Intestinal obstruction (IO) remains a prevalent surgical emergency, associated with significant morbidity, mortality, and healthcare burden worldwide. Despite improvements in diagnostic modalities and surgical interventions, timely decision-making regarding operative management continues to be a clinical challenge, especially in resource-limited settings. Intestinal obstruction encompasses a wide range of pathologies, and its clinical presentation varies significantly based on patient demographics, anatomical site, and underlying etiology [1,2].

Conventional approaches for managing IO often rely on a combination of clinical judgment and isolated diagnostic markers. However, no single parameter has proven adequately sensitive or specific to guide decisions regarding early surgical intervention. This delay can lead to complications such as bowel ischemia, strangulation, perforation, sepsis, and even death [3,4]. Thus, there exists a critical need for a standardized, evidence-based tool that can assist clinicians in accurately identifying patients requiring timely surgery.

This study addresses this gap by developing and validating a composite scoring system that integrates clinical, pathological, biochemical, and radiological parameters. Such a multimodal approach considers both observable signs (e.g., duration of vomiting, pain, distension) and measurable indicators (e.g., leukocyte count, urea, creatinine, amylase, and X-ray findings) [5,6]. By leveraging these parameters, we aim to enhance predictive accuracy, enabling surgeons to intervene before irreversible complications develop.

Our prospective observational study of 385 patients provides the foundation for constructing and evaluating this novel score. Statistical analysis using sensitivity, specificity, and ROC curve analysis enabled optimization of parameter weightage. Patients were categorized into operative and conservative management groups to determine threshold scores predictive of surgical necessity [7].

This predictive score is expected to reduce diagnostic ambiguity, improve triage accuracy, and enhance clinical outcomes in IO patients. It holds promise not only for tertiary institutions but also for peripheral healthcare centers with limited investigative capabilities.

This prospective observational study was conducted in the Department of Surgery at Shyam Shah Medical College and the associated Sanjay Gandhi Memorial Hospital, Rewa (M.P.), from September 2022 to March 2024. Ethical clearance was obtained from the institutional ethics committee prior to the commencement of the study.

A total of 385 patients aged between 6 months and 80 years, diagnosed with intestinal obstruction based on clinical evaluation and supported by radiological, biochemical, and pathological investigations, were enrolled. Patients with congenital anorectal malformations, chronic systemic illnesses (e.g., tuberculosis, hypertension, diabetes, malignancy), or those unwilling to consent were excluded from the study.

All participants underwent a standardized assessment protocol upon presentation. Clinical parameters recorded included age, sex, body mass index (BMI), and duration (in days) of key symptoms such as vomiting, abdominal pain, distension, and obstipation. Biochemical and pathological investigations involved estimation of hemoglobin, total leukocyte count (TLC), random blood sugar, serum urea, creatinine, total bilirubin, SGOT, SGPT, serum amylase, lipase, sodium, and potassium. Radiological assessment included X-ray abdomen (erect view) and ultrasonography (USG) of the whole abdomen.

The timing and mode of management (operative or conservative) were recorded. Based on statistical analysis of the sensitivity and specificity of each parameter, a scoring system was developed. Each parameter was assigned a binary Likert value (0 or 1), depending on its statistical significance in predicting surgical intervention.

Statistical analysis was performed using SPSS version 21.0. Receiver operating characteristic (ROC) curves were generated to determine cut-off values, and Pearson’s correlation coefficient was used to evaluate the association between variables and surgical outcomes. A composite predictive score was validated to determine its clinical utility in identifying candidates for timely surgical intervention.

The demographic analysis of 385 patients with intestinal obstruction revealed a marked concentration in the middle-aged population, with the 41–60 year age group contributing the largest proportion of cases. The distribution by gender showed a striking male predominance, and BMI analysis indicated that overweight individuals were the most affected demographic (Table 1).

Table 1: Demographic Distribution of Patients with Intestinal Obstruction

There were 13 factors which on retrospective analysis were found to have a positive association with Operative management in patients with Intestinal obstruction. This factors were given a score of 0 or 1 on the basis of the retrospective analysis of patient’s profile. The cumulative score which can help decide a clinician on the treatment protocol is as mentioned below (Table 2).

Table 2: Cumulative score for Intestinal Obstruction

Timely and accurate decision-making in the management of intestinal obstruction remains a cornerstone of surgical practice [8]. In the absence of standardized protocols, clinicians often rely on subjective judgment and varied institutional practices to determine the need for operative intervention [9]. This study sought to overcome these limitations by developing and validating a multimodal scoring system using 13 objectively measurable clinical, biochemical, pathological, and radiological parameters.

Our findings demonstrate that a composite score derived from easily available indicators such as age, BMI, symptom duration (obstipation, abdominal pain, distension), leukocyte count, renal function tests, pancreatic enzymes, liver enzymes, and ultrasonographic loop wall thickness, can effectively stratify patients based on their likelihood of requiring surgery [10]. Each variable was chosen based on statistically significant differences observed between patients who underwent exploratory laparotomy and those who were managed conservatively [11].

Previous studies have identified individual predictors—such as leukocytosis, raised serum urea, and radiological air-fluid levels—but their isolated use lacks adequate sensitivity and specificity [12]. By integrating 13 parameters into a cumulative score, our model offers improved diagnostic precision [13]. The binary scoring (0 or 1) simplifies bedside application and facilitates rapid decision-making, particularly in emergency departments or settings with limited access to advanced imaging [14].

Importantly, the cumulative score demonstrated a high predictive value, with higher scores correlating with increased likelihood of operative need [15]. This system has potential to be especially valuable in resource-limited rural hospitals, where access to subspecialty consultation or serial imaging is restricted [16]. Furthermore, early application of this score may reduce delays in surgical decision-making, thereby mitigating complications such as ischemia or perforation [17].

However, validation in larger, multicentric cohorts is essential to establish generalizability [18]. Future integration into mobile applications or electronic health records may enhance its accessibility and clinical utility [19].

This study presents a validated, practical scoring system that incorporates 13 routinely measurable clinical, biochemical, and radiological parameters to aid in predicting the need for surgical intervention in patients with intestinal obstruction. The simplicity, objectivity, and diagnostic accuracy of this model make it an effective tool for early risk stratification and surgical triage. Its application may standardize decision-making across varying healthcare settings, particularly benefitting emergency and resource-limited environments.

1. Ndong, A., Togtoga, L., Bah, M.S. et al. Prevalence and mortality rate of abdominal surgical emergencies in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Surg 24, 35 (2024). https://doi.org/10.1186/s12893-024-02319-0
2. Pasławski M, Gwizdak J, Złomaniec J. The diagnostic value of different imaging modalities in evaluation of bowel obstruction. Ann Univ Mariae Curie Sklodowska Med. 2004;59(2):268-74.
3. Hafner J, Tuma F, Hoilat GJ, et al. Intestinal Perforation. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538191/
4. Nelms DW, Kann BR. Imaging Modalities for Evaluation of Intestinal Obstruction. Clin Colon Rectal Surg. 2021 Jul;34(4):205-218.
5. Wassmer CH, Revol R, Uhe I, Chevallay M, Toso C, Gervaz P, Morel P, Poletti PA, Platon A, Ris F, Schwenter F, Perneger T, Meier RPH. A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia: a cohort study. Int J Surg. 2023 Jun 1;109(6):1620-1628.
6. Besler E, Teke E, Akkuş D, Demir MH, Aksaray S, Aydın Aksu S, Gürleyik MG. A new risk scoring system for early prediction of surgical need in patients with adhesive small bowel obstruction: a single-center retrospective clinical study. Ann Surg Treat Res. 2023 Sep;105(3):165-171.
7. Udhayasuriyan R, Dharmarajan M, Boobalan M, Subramaniam S. Validation of AGESS-SBO scoring system for the prognosis and outcome of small bowel obstruction. Int J Acad Med Pharm. 2023;5(4):1029-34.
8. Lobo DN, Bastero J, Soderquist RS, et al. The role of scoring systems in the management of acute intestinal obstruction. Surg Infect (Larchmt). 2002;3(3): 287–294.
9. Zhang T, Wang B, Zhang Z, et al. Surgical decision-making and management of acute small bowel obstruction: A review of contemporary approaches. Int J Surg. 2017;41: 45–50.
10. Hwang JY, Jang YS, Park IS, et al. Evaluation of clinical parameters in predicting the need for surgery in patients with small bowel obstruction. World J Surg. 2013;37(8): 1872–1879.
11. Chowdhury B, Al-Dujaili A, Baig MK, et al. Predictive factors for the decision-making process in the management of acute small bowel obstruction. Am Surg. 2009;75(6): 482–487.
12. Lee Y, Kim SH, Kim TH, et al. Utility of leukocytosis and serum urea as diagnostic markers in acute intestinal obstruction. Ann Surg Treat Res. 2015;88(1): 10–15.
13. Choi YJ, Cho YS, Park SH, et al. A new predictive scoring model for evaluating small bowel obstruction severity and surgical intervention. J Trauma Acute Care Surg. 2018;85(2): 288–296.
14. Koppes SA, Nio Y, de Jongh MA, et al. Point-of-care diagnostic systems for decision-making in small bowel obstruction: A review of advancements. J Clin Med. 2020;9(3): 785–792.
15. Khouzam RN, Markwood G, Adhikari R, et al. A predictive scoring system for intestinal obstruction based on clinical and radiological parameters. Ann Surg. 2019;270(3): 510–517.
16. Vasilenko A, Rehder R, Torbenson M, et al. Impact of resource constraints on surgical outcomes in rural hospitals: The case of small bowel obstruction. J Rural Health. 2018;34(2): 142–150.
17. Mitry D, Brown C, Yelland S, et al. Delays in surgical decision-making and outcomes of small bowel obstruction: A hospital-based cohort study. J Surg Res. 2019;245: 267–274.
18. Sainz E, Zubero M, Lopez A, et al. Validation of a predictive model for operative intervention in patients with acute bowel obstruction: A multicenter study. Br J Surg. 2021;108(5): 612–618.
19. Li Q, Zhao R, Wu X, et al. The future of clinical decision-making tools: Integrating scoring systems with mobile applications and electronic health records. Health Inf J. 2022;28(3): 334–342.