Parameters Predicting The Outcome Of Adhesive Small Bowel Obstruction In Patients Managed With A Ileus Tube

Introduction:Ileus tube is a common nonoperative management for adhesive small bowel obstruction(ASBO). The aim of this study was to evaluate the parameters predicting the outcome(successful treatment and recurrence) of ASBO in patients managed with a ileus tube.Methods:A total of 64 patients (33 male and 31 female; age range 16-88 years) with ASBO managed with a transnasal ileus tube were enrolled in the second affiliated hospital of Zhejiang University, School of Medicine, from January 2013 to December 2015. These patients were divided into two groups according to whether the treatment succeed and whether there was recurrence after the treatment, then univariate and multivariate analysis were carried out to find predicting parameters.Results:The overall rate of successful nonoperative treatment with a transnasal ileus tube was 65.63%(42/64). Successful group and unsuccessful group had a significant difference in the duration of ABSO before admission(11.40 days vs.27.41 days, P< 0.05), previous tumor disease(38.1%vs.63.6%, P=0.046), blood platelet level(205.14*109L-1 vs.269.45* 109L-1, P=0.017), CA125 level(39.50 U/ml vs.90.90 U/ml, P< 0.05), the tube progressing depth on day 1(34.12cm vs.11.55cm, P< 0.05) and the tube progressing depth on day 2(66.92cm vs.20.77cm, P= 0.017). By multivariate analysis, CA125 level(OR= 0.793, P= 0.041) and the tube progressing depth on day 2(OR=1.477, P< 0.05) were independent parameters predicting the success of nonoperative treatment. In the meanwhile, the high CA125 level group had longer duration of ileus tube placement(19.90 days vs.11.53 days, P< 0.05) and length of stay (LOS,26.00 days vs.19.28 days, P= 0.017) than the low CA125 level group; the fast tube progressing group had shorter duration of ileus tube placement(10.42 days vs.17.67 days, P= 0.011), shorter LOS(16.83 days vs.26.28 days, P= 0.026) and lower costs(ï¿¥27120 vs. ï¿¥41067, P=0.047) than the slow tube progressing group. The overall recurrence rate of ASBO was 20%, and the median time of recurrence was 2.5 months. The recurrence group and the no-recurrence group had a significant difference in previous ASBO episodes(50% vs.12.5%, P=0.008), the tube progressing depth on day 1(19.98cm vs.30.30cm, P= 0.011), the final tube depth(140.70cm vs.193.80cm, P < 0.05) and the duration of ileus tube placement(22.60 days vs.10.45 days, P< 0.05). By multivariate analysis, previous ASBO episodes (OR= 13.882, P= 0.015) and the duration of ileus tube placement (OR= 1.224, P= 0.041) were independent parameters predicting the recurrence of ASBO.Conclusion:The speed of ileus tube progressing and the level of CA125 are parameters for predicting the successful nonoperative treatment in ASBO; previous ASBO episodes and the duration of ileus tube placement are parameters for predicting the recurrence of ASBO.