A clinical study of aetiology of acute intestinal obstruction

Abstract

Background: Acute intestinal obstruction is one of common abdominal emergency and is associated with significant morbidity and mortality especially if it progresses to bowel ischemia. The diagnosis and management of the patient with intestinal obstruction is one of the more challenging emergencies that a general surgeon can come across. Although the mortality due to acute intestinal obstruction is decreasing with better understanding of pathophysiology and improvement in diagnostic techniques, fluid and electrolyte correction, much potent anti-microbials but still mortality ranges from 10-15% and more so in developing countries.Methods: The study will be conducted in the department of general surgery with symptoms and signs of acute intestinal obstruction admitted in the surgical ward. Fifty cases of intestinal obstruction have been studied. Patients belonged to all the age groups except infants are included in present study. The criteria for selection of cases was based on clinical history, physical findings, radiological and haematological investigations. The study was divided into clinical study, investigations and treatment. The results are tabulated stressing on following points age, sex, symptoms examination findings, investigations, abnormalities, probable causative factors, operative findings and operative procedure adopted and complications if any.Results: The commonest cause of intestinal obstruction in the adults in this study series was postoperative adhesions (36%) followed by obstructed/strangulated hernia (26%). Malignancy of the large bowel was seen in 9 cases constituting 18% of cases where as incidence of Volvulus of bowel was 4% in this series. Although pulmonary tuberculosis is more prevalent in India due to advent in use of antitubercular drugs incidence of abdominal tuberculosis is becoming less. In present study incidence of ileocaecal tuberculosis was 10%. One case of mesenteric ischaemia was present in our study.Conclusions: Acute intestinal obstruction remains an important surgical emergency in the surgical field. Success in the treatment of acute intestinal obstruction depends largely upon its early diagnosis, skilful management and treating the pathological effects of the obstruction just as much as the cause itself.

Clinical study and surgical management of acute intestinal obstruction in the adults

“…The mortality has been decreasing consistently, associated medical problems (like respiratory cardiac or metabolic diseases) and advanced age carries a considerable contribution in adding the mortality. 12,13 In our study the incidence of intestinal obstruction in males was 42 and that of females was 18. Male to female ratio is 2:1.…”

Study of acute intestinal obstruction management and its outcome

“…Another study also designated abdominal pain as the most common symptom followed by vomiting as the second most prevalent symptom, similar to our study. 5 Tiwari et al in their study, however, found the peak incidence of distension in the abdomen as the most recurrent symptom closely followed by constipation and vomiting. 13 About the site of obstruction, the small intestine was more common than that of the large intestine.…”

“…Nasiruddin et al also reported peak incidence of IO among males with a prevalent % of 66. 5 Tiwari et al also recorded that IO was found to occur predominantly in males (65%) compared to females (35%). 13 Abdominal pain turned out to be the most common symptom of IO in our patients, with the occurrence of 91.7% followed by vomiting (18.3%), distension, constipation and tenderness in sequential order.…”

“…18 Although the frequency of strangulated hernia was higher in developing nations, it was the second most prevalent cause of obstruction in this research group, similar to the previous study. 5 Hernias may be treated early due to public awareness and the availability of surgical facilities in the periphery for hernia repair. Soressa et al also designated the most important causes of IO to be hernias, adhesions, volvulus besides intussusceptions.…”

“…While intestinal blockage is easily detected, the obstruction's underlying cause, except surgical adhesions and external hernias, is difficult to determine preoperatively. 5 Early detection and timely care can help avoid irreversible ischemia, lowering mortality and long-term morbidity. Postoperative adhesions and hernias are the most common causes of intestinal blockage.…”