The role of intestinal fatty acid binding protein (iFABP) in the treatment of small bowel obstruction

Small bowel obstruction due to adhesions forms a large part of postoperative
morbidity in Western countries. In the management of small bowel obstruction it
is often said to "never let the sun rise or set on small-bowel obstruction"
because they are sometimes fatal if treatment is delayed. This traditional
surgical canon is no longer followed, since for a large group of patients it is
unclear who can be treated conservatively, and in which cases a surgical
intervention is needed. Unnecessary surgical intervention needs to be avoided
since this is accompanied with risks of intestinal damage, anastomotic leakage
in case of resection and a prolonged postoperative ileus afterwards.
Water-soluble contrast such as gastrograffin may aid in the management of small
bowel obstruction due to adhesions as both a diagnostic tool and a therapeutic
tool (it is a laxative). Also a CT-scan of the abdomen may help to better
differentiate between those patients taht can be treated conservatively and
patients that need surgery. Despite these different diagnostic modalities,
timing and decision for surgery remains an important clinical problem. A
combination of clinical symptoms, experience of the surgeon and radiologic
findings ultimately result in the final decision. Patients that require
surgery for small bowel obstruction often have a longer period of strangulation
of the small bowel leading to intestinal damage. A marker with sufficient
sensitivity and specificity for intestinal damage may be of importance in
selection of patients with small bowel obstruction for surgery.
Intestinal-Fatty Acid Binding Protein (I-FABP) is a cytosolic protein that
resides in the intestinal epithelium and is released in the blood following
intestinal damage. In previous experimental and clinical studies has been shown
that I-FABP is strongly associated with the intestinal damage and is increased
in mesenteric ischemia. We hypothesize that increased levels of I-FABP aid in
the surgical management of small bowel obstruction.

usefulness of I-FABP in the surgical managment of small bowel obstruction
caused by adhesions.

Blood and urine will be sampled at time of diagnosis (day 0) untill three days
afterwards. I-FABP values will be compard with clinical outcome and
radiological findings.

Venous puncture will be performed, in total 4 times. This will be in most cases
part of regular blood sampling. Collection of urine is without risks.
Benefit: This study will aid in a more adequate surgical management of small
bowel obstruction.