obstruction attending General Surgery department of Government Mohan Kumaramangalam Medical College and Hospital, Salem during January 2021 and September 2022.

Results: Most of the study population is between 51 – 60 years with mean age of 55 years with male predominance. Mean time between admission and surgery is 6 hours. All patients had previous history of surgery, with appendicectomy being most common followed by hollow viscous perforation. Of the 50 patients in the study 19 patients underwent resection. Pain > 4 days, Guarding, Total leucocyte count > 10000/mm3, CRP > 75mg/dl, reduced contrast enhancement in CECT is frequently found in strangulated obstruction. On comparing with Schwenter score, of 36 patients who scored 0 -3, 5 patients underwent resection whereas all 14 patients who scored > 4 underwent resection.

Conclusions: A combination of clinical, laboratory and radiological parameters helps in earlier prediction of risk of ischaemia in acute intestinal obstruction and timely intervention.