Small Bowel Obstruction in Virgin Abdomen Predictors of Surgical Intervention Need in Resource-Limited Setting

Background: Limited evidence is available regarding the management of small bowel obstruction in the virgin abdomen (SBO-VA), with most studies excluding this entity. This study aims to assess the available data on the treatment outcomes and predictors of surgical intervention in SBO-VA.Methods: A retrospective cross-sectional study was conducted between 2015 and 2021, including all diagnosed and managed cases of SBO-VA at Al-Nasar Hospital. Patients were divided according to the treatment approach into surgical or conservative groups. Preoperative laboratory and radiologic data were gathered and compared between groups.Results: During the study period, 67 cases, primarily males (58.2%), with an average age of 52.2 +/- 14.4 years were assessed. Common comorbidities included diabetes (20.9%) and hypertension (16.4%). Key symptoms were rebound tenderness (82.1%) and abdominal tenderness (70.1%). The predominant etiology was adhesions (23.9%). About 46.2% received conservative treatment, 53.8% under-went urgent surgery. Conservative treatment failed in 9.4% of cases, and complications arose in 23.9%, with most being fever (17.9%). Factors necessitating surgical management included older age (58.8 +/- 11.7 vs 44.9 +/- 13.8 years, p<0.001), previous hospital admission (p<0.001), presence of abdominal tenderness (p=0.030), longer abdominal pain duration (4.0 +/- 0.9 vs 2.1 +/- 0.6 days, p<0.001), higher C-reactive protein (p= 0.033), higher white blood cell (p= 0.006), longer time to hospital presentation (75.3 +/- 17.2 vs 39.0 +/- 22.8 days, p= <0.001), small bowel thickness >= 3 cm (p=0.009), and reduced bowel enhancement (p <0.001) on computed tomography imaging. In surgical group, the need for ICU admission was higher and hospital stays were shorter than in conservative group and were statistically significant (p<0.05).Conclusion: The main etiology of SBO-VA in our study was adhesions. Older age, previous hospital admission, longer abdominal pain duration, abdominal tenderness, increased inflammatory markers, and alarm signs on CT scans are the main factors for determining the need for urgent surgical exploration in patients with SBO-VA. To achieve prompt identification and intervention, it is crucial to maintain a high level of vigilance and awareness, even in individuals with no prior surgical history. Plain language summary: here is limited evidence available regarding the management of small bowel obstruction in the virgin abdomen (SBO-VA), with most studies excluding this entity especially in resource-limited settings. In this study, we investigated the factors associated with the need for surgical interventions in 67 cases diagnosed with SBO-VA. Our result showed that the predominant etiology was adhesion. While 46.2% received conservative treatment, 53.8% underwent urgent surgery. Conservative treatment failed in 9.4% of cases. Factors associated with need for surgical management included older age, previous hospital admission, presence of abdominal tenderness, longer abdominal pain duration, higher C-reactive protein (CRP), higher white blood cell (WBC), longer time to hospital presentation, small bowel thickness >= 3 cm and reduced bowel enhancement on computed tomography imaging. In surgical group, the need for ICU admission was higher and hospital stays were shorter than in conservative group.