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