Development of a Nomogram for Predicting Surgical Conversion After Failure of Intestinal Obstruction Catheter Treatment in Adhesive Small Bowel Obstruction: A Single-Center Retrospective Study

Background: Nonoperative management (NOM) with nasoenteric decompression tubes is a preferred strategy for adhesive small bowel obstruction (ASBO), yet treatment failure may lead to delayed surgery and increased mortality. Current predictive tools lack integration of clinical, laboratory, and imaging indicators. Objective: To develop and validate a nomogram for predicting the risk of NOM failure requiring surgical conversion in ASBO patients. Methods: This retrospective study included 61 ASBO patients treated with nasoenteric decompression at Qilu Hospital of Shandong University Dezhou Hospital (January 2022–January 2025). Independent predictors were identified via univariate and multivariate logistic regression. A nomogram was constructed and internally validated using 1000 bootstrap resamples. Model performance was assessed using ROC curves, calibration curves, and decision curve analysis (DCA). Results: Multivariate analysis identified three independent predictors: History of previous adhesive small bowel obstruction (OR=6.661, 95% CI: 1.210–36.680), low hemoglobin (OR=0.951, 95% CI: 0.906–0.998), and Small bowel feces sign (OR=0.11, 95% CI: 0.022–0.542). The nomogram demonstrated excellent discrimination (AUC=0.864, 95% CI: 0.753–0.946), calibration (Brier score=0.039), and clinical net benefit (0.361 within a threshold probability of 15%–65%). Conclusion: This nomogram, integrating clinical, laboratory, and imaging data, provides a practical tool for early identification of high-risk ASBO patients.