Does a Plain Abdominal X-ray have a Role in the Management of Patients with Adhesional Small Bowel Obstruction? A Retrospective Study

BACKGROUND Small bowel obstruction (SBO) is a common surgical entity and represents 16% of surgical admissions. Surgical adhesions account for 75–80% of all SBO cases. The treatment of SBO is non-operative in 70–90% of cases. Many articles have shown the advantage of CT scans over plain radiographs, thus suggesting that the use of plain abdominal X-rays is no longer relevant. We hypothesized that most patients can be managed with a plain X-ray without the need for CT. METHODS A retrospective study was conducted, including all patients who were admitted with SBO due to adhesions in our medical center between 2015 and 2019. All patients had previous abdominal operations and were above 18 years of age. Patients were divided into two groups: Group I—those who had a plain abdominal radiograph at admission without a CT, and Group II—those who underwent a CT scan at admission. RESULTS Overall, 629 patients were admitted with an SBO diagnosis. 487 (77%) patients were diagnosed by plain abdominal X-ray in the emergency department—Group I. 142 patients (22%) had a CT in the ER—Group II. 68.5% of Group I patients had previous SBO episodes compared to 24.6% in Group II. Group I had significantly fewer patients with abnormal lactate levels and WBC counts. Only 11.7% of Group I patients required a CT during their admission. Fifty patients (35.5%) from Group II underwent surgery compared to only 7% from Group I. LOS was not significantly different (Group I: 4 days vs. Group II: 5 days, P = 0.072). Previous episodes of SBO correlated with management without surgery. Postoperative morbidity and mortality were not different between the groups. CONCLUSIONS Most patients with adhesional SBO can be managed without CT, especially those with recurrent episodes of SBO.