Clinical features of failure of conservative management in adult patients with adhesive small bowel obstruction: a retrospective cohort study.

Background: Adhesive small bowel obstruction (ASBO) is a common cause of acute abdominal pain in adults. Most patients with ASBO without strangulation are successfully managed conservatively. However, some patients fail nonoperative treatment, develop intestinal ischemia and undergo surgical management. The clinical features of these patients require further investigation. Methods: Patients who received conservative management as the initial treatment for ASBO between January 2017 and December 2025 were selected from the electronic medical records of a single institution. The patients were categorized into a successful conservative treatment group (group A) and a surgery group (group B). Demographic and clinical variables were compared between the two groups. Results: A total of 510 patients were included in this retrospective study. Groups A and B comprised 456 and 54 patients, respectively. Univariable analysis demonstrated a significant difference in five factors: age, multiple previous operations, C-reactive protein (CRP) level, body temperature, and maximum diameter of the dilated small bowel (MDSB) ( Conclusion: Our study established older age, higher CRP level, fever, and larger MDSB on admission as risk factors for failure of conservative ASBO management. The risk of ASBO recurrence was not increased by surgical intervention. Although these results should be interpreted with caution, these findings might assist clinical practice. Conversion to operation increases the length of hospital stay, hospitalization costs, and intensive care unit admission.