Acute Mechanical Intestinal Obstruction: the problem of diagnosis of strangulation without CT scans

Abstract

To assess the possibility of pre-operative differentiation of strangulated and non-strangulated intestinal obstruction based on clinical; radiological and laboratory features without CT scan, 66 patients with acute bowel obstruction were studied prospectively. Forty-nine (74%) were male, 17 (26%) female with a wide age distribution. In 56 (85%) the small bowel was obstructed, in ten (15%) the large bowel. Adhesions were the most common cause of obstruction (36%), followed by hernias (20%), volvulus (12%), intussusception (11%), malignancies (11%) and other causes (10%). At surgery strangulation, defined as compromise of the blood supply and necessitating resection of gangrenous bowel, was found in 18 (27%) of the patients. Ten patients (15%) developed complications after surgery and ten patients died, mostly from age and cardiovascular conditions. Persistent abdominal pain, rebound tenderness, elevated temperature, leukocytosis, and air-fluid levels were considered as possible predictive factors for the pre-operative diagnosis of strangulation but it was concluded that such factors were not sufficiently reliable and early surgery was imperative to detect reversible ischemic bowel in strangulated obstruction.