Clinical performance of the Antoine Béclère score in predicting operative requirement in adhesive small bowel obstruction.

backgroundAdhesive small bowel obstruction (ASBO) remains a common surgical emergency, yet distinguishing patients who will fail conservative management continues to be difficult. Although many clinical and radiologic predictors have been proposed, their accuracy is inconsistent, and simple objective tools are still lacking.

methodsA retrospective cohort study was conducted including adults admitted with CT-confirmed ASBO between 2020 and 2024. Demographics, comorbidities, laboratory values, PNI, PLR, radiologic parameters, and Antoine Béclère (AB) scores were collected. Predictors of surgery were examined using univariate and multivariable logistic regression. Diagnostic accuracy of the AB score was assessed using receiver operating characteristic (ROC) analysis.

resultsA total of 106 patients were included, of whom 51 (48.1%) required operative management. PNI and PLR did not differ significantly between operative and non-operative groups. Older age, higher comorbidity burden, and higher AB scores were associated with surgery. An AB score ≥2 predicted operative need in 82.4% of cases (p < 0.001). In multivariable analysis adjusted for age and Charlson index ≥4, an AB score ≥2 remained an independent predictor (OR 4.20). ROC analysis showed moderate discriminative ability for the AB score, with an AUC of 0.71, sensitivity of 82%, and specificity of 66.

conclusionThe AB score helped identified patients unlikely to respond to conservative treatment, with a score ≥2 strongly associated with operative need. Its performance was not influenced by nutritional or inflammatory status. These findings highlight the clinical utility of simple, reproducible indicators in guiding early management of ASBO.