Kim et al used clinical findings to support the diagnosis of strangulation in small bowel obstruction. This can be used in conjunction with CT findings (see next section). The authors are from University of Ulsan College of Medicine at the Asan Medical Center (Seoul) and the New Jersey Medical School in Newark.
Patient selection: small bowel obstruction
Parameters:
(1) abdominal tenderness on palpation
(2) pulse
(3) body temperature
(4) white blood cell count
Parameter
Finding
Points
abdominal tenderness
absent
0
present
1
heart rate
<= 100 beats per minute
0
> 100 beats per minute
1
body temperature
<= 38.5°C
0
> 38.5°C
1
white blood cell count
<= 10,000 per µL
0
> 10,000 per µL (leukocytosis)
1
clinical score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum clinical score: 0
• maximum clinical score: 4
• Tachycardia and leukocytosis were the 2 most specific findings.
Clinical Score
Interpretation
0 or 1
simple obstruction
2
indeterminate
3 or 4
strangulation present
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