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

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.

Surgical Management Outcome of Intestinal Obstruction and Its Associated Factors at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2018

“…Intestinal obstruction (IO) is a potentially risky surgical emergency associated with high morbidity and mortality rates in both developed and developing world [1, 2]. It also causes significant surgical side effects in hospital admissions and adversely affects the life of millions of people, cutting across all age groups, with considerable direct and indirect economic impacts on the healthcare system and the affected patients [3].…”

“…Based on the anatomical location, IO is mainly classified as small bowel obstruction (SBO) and large bowel obstruction (LBO) [2]; it can also be either mechanical or functional on the basis of the underlying pathophysiology of obstruction [11]. The etiology of IO has been varied with SBO caused by adhesions, strangulated hernia, malignancy, and volvulus [2]. The causes of IO also vary in different populations and areas.…”

Correlation of Clinical Findings with Radiological and Intraoperative Findings in Cases of Intestinal Obstruction

“…Taneja et al report shows 90% of cases with multiple air fluid level and Savage et al reports 95% cases with significant findings. Tiwari SJ et al 21 reported multiple air fluid levels in 70% patients. Suri et al 22 reported 77% sensitivity and 50% specificity of x-ray in the diagnosis of intestinal obstruction.…”

“…Jancelewicz et al 25 found that decreased bowel wall enhancement on CT, leucocytosis, and peritoneal signs were the only independent predictors of strangulation obstruction on a multiple logistic regression analysis. Tiwari SJ et al 21 reported multiple air fluid levels in 70% patients. Suri et al 22 reported 93% sensitivity and 100% specificity of CT-scan in the diagnosis of intestinal obstruction.…”

A study on the trends and patterns of intestinal obstruction and surgical outcome based on APACHE score II in a tertiary care centre

“…1 12-16% of acute abdominal emergencies may be contributed to intestinal obstruction. 2 The etiology of bowel obstruction has been varied with small intestinal obstruction caused by adhesions in 60% , strangulated hernia in 20%, malignancy in 5% and volvulus in 5%. 2 The timing of surgical intervention putting in mind possibility of Intestinal Ischemia (strangulation) is important which needs urgent exploration.…”