Journal Review in Emergency General Surgery: Small Bowel Obstruction - What 15 Years of Data Teach Us in Tiger Country

Strap in and grab your NG tubes, because the EGS team in TIGER Country is taking you on a fast, forceful, and evidence-packed ride through 15 years of global SBO literature. From the OG 2011 Zielinski model to the latest 2025 predictive tools sweeping across Europe and North America, we’re breaking down what matters when the bowel stops behaving and the clock starts ticking.

Join Dr. Rushabh Dev and the Acute Care Surgery crew at the University of Missouri as they tackle the most common EGS consult in America with humor, data, and real-world pearls. Get ready for CT red flags, strangulation scores, Gastrografin truths, and the eternal battle between “operate early” vs. “wait it out.” Whether you’re a med student trying to decode your first CT or a seasoned attending debating the next Gastrografin challenge, this episode delivers the insights you need to Dominate the Day.

Participants:

• Dr. Rushabh Dev FACS (Moderator, Surgical Attending) – Assistant Professor of Surgery, Associate PD ACS & SCCM Fellowship, SICU Medical Director, Lieutenant Commander United States Navy Reserve
• Dr. Raymond Okeke; Acute Care Surgery & SCCM Fellow
• Dr. Eugene Ismailov, General Surgery Resident; PGY 5
• Dr. Brycen Ratcliffe, General Surgery Resident; PGY 4
• Dr. Desra Flecher, General Surgery Resident; PGY 3

Objectives:
1. Identify the core clinical and CT predictors of operative need in SBO including mesenteric edema, free fluid, closed-loop obstruction, lack of enhancement, and feces sign absence — and understand how these features have remained consistent across 15 years of research.

2. Compare major international SBO predictive models (Zielinski, Geneva Severity Score, STRISK, and NOFA) and describe how they inform real-time decision-making in North American acute care surgery.

3. Apply evidence-based algorithms, including the 2025 JTACS EGS pathway to structure SBO evaluation, integrate Water-Soluble Contrast studies, and avoid delayed surgery in high-risk patients.

4. Evaluate the long-term impact of operative vs. non-operative management with emphasis on recurrence risk, timing between episodes, and how to incorporate recurrence data into patient counseling.

5. Synthesize 15 years of evolving SBO literature into practical bedside strategies by balancing red-flag findings, risk-model guidance, and individualized clinical judgment to optimize outcomes.

STRISK and NOFA Calculator: Prediction Models | Clinical Abdominal Surgery Helsinki

References

1. Geneva Clinical Severity Score
Wassmer, C. H., Guber, J., Zeindler, J., Meier, R. P. H., Ouaïssi, M., Ris, F., Morel, P., Didier, C., & Gkikas, I. (2023). A new clinical severity score for the management of adhesive small bowel obstruction: A cohort study. International Journal of Surgery, 109, 262–270. https://pubmed.ncbi.nlm.nih.gov/37026805/

2. STRISK & NOFA Predictive Models
Räty, S., Rinta-Kilpinen, E., Eklund, M., Turunen, N., Koskinen, I., Rasilainen, S., Korhonen, T., & Paajanen, H. (2025). Development and external validation of prediction risk models for strangulation or non-operative treatment failure in small bowel obstruction: A multicenter prospective study. Surgery, 178(1), 45–56.
Prediction Models | Clinical Abdominal Surgery Helsinki

3. JTACS EGS Algorithm – Evidence-Based, Cost-Effective Management
Livingston, D. H., Wolfson, D., Cogbill, T. H., Rice, T. W., Patel, N., et al. (2025). Evidence-based, cost-effective management of small bowel obstruction: An Emergency General Surgery Algorithms Work Group project. Journal of Trauma and Acute Care Surgery, 98(4), 512–528. https://pubmed.ncbi.nlm.nih.gov/40842046/

4. Tennessee Recurrence Study (Operative vs Non-Operative Management)
Medvecz, A. J., Dennis, B. M., Wang, L., Countouris, M. E., Croce, M. A., Sharpe, J. P., Ivanova, A., & Miller, R. S. (2020). Impact of operative management on recurrence of adhesive small bowel obstruction: A longitudinal analysis of a statewide database. Journal of the American College of Surgeons, 230(4), 544–551.e1. https://pubmed.ncbi.nlm.nih.gov/31954815/

5. Early Predictive SBO Work – Zielinski (2010–2011)
Zielinski, M. D., Eiken, P. W., Bannon, M. P., Heller, S. F., Lohse, C. M., & Huebner, M. (2010). Small bowel obstruction—Who needs an operation? A multivariate prediction model. World Journal of Surgery, 34(5), 910–919. https://pubmed.ncbi.nlm.nih.gov/20217412/

6. Zielinski, M. D., Haddad, N. N., Cullinane, D. C., Eiken, P. W., & Huebner, M. (2011). Prospective, observational validation of a multivariate small bowel obstruction model to predict the need for operative intervention. Journal of the American College of Surgeons, 212(6), 1068–1076. https://pubmed.ncbi.nlm.nih.gov/21458305/

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