Bowel Ischemia and clinical signs

Q: Presence or absence of bowel ischemia can be quickly predicted by an experienced clinician at the bedside? (select one)

A) True

B) False

Answer: B

The objective of the above question is to emphasize the deceiving nature of bedside clinical assessment of bowel ischemia. It is extremely difficult to accurately predict bowel ischemia just based upon clinical signs alone. Actually, a study has shown that even experienced clinicians were wrong in preoperative assessment more than fifty percent of times where patients eventually have gangrenous bowel. A decision should be taken in conjunction with radiological findings.

Said that, a study has shown that despite the deceiving nature of bowel ischemia, clinical experience matters. Patients with Small Bowell Obstruction (SBO) who gets admitted to a surgical service have found to have a shorter length of stay (LOS), lower hospital bills, a shorter time to surgery, and lower mortality when compared to similar kind of patients admitted to a medical service!

#surgical-critical-care

References:

Sarr MG, Bulkley GB, Zuidema GD. Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability. Am J Surg 1983; 145:176.

Oyasiji T, Angelo S, Kyriakides TC, Helton SW. Small bowel obstruction: outcome and cost implications of admitting service. Am Surg 2010; 76:687.