Acute intestinal obstruction: small intestine vs. large intestine: an analysis

Authors

  • Latika Sharma Department of Surgery, Dr. SN Medical College, Jodhpur, Rajasthan, India
  • Harshit Srivastava Department of Surgery, Dr. SN Medical College, Jodhpur, Rajasthan, India
  • Dharmendra Kumar Pipal Department of Surgery, Dr. SN Medical College, Jodhpur, Rajasthan, India
  • Saurabh Kothari Department of Surgery, Dr. SN Medical College, Jodhpur, Rajasthan, India
  • Rohit Dhawan Department of Surgery, Dr. SN Medical College, Jodhpur, Rajasthan, India
  • Poojan M. Purohit Department of Surgery, Dr. SN Medical College, Jodhpur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-2902.isj20175888

Keywords:

Background, Bowel obstruction is one of the most common causes of acute abdomen and also a common surgical emergency. The causes of IO vary significantly depending on geographical location. The aim of this study was to identify the etiology, clinical pres

Abstract

Background: Bowel obstruction is one of the most common causes of acute abdomen and also a common surgical emergency.The causes of IO vary significantly depending on geographical location. The aim of this study was to identify the etiology, clinical presentation, management and outcomes of patients with acute mechanical IO presenting in Jodhpur, Rajasthan.

Methods: A prospective study was conducted at Mahatma Gandhi Hospital and Mathura Das Mathur Hospital (associated with Dr. SN Medical College), Jodhpur, Rajasthan. 100 patients with acute intestinal obstruction were admitted and evaluated. Blood routine, X-Ray abdomen, USG abdomen and CECT (if required) were done. A pre-operative diagnosis was made. Intra-operative findings and Post-operative complications were noted and follow up was done till the patient was discharged from the hospital.

Results: A total of 69 male and 31 female patients, presented with acute mechanical IO during the period of the study. Mean patient age was 48.5 years with peak incidence in those aged 31-45 years. The foremost signs and symptoms were abdominal distension (88%), obstipation (87%), abdominal pain (81%) and nausea/ vomiting (47%). Adhesions and bands (29%), hernia (13%), neoplasm (9%) and pseudo-obstruction (8%) were the leading causes of intestinal obstruction. The sensitivity of X-ray and USG in present study was 67% and 75% respectively. Most common complication associated was wound infection (17%) followed by paralytic ileus (7%) and respiratory tract infections (6%). Late presentation was associated with poor prognosis. 4 patients expired before surgery. Post-operative mortality was associated with 6 patients and was more common in cases which presented with gangrenous bowel.

Conclusions: The most common causes of IO in this study were adhesions and bands, hernia, neoplasm and pseudo-obstruction. Presence of bowel gangrene was associated with higher morbidity and mortality.

References

Jackson PG. Harrison's principles of internal medicine. New York: McGraw-Hill; 2010.

Bruch HP, Schwander O, Markert U. Intestinal obstruction as cause of acute abdomen. Chir Gastroenterol. 2002;18(3):244-51.

Stephenson JA, Singh B. Intestinal obstruction. Surgery (Oxford). 2011;29(1):33-8.

Kulaylat MN, Doerr RJ. Small bowel obstruction. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001.

Saravanan PS, Bala VP, Sivalingam J. Clinical study of acute intestinal obstruction in adults. IOSR-JDMS. 2016;15(11):76-83.

Philip Blasto Ooko. Pattern of adult intestinal obstruction. Pan Afr Med J. 2015;20:31.

Souvik A, Hossein MZ, Amitabha D, Nilanjan M, Udipta R. Etiology and outcome of acute intestinal obstruction: A review of 367 patients in Eastern India. Saudi journal of gastroenterology: official J Saudi Gastroenterol Ass. 2010 Oct;16(4):285.

Ojo EO, Ihezue CH, Sule AZ, Ismaila OB, Dauda AM, Adejumo AA. Aetiology, clinical pattern and outcome of adult intestinal obstruction in JOS, north central Nigeria. Af J Med Sci. 2014;43:29.

Soressa U, Mamo A, Hiko D, Fentahun N. Prevalence, causes and management outcome of intestinal obstruction in Adama Hospital, Ethiopia. BMC surgery. 2016 Jun 4;16(1):38.

Chen XZ, Wei T, Jiang K, Yang K, Zhang B, Chen ZX, et al. Etiological factors and mortality of acute intestinal obstruction: a review of 705 cases. Journal of Chinese integrative medicine. 2008;6(10):1010-6.

Mohamed AY. Causes and management of intestinal obstruction in a Saudi Arabian hospital. J R Coll Surg Edinb. 1997 Feb;42(1):21-3.

Heis HA. Sigmoid volvulus in the Middle East. World J Surg. 2008;32:459-64.

Maglinte DD. Role of plain radiography and CT in diagnosing small bowel obstruction. AJR Am J Roentgenol. 1996;167(6):1451-5.

Ogata M, Mateer JR, Condon RE. Prospective evaluation of abdominal sonography for the diagnosis of bowel obstruction. Ann Surg. 1996;223(3):237.

Schmutz GR, Benko A, Fournier L, Peron JM, Morel E, Chiche L. Small bowel obstruction: role and contribution of sonography. Eur Radiol. 1997;7(7):1054-8.

Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med. 2013;20(6):528-44.

Musoke F, Kawooya MG, Kiguli-Malwadde E. Comparison between sonographic and plain radiography in the diagnosis of small bowel obstruction at Mulago Hospital, Uganda. East Afr Med J. 2003;80(10):540-5.

Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J. 2011;28(8):676-8.

Deshmukh SN. Pattern of dynamic intestinal obstruction in adults at tertiary care centre. Int Surg J. 2016;3(2):492-6.

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Published

2017-12-26

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Original Research Articles