Usefulness of The Judgement of SIRS in Strangulated Small Bowel Obstruction

Abstract

We have experienced 35 surgical cases of strangulated small bowel obstruction and 41 surgical cases of adhesive small bowel obstruction in the past 16 years. Retrospective investigation was conducted in these cases to determine the usefulness of the presence of systemic inflammatory response syndrome (SIRS) as an indication for emergent operation. Twenty-five of the 35 patients with strangulated small bowel obstruction manifested SIRS during admission and before operation. All 35 patients were divided into three groups: with SIRS on admission (group A), shifted to SIRS during admission before operation (group B), without SIRS throughout preoperative admission (group C). We also investigated the presence and length of intestinal necrosis. Finally, we compared this data with that of the patients with adhesive small bowel obstruction. Extensive intestinal necrosis was found at operation in 94.7% of the patients in group A, and the average length was 120cm. Intestinal necrosis was found in 66.7% of the patients in group B, whereas only 30% of the patients in group C was found to have intestinal necrosis at operation, and the average length was 24cm. On the other hand, only 2.3% of the patients with adhesive bowel obstruction manifested SIRS on admission. Thus, the presence of SIRS in patients with bowel obstruction may be a diagnostic clue for determing whether the obstruction is strangulated or adhesive, and the presence of SIRS may well be correlated to the length of intestinal necrosis.