Prospective Evaluation of Conservative Management in Intestinal Obstruction with Analysis of Predictors of Treatment Failure and Need for Surgery

A BSTRACT Background: Intestinal obstruction is a common surgical emergency associated with significant morbidity and healthcare burden. Although many patients can be managed conservatively, delayed recognition of cases requiring surgery may lead to complications such as bowel ischemia and perforation. This study aims to evaluate outcomes of conservative management and identify predictors of treatment failure requiring surgical intervention. Materials and Methods: This prospective observational study was conducted at Civil Hospital, Ahmedabad, between July 2022 and June 2023. A total of 100 patients presenting with clinical and radiological features of intestinal obstruction were included. Patients requiring immediate emergency surgery were excluded. All patients initially underwent conservative management, including nasogastric decompression, intravenous fluid resuscitation, and close clinical monitoring. Patients who failed to improve within 72 h or developed signs of complications underwent surgical intervention. Data regarding etiology, management outcomes, predictors of conservative treatment failure, and recurrence were analyzed. Associations between categorical variables were assessed using Fisher’s exact test, and odds ratios (ORs) with 95% confidence intervals were calculated. Results: Among the 100 patients studied, 44 were successfully managed conservatively, while 56 required surgical intervention. Postoperative adhesions were the most common cause of intestinal obstruction (40%), followed by tuberculosis (16%) and tumors (14%). Adhesiolysis was the most frequently performed surgical procedure (51.78%). Persistent abdominal tenderness (OR: 0.15, P < 0.001), failure to pass stool within 72 h (OR: 0.16, P < 0.001), leukocytosis (white blood cell: >15000/mm 3 ) (OR: 0.38, P = 0.025), elevated C-reactive protein (>75 mg/L) (OR: 0.34, P = 0.021), and reduced bowel wall enhancement on computed tomography scan (OR: 0.13, P = 0.003) were significant predictors of failure of conservative management. Recurrence was higher in the conservative group (38%) compared to the surgical group (20%). Conclusion: While conservative management is effective in selected patients with intestinal obstruction, early identification of predictors of treatment failure is crucial. Clinical, laboratory, and radiological parameters can aid in timely surgical decision-making and may improve patient outcomes.