DOI: http://dx.doi.org/10.18203/2349-2902.isj20195961

A clinical study on the surgical management of intestinal obstruction

Jyotsna Choudary Gogineni, Trupti Tonape, V. S. Athavale, Sree Kumar, Shweta Achuthan Kutty, K. Sri Likhita

Abstract


Background: Intestinal obstruction remains one of the common emergencies encountered by general surgeons all over the world. Acute intestinal obstruction occurs when there is a disruption in the frontward flow of intestinal contents.

Methods: This study is a prospective study conducted in Dr. D Y Patil Medical College and Hospital, Pimpri, Pune. Patients coming to the hospital with signs and symptoms suggestive of intestinal obstruction and willing for surgical management in our hospital were included after taking written and informed consent.

Results: In our study, pain abdomen and abdominal distension was the most common presenting complaints in 90% and 92% of the patients respectively. On palpation, 96% of the patients had abdominal tenderness, 72% of the patients had guarding and 12% of the patients had rigidity. On auscultation, all patients had some abnormality with regard to bowel sounds. It has been noted that intestinal strictures and abdominal adhesions were amongst the most common causes of intestinal obstruction in our study.

Conclusions: Prompt clinical assessment aided by radiological imaging is of crucial importance in reaching the diagnosis of intestinal obstruction. Decision regarding surgical intervention is taken based on the initial presentation of the patient, and his/her response to first line conservative management and fluid resuscitation

Keywords


Intestinal, Obstruction, Radiological, Imaging, Surgical, Intervention

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References


Kloiber H. Die. Roentgen diagnose Des Ileus Ohne Koutrastmittel. Arch F Klin Chir. 1919;112:513.

Owen H. Wangensteen. Historical aspect of the management of the acute intestinal obstruction. Surgery. 1969;63:363-83.

Drake RL, Vogl AW, Mitchell AWM. Abdomen. 2nd ed. Chapter 4. Gray’s Anatomy for students. Philadelphia: Churchill Livingstone Elsevier; 2010: 300.

Decker GAG, du Plessis DJ. The duodenum, jejunum and ileum. 12th ed. Chapter 4. In: Lee McGregor’s Synopsis of Surgical Anatomy. Bombay: Wright Verghese; 1986: 30.

Ganong WF. Regulation of gastrointestinal function.19th ed. Chapter 26. Review of medical physiology. Philadelphia, USA: Appleton and Lance; 1999: 483.

Robert M Berne. Physiology, Gastrointestinal regulation and motility. 5th ed. Chapter 31. In: Berne RM, Levy MN, Koeppen BM, Stanton BA, eds. Mosby Publication; 2008: 539.

Souvik A, Hossein MZ, Amitabha D, Nilanjan N, Udipta R. Etiology and Outcome of Acute Intestinal Obstruction: A Review of 367 Patients in Eastern India. Saudi J Gastroenterol. 2010;16: 285-7.

Lloyd DA, Kenny SE. The surgical abdomen. Pediatric Gastrointestinal Disease: Pathopsychology, Diagnosis, Management. 4th ed. In: Walker WA, Goulet O, Kleinman RE, eds. Ontario: BC Decker; 2004: 604.

Jiang J, Jiang B, Parashar U, Nguyen T, Bines J, Patel MM. Childhood intussusception: a literature review. PLoS One. 2013;8(7):e68482.

Adhikari S, Hossein MZ, Das A, Mitra N, Ray U. Etiology and outcome of acute intestinal obstruction: a review of 367 patients in Eastern India. Saudi J Gastroenterol. 2010;16(4):285-7.

Jackson PG, Raiji MT. Evaluation and management of intestinal obstruction. Am Fam Physician. 2011;83(2):159-65.

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.

Tabibian N, Swehli E, Boyd A, Umbreen A, Tabibian JH. Abdominal adhesions: a practical review of an often overlooked entity. Ann Med Surg. 2017;15:9-13.

Di Saverio S, Coccolini F, Galati M, Biffl WL, Ansaloni L, Velmahos GC, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2013;8(1):42.

Nguyen VH. Intestinal obstruction due to tuberculosis. Asian J Surg. 2002;25(2):145-8.

Breum BM, Rud B, Kirkegaard T, Nordentoft T. Accuracy of abdominal auscultation for bowel obstruction. World J Gastroenterol. 2015;21(34):10018-24.

Arnbjörnsson E. Normal and pathological bowel sound patterns. Ann Chir Gynaecol. 1986;75(6):314-8.

Ashindoitiang JA, Atoyebi AO, Arogundade RA. The value of plain abdominal radiographs in management of abdominal emergencies in Luth. Nig Q J Hosp Med. 2008;18(3):170-4.

Geng WZM, Fuller M, Osborne B, Thoirs K. The value of the erect abdominal radiograph for the diagnosis of mechanical bowel obstruction and paralytic ileus in adults presenting with acute abdominal pain. J Med Radiat Sci. 2018;65(4):259-66.

Simpson A, Sandeman D, Nixon SJ, Goulbourne IA, Grieve DC, Macintyre IM. The value of an erect abdominal radiograph in the diagnosis of intestinal obstruction. Clin Radiol. 1985 Jan;36(1):41-2.

Li MZ, Lian L, Xiao LB, Wu WH, He YL, Song XM. Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis. Am J Surg. 2012;204:779-86.

Lockhart K, Dunn D, Teo S, Ng JY, Dhillon M, Teo E, et al. Mesh versus non-mesh for inguinal and femoral hernia repair. Cochrane Database Syst Rev. 2018;9:CD011517.

Eraki ME. A comparison of hydrostatic reduction in children with intussusception versus surgery: Single-centre experience. Afr J Paediatr Surg. 2017;14(4):61-4.

Subbaraman R, Nathavitharana RR, Satyanarayana S, Pai M, Thomas BE, Chadha VK, et al. The Tuberculosis Cascade of Care in India's Public Sector: A Systematic Review and Meta-analysis. Plos Med. 2016;13(10):e1002149.

Quintas ML, Rodrigues CJ, Yoo JH, Rodrigues Junior AJ. Age related changes in the elastic fiber system of the interfoveolar ligament. Revista do Hospital das clínicas. 2000;55(3):83-6.

Maglinte DD, Gage SN, Harmon BH, Kelvin FM, Hage JP, Chua GT, Ng AC, et al. Obstruction of the small intestine: accuracy and role of CT in diagnosis. Radiology. 1993;188(1):61-4.

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

Halepota HF, Khan MA, Shahzad N. Sensitivity and specificity of CT scan in small bowel obstruction among children. J Pak Med Assoc. 2018;68(5):744-6.