DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20173587

A clinical study of acute intestinal obstruction in adults-based on etiology, severity indicators and surgical outcome

Saurabh J. Tiwari, Rajiva Mulmule, Varsha N. Bijwe

Abstract


Background: Patients with bowel obstruction still represent some of the most difficult and vexing problems that surgeons face today. While the adage, “never let the sun rise or set on a bowel obstruction” remains true, there has been a trend towards selective non-operative management of this problem. Aims and objectives were to study the various causes and modes of presentation of intestinal obstruction and to evaluate the importance of different severity indicators of obstruction with early recognition, diagnosis and thus timely abdominal exploration.

Methods: 2 years prospective study conducted in PDMMC college, Amravati, Maharashtra, India, from September 2013 to September 2015. Each intestinal obstruction patient was evaluated with specific severity indicators, scored and then analyzed.

Results: The commonest cause of intestinal obstruction in adults in this study series was adhesions in 33.33% cases. Other causes were mesenteric ischaemia, i.e. 7 (11.67%), Koch’s abdomen, i.e. 5 (8.33%), sigmoid volvulus, i.e. 5 (8.33%) and carcinoma, i.e. 5 (8.33%). Resection anastomosis was most commonly performed procedure in 45.7 % cases, followed by adhesiolysis in 14% patients. 66.66% patients having a score less than 3 were managed conservatively, 95.83 % having a score of 3 or more where operated on.

Conclusions: The evaluation of patients endeavours not only to confirm the diagnosis but also to determine the need for and timing of surgery. Certain severity indicators and scoring systems can help to optimize this timing of surgery and prevent mortality.


Keywords


Adhesions, Intestine, Obstruction, Resection and anastomosis, Scores

Full Text:

PDF

References


Scott G Houghton, Antonio Ramos De la Medina, Michael G Sarr. Bowel obstruction. In: Michael J Zinner, Stanley W Ashley, eds. Maingot’s Abdominal operations. 11th ed. New York: McGraw-Hill Medical; 2007:479-505.

Miller G, Boman J, Shrier I, Gordon P. Etiology of small bowel obstruction. The American Journal of Surgery. 2000;180(1):33-36.

Khurana B, Ledbetter S, McTavish J, Wiesner W, Ros P. Bowel Obstruction Revealed by Multidetector CT. American Journal of Roentgenology. 2002;178(5):1139-1144.

Schwenter F, Poletti P, Platon A, Perneger T, Morel P, Gervaz P. Clinicoradiological score for predicting the risk of strangulated small bowel obstruction. British Journal of Surgery. 2010;97(7):1119-1125.

A Kratz, M.A.Pesce, RC Basner, AJ Einstein. Appendix: Laboratory values of clinical importance. In:Harrison T, Wiener C, Brown C, Hemnes A, eds. Harrison's principles of internal medicine. 18th ed. New York: McGraw-Hill Medical; 2012:3590.

Cole G. A review of 436 cases of intestinal obstruction in Ibadan. Gut. 1965;6(2):151-162.

Adhikari S, Hossein M, 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.

Harban Singh. Acute intestinal obstruction. Arch Surg 1965; 91:389-392.

Osuigwe A, Anyanwu S. Acute intestinal obstruction in Nnewi Nigeria: a five-year review. Nigerian Journal of Surgical Research. 2002;4(3): 14-16.

Jahangir Sarwar Khan, Junaid Alam, Hamid Hassan, Mohammed Iqbal. Pattern of intestinal obstruction a hospital based study. Pakistan Armed Forces Med J. 2007;57(4):295-299.

David I Soybel. Ileus and small bowel obstruction. 3rd ed. Chapter 26. In: Lazar J Greenfield, Michael W Mulhihand, Veiyh J Oldham, Gerald B Zelenock, Keith D Lillinoe, eds. Scientific principles and practice of surgery. Philadelphia. Lipincott Williams and Wilkins; 2003:810.

Brooks VLH, Butler A. Acute intestinal obstruction in Jamaica. Surg Gynaec Obstet 1996;122:261-264.

Playforth R, Holloway J, Griffen W. Mechanical small bowel obstruction. Ann Surg. 1970;171(5):783-788.

Salem T, Molloy R, O'Dwyer P. Prospective study on the role of C-Reactive Protein (CRP) in patients with an acute abdomen. Ann Royal Coll Surg Eng. 2007;89(3):233-237.

Ogata M, Imai S, Hosotani R, Aoyama H, Hayashi M, Ishikawa T. Abdominal ultrasonography for the diagnosis of strangulation in small bowel obstruction. British Journal of Surgery. 1994;81(3):421-424.

Sheedy S, Earnest F, Fletcher J, Fidler J, Hoskin T. CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology. 2006;241(3):729-736.

Zielinski M, Eiken P, Bannon M, Heller S, Lohse C, Huebner M et al. Small bowel obstruction—who needs an operation? A multivariate prediction model. World J Surg. 2010;34(5):910-919.

Schwenter F, Poletti P, Platon A, Perneger T, Morel P, Gervaz P. Clinicoradiological score for predicting the risk of strangulated small bowel obstruction. Br J Surg. 2010;97(7):1119-1125.