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Updated: Sep 10, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
A novel predictive scoring system for irreversible intestinal ischemia in patients with strangulated bowel
Kensuke Kudou1,2,3, Tetsuro Kawazoe4, Tomonori Nakanoko4
1Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. k.k.vermillion0920@gmail.com.
Purpose:
Strangulated bowel obstruction is a critical condition requiring emergency surgery. This study investigated the clinical parameters of patients undergoing emergency surgery for strangulated and non-strangulated bowel obstructions and identified the predictive factors for intestinal ischemia.
Methods:
This retrospective review included 270 patients who underwent surgery for bowel obstruction. The clinical and operative factors were analyzed to determine the predictive factors for intestinal ischemia. A novel predictive scoring system was developed based on significant parameters identified by a multivariate analysis.
Results:
Among patients with strangulated bowel obstruction, independent predictors for the need for intestinal resection were massive ascites, computed tomography value ≤ 50 Hounsfield units, lactate levels ≥ 30 mg/dL, and neutrophil-lymphocyte ratio ≥ 8.5. A novel predictive score was developed using these four parameters. Patients with a score of 0 did not require intestinal resection because of strangulation. Fifteen patients, with a score of 7, developed irreversible ischemia and required intestinal resection.
Conclusions:
A predictive score incorporating ascites, computed tomography values, lactate levels, and neutrophil-lymphocyte ratio effectively stratified patients with strangulated bowel obstruction, aiding early diagnosis and risk stratification.
