The Angers CT Score is a Risk Factor for the Failure of the Conservative Management of Adhesive Small Bowel Obstruction: A Prospective Observational Multicentric Study - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue World Journal of Surgery Année : 2023

The Angers CT Score is a Risk Factor for the Failure of the Conservative Management of Adhesive Small Bowel Obstruction: A Prospective Observational Multicentric Study

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Jeanne Burgmaier
  • Fonction : Auteur
Mélanie Loison
  • Fonction : Auteur
Thierry Yzet
  • Fonction : Auteur
Audrey Fohlen
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Estelle Vauclair
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Julie Pellegrini
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Alexandre Lansier
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Emeric Abet
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Alexandre Nevot
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Mehdi Ouaissi
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Marie Besson
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Maxime Ronot
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Massimo Giacca
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Edouard Girard
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Yann Tessier
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Damien Massalou
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Florent Poirier
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Zaher Lakkis
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Christophe Aubé
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Jean Francois Hamel
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Guillaume Passot
  • Fonction : Auteur
Aurélien Venara

Résumé

Background: Identifying the 30% of adhesive small bowel obstructions (aSBO) for which conservative management will require surgery is essential. The association between the previously described radiological score and failure of the conservative management of aSBO remains to be confirmed in a large prospective multicentric cohort. Our aim was to assess the risk factors of failure of the conservative management of aSBO considering the radiological score. Material and methods: This prospective observational study took place in 15 French centers over 3 months. Consecutive patients experiencing aSBO with no early surgery were included. The six radiological features from the Angers radiological computed tomography (CT) score were noted (beak sign, closed loop, focal or diffuse intraperitoneal liquid, focal or diffuse mesenteric haziness, focal or diffuse mesenteric liquid, and diameter of the most dilated small bowel loop > 40 mm). Results: Two hundred and seventy nine patients with aSBO were screened. Sixty patients (21.5%) underwent early surgery, and 219 (78.5%) had primary conservative management. In the end, 218 patients were included in the analysis of the risk factors for conservative treatment failure. Among them, 162 (74.3%) had had successful management while for 56 (25.7%) management had failed. In multivariate analysis, a history of surgery was not a significant risk factor for the failure of conservative treatment (OR = 0.11; 95%CI = 0-1.23). A previous episode of aSBO was protective against the failure of conservative treatment (OR = 0.36; 95%CI = 0.15-0.85) and an Angers CT score ≥ 5 as the only individual risk factor (OR = 2.39; 95%CI = 1.01-5.69). Conclusion: The radiological score of aSBO is a promising tool in improving the management of aSBO patients. A first episode of aSBO and/or a radiological score ≥5 should lead physicians to consider early surgical management.
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Dates et versions

hal-03947016 , version 1 (19-01-2023)

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Anita Paisant, Jeanne Burgmaier, Paul Calame, Mélanie Loison, Sébastien Molière, et al.. The Angers CT Score is a Risk Factor for the Failure of the Conservative Management of Adhesive Small Bowel Obstruction: A Prospective Observational Multicentric Study. World Journal of Surgery, 2023, ⟨10.1007/s00268-023-06906-9⟩. ⟨hal-03947016⟩
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