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Early surgical decision-making is challenging because classical clinical and radiological signs of ischemia are often absent during the reversible phase. This study aimed to identify clinical, imaging, and biochemical factors associated with bowel strangulation and delayed surgical intervention in patients with internal hernia\u2013related SBO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included patients who underwent surgery for internal hernia\u2013related SBO between January 2019 and December 2025. Admission laboratory parameters and preoperative non-enhanced abdominal computed tomography (CT) findings were analyzed. Multivariable logistic regression was used to identify predictors of bowel strangulation and factors associated with delayed surgical intervention. Clinical outcomes were compared between delayed and non-delayed surgery groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 119 patients were included, of whom 82 (68.9%) had strangulated internal hernia. Lactate (OR\u2009=\u20093.975) and D-dimer (OR\u2009=\u20093.412) were independent predictors of bowel strangulation. In patients with strangulated internal hernia, the absence of peritonitis (OR\u2009=\u20090.021), absence of the whirlpool sign on CT (OR\u2009=\u20090.147), and higher base excess (OR\u2009=\u20091.274) were independently associated with delayed surgical intervention. Patients in the delayed surgery group had significantly higher rates of bowel resection (85.7% vs. 53.2%), bowel necrosis, and longer hospital stays compared with those undergoing timely surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Surgical delay in internal hernia\u2013related SBO is frequently driven by deceptively mild clinical and radiological findings during early ischemia. While lactate and D-dimer indicate established strangulation, base excess\u2014together with non-enhanced CT features\u2014may provide earlier warning of mesenteric compromise. An integrated interpretation of laboratory and imaging findings may facilitate earlier surgical intervention, reduce bowel resection, and improve clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-026-04835-0","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T12:46:25Z","timestamp":1776775585000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of surgical delay on bowel viability in internal hernia-related small bowel obstruction: a retrospective cohort study of clinical, imaging, and biochemical predictors of strangulation"],"prefix":"10.1186","volume":"26","author":[{"given":"Judong","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifang","family":"Hsieh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longchun","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7126-1652","authenticated-orcid":false,"given":"Jing","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"issue":"6","key":"4835_CR1","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1007\/s11894-017-0566-9","volume":"19","author":"SR Rami Reddy","year":"2017","unstructured":"Rami Reddy SR, Cappell MS. A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep. 2017;19(6):28. https:\/\/doi.org\/10.1007\/s11894-017-0566-9.","journal-title":"Curr Gastroenterol Rep"},{"issue":"3","key":"4835_CR2","doi-asserted-by":"publisher","first-page":"703","DOI":"10.2214\/AJR.05.064","volume":"186","author":"LC Martin","year":"2006","unstructured":"Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006;186(3):703\u201317. https:\/\/doi.org\/10.2214\/AJR.05.064.","journal-title":"AJR Am J Roentgenol"},{"issue":"6","key":"4835_CR3","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1097\/TA.0000000000003182","volume":"90","author":"J Guerrini","year":"2021","unstructured":"Guerrini J, Zugna D, Poretti D, et al. Adhesive small bowel obstruction: single band or matted adhesions? A predictive model based on computed tomography scan. 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This retrospective observational study was reviewed and approved by the Medical Ethics Committee of Tianjin People\u2019s Hospital (Approval No. (2026) Fast Review No. (B020)). Due to the retrospective nature of the study, the requirement for informed consent to participate was waived by the ethics committee.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All patients provided general written informed consent for treatment and use of anonymized clinical data at hospital admission. Additional written informed consent was obtained for publication of representative clinical images when applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"321"}}