Role of Intestinal fatty acid binding protein in diagnosing adhesive small bowel obstruction: a pilot study.

The incidence of adhesive small bowel obstruction (ASBO) after abdominal surgery is 2.4%. Delay in surgery increases morbidity and mortality. Plasma Intestinal fatty acid binding protein (I-FABP) levels indicate intestinal damage and may guide treatment. Aim of this study is to investigate whether plasma I-FABP levels may optimize selection of patients requiring surgery. Patients with suspected ASBO underwent a contrast swallow. If bowel transit was absent after 8 hours, surgery was performed. I-FABP levels were assessed. Data were analysed by comparing groups based on bowel transit, ischemia and positive or negative laparotomies. Furthermore a true operative group (patients with mechanical obstruction during surgery and patients needing operative treatment who deceased due to non-operative treatment) was compared to a true non-operative group (patients with negative laparotomies and patients successfully treated with non-operative treatment). Median I-FABP levels were higher in patients without bowel transit (1207 pg/mL) than in patients with bowel transit (589 pg/mL, P = 0.01). Median I-FABP levels in the negative laparotomy group (301 pg/mL) showed a trend to significance compared to the positive laparotomy group (1177 pg/mL, P = 0.05). There was no significant difference between the true operative group (1150 pg/mL) and the true non-operative group (664 pg/mL) or between proven ischemia (975 pg/mL) and no ischemia (921 pg/mL). In conclusion I-FABP might help to identify ASBO patients in whom surgery can be postponed.