When intestinal ischemia is unlikely, a conservative

approach can be followed for 24-48 h. Meagher et al. have suggested that surgery is unavoidable in patients with small bowel obstruction after previous appendectomy or surgery on the fallopian tubes or ovaries [50]. In another recently developed model for predicting the risk of strangulated SBO, six variables correlated with small bowel resection: history of pain lasting 4 days or more, guarding, C-reactive protein level at least 75 mg/l, leucocyte count 10 × 10(9)/l or greater, free intraperitoneal fluid volume at least 500 ml on computed tomography (CT) and reduction of CT small bowel wall contrast enhancement [51]. A further multivariate predictive model of surgical operation in SBO [52], www.selleckchem.com/products/qnz-evp4593.html showed free intraperitoneal fluid, mesenteric edema, lack Selleckchem Compound C of the ”small bowel feces sign” at CT, and history of vomiting to be significant predictors of the need for operative exploration. In a retrospective study of 53 patients with ASBO treated using a long nasointestinal tube (LT), complete SBO (no evidence of air within the large bowel) and increased serum creatine phosphokinase (>or = 130 IU/L) were independent predictive factors for LT decompression failure [53]. A recent prospective Panobinostat manufacturer study aimed to evaluate an algorithm using CT-scans and Gastrografin in the management of small bowel obstruction, severe abdominal pain (VAS > 4),

abdominal guarding, raised WCC and devascularized bowel at CT predict the need for emergent laparotomy at the time of admission [54]. Furthermore this study demonstrated

the diagnostic role of Gastrografin in discriminating between partial and complete small bowel obstruction whilst CT-scans were disappointing in their ability to predict the necessity of emergent laparotomies. Coproporphyrinogen III oxidase Again two systematic reviews confirmed the value of water soluble contrast medium in predicting need for surgery in ASBO patients. Abbas et al. in 2007 already confirmed that Water-soluble contrast followed by an abdominal radiograph after at least 4 hours can accurately predict the likelihood of resolution of a small bowel obstruction [55] and that appearance of water-soluble contrast agent in the colon on an abdominal radiograph within 24 h of its administration predicted resolution of obstruction with a pooled sensitivity of 97 per cent and specificity of 96 per cent [56]. Branco et al. as well found that the appearance of WS contrast in the colon within 4-24 h after administration accurately predicts resolution of ASBO with a sensitivity of 96 per cent and specificity of 98 per cent [57]. In conclusion patients without the above mentioned clinical picture (including all signs of strangulation and/orperitonitis etc.) and a partial SBO or a complete SBO can both undergo non-operative management safely; although, complete obstruction has a higher level of failure [58].