Etiological patterns, clinical outcomes and management of acute intestinal obstruction: a prospective study from a tertiary care center
DOI:
https://doi.org/10.18203/2320-6012.ijrms20254367Keywords:
Intestinal obstruction, Adhesions, Surgical emergency, Mortality, Morbidity, Developing countriesAbstract
Background: Acute intestinal obstruction represents one of the most prevalent surgical emergencies worldwide, significantly impacting healthcare systems and patient outcomes. This study aimed to comprehensively analyze the causes, clinical presentations, management approaches and outcomes of acute intestinal obstruction in a tertiary care setting in Maharashtra, India.
Methods: A prospective observational study was conducted over twelve months (2022-23) at Shri Bhausaheb Hire Government Medical College and Hospital, Dhule. Eighty-two consecutive patients with acute intestinal obstruction were enrolled after informed consent. Comprehensive clinical evaluation, laboratory investigations, imaging studies and surgical findings were systematically recorded. Primary outcomes included etiology identification, management approach (conservative versus surgical) and in-hospital mortality. Secondary outcomes comprised postoperative complications and hospital length of stay.
Results: The cohort comprised 82 patients with mean age of 48.7±22.3 years and slight male predominance (51.2%). Age distribution showed bimodal pattern with peaks in middle-aged adults (41-50 years, 26.8%) and elderly patients (71-80 years, 17.1%). Adhesions emerged as the predominant cause (35.4%), followed by obstructed hernia (15.9%), malignancy (8.5%) and tuberculous stricture (7.3%). Conservative management succeeded in 24 patients (29.3%), while 58 patients (70.7%) required surgical intervention. Postoperative complications occurred in 29.3%, with septicemia most common (8.5%). Overall mortality was 8.5%, exclusively in the surgical group. Mean hospital stay was 12.3 days.
Conclusions: This study demonstrates significant epidemiological transition with adhesions becoming the predominant cause of acute intestinal obstruction, replacing historically dominant obstructed hernias in developing countries. Early diagnosis, appropriate management selection and timely intervention remain critical determinants of outcome. The substantial morbidity and mortality emphasize the need for enhanced preventive strategies and optimized perioperative care protocols.
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References
Markogiannakis H, Messaris E, Dardamanis D. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007;13(3):432-7. DOI: https://doi.org/10.3748/wjg.v13.i3.432
Hayanga AJ, Bass-Wilkins K, Bulkley GB. Current management of small-bowel obstruction. Adv Surg. 2005;39:1-33. DOI: https://doi.org/10.1016/j.yasu.2005.05.001
Menzies D, Ellis H. Intestinal obstruction from adhesions-how big is the problem? Ann R Coll Surg Engl. 1990;72(1):60-3.
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. DOI: https://doi.org/10.4103/1319-3767.70617
Malik AM, Shah M, Pathan R, Sufi K. Pattern of acute intestinal obstruction: is there a change in the underlying etiology. Saudi Med J. 2010;31(7):772-6. DOI: https://doi.org/10.4103/1319-3767.70613
Zielinski MD, Eiken PW, Heller SF. Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. J Am Coll Surg. 2011;212(6):1068-76. DOI: https://doi.org/10.1016/j.jamcollsurg.2011.02.023
Fevang BT, Fevang J, Stangeland L. Complications and death after surgical treatment of small bowel obstruction: A 35- year institutional experience. Ann Surg. 2000;231(4):529-37. DOI: https://doi.org/10.1097/00000658-200004000-00012
Jena SK, Sharma NK, Vakil H. Changing patterns of etiology and management of intestinal obstruction over 23 years at a tertiary care center in India. Indian J Surg. 2021;83(1):128-34.
Pradeepkumar KS, Rudraswamy AC, Parameshwarappa AK. A clinical study of mechanical intestinal obstruction. Int Surg J. 2017;4(6):1843-8.
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. DOI: https://doi.org/10.1186/s12893-016-0150-5
Madziga AG, Nuhu AI. Causes and treatment outcome of mechanical bowel obstruction in north eastern Nigeria. West Afr J Med. 2008;27(2):101-5.
Deshmukh SN, Jain SS, Borle N. An observational study of etiology, clinical features and outcome of intestinal obstruction at tertiary care hospital. Int J Res Med Sci. 2017;5(2):500-3.
Frago R, Ramirez E, Millan M, Kreisler E, del Valle E, Biondo S. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg. 2014;207(1):127-38. DOI: https://doi.org/10.1016/j.amjsurg.2013.07.027
Shih SC, Jeng KS, Lin SC. Adhesive small bowel obstruction: how long can patients tolerate conservative treatment? World J Gastroenterol. 2003;9(3):603-5. DOI: https://doi.org/10.3748/wjg.v9.i3.603
Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am. 2008;92(3):575-97. DOI: https://doi.org/10.1016/j.mcna.2008.01.003
Maglinte DD, Balthazar EJ, Kelvin FM, Megibow AJ. The role of radiology in the diagnosis of small-bowel obstruction. AJR Am J Roentgenol. 1997;168(5):1171-80. DOI: https://doi.org/10.2214/ajr.168.5.9129407
Foster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg. 2006;203(2):170-6. DOI: https://doi.org/10.1016/j.jamcollsurg.2006.04.020
Di Saverio S, Coccolini F, Galati M. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction. World J Emerg Surg. 2013;8(1):42. DOI: https://doi.org/10.1186/1749-7922-8-42
Catena F, Di Saverio S, Coccolini F. Adhesive small bowel obstruction: evolutions in diagnosis, management and prevention. World J Gastrointest Surg. 2016;8(3):222-31. DOI: https://doi.org/10.4240/wjgs.v8.i3.222
Silva AC, Pimenta M, Guimaraes LS. Small bowel obstruction: what to look for. Radiographics. 2009;29(2):423-39. DOI: https://doi.org/10.1148/rg.292085514
Jancelewicz T, Vu LT, Shawo AE. Predicting strangulated small bowel obstruction: an old problem revisited. J Gastrointest Surg. 2009;13(1):93-9. DOI: https://doi.org/10.1007/s11605-008-0610-z
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