Current spectrum of intestinal obstruction

McEntee, Gerry; Pender, Daniel J.; Mulvin, D.; McCullough, Majella; Naeeder, S B; Farah, Safia; Badurdeen, M. S.; Ferraro, Vincent; Cham, Chee Wee; Gillham, N R; Matthews, P. N.

doi:10.1002/bjs.1800741105

Cited by 169 publications

(125 citation statements)

References 9 publications

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“…With older age, the risk of incarceration and strangulation increases for both genders [7,14,34]. Brasso et al [35] found a peak incidence in the age group of 61-80 years, and McEntee et al [36] found a peak incidence in the age group of 70-80 years. The cumulative probability of incarceration and strangulation increases over time; 3 months after the onset of signs of an inguinal hernia, the cumulative probability of incarceration and strangulation is 2.8%.…”

Section: Risk Of Incarceration and Strangulationmentioning

confidence: 99%

Is surgical repair of an asymptomatic groin hernia appropriate? A review

Heuvel

Dwars

Klassen

et al. 2011

Hernia

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Purpose Groin herniorrhaphy is the most common operation performed by general surgeons. Annually, more than 20 million groin hernias are repaired worldwide. The general approach towards groin hernias is surgical repair regardless of the presence of symptoms. The rationale to recommend surgery for asymptomatic groin hernias is prevention of visceral strangulation. The goal of this review is to evaluate the appropriateness of surgery in patients with asymptomatic groin hernias. Methods The review was based on an extensive literature search of Pubmed, Medline and the Cochrane Library. Results The risk of incarceration is approximately 4 per 1,000 patients with a groin hernia per year. Risk factors for incarceration are age above 60 years, femoral hernia site and duration of signs less than 3 months. Morbidity and mortality rates of emergency groin hernia repair are higher in patients who are older than 49 years, have a delay between onset of symptoms and surgery of more than 12 h, have a femoral hernia, have nonviable bowel and have an ASA-class of 3 or 4. The recurrence rate after tension-free mesh repair in the management of emergency groin hernias is comparable to that of elective repair. There is no diVerence in pain and quality of life after elective repair compared to watchful waiting. There is no advantage in cost-eVectiveness of elective repair compared to watchful waiting. ConclusionWatchful waiting for asymptomatic groin hernias is a safe and cost-eVective modality in patients who are under 50 years old, have an ASA class of 1 or 2, an inguinal hernia, and a duration of signs of more than 3 months.

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Section: Risk Of Incarceration and Strangulationmentioning

confidence: 99%

Is surgical repair of an asymptomatic groin hernia appropriate? A review

Heuvel

Dwars

Klassen

et al. 2011

Hernia

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“…[2] Our study results are comparable with other study groups like Thampi et al [3] and Playforth et al [4] According to a study by McEntee et al, adhesions formed the most important cause of intestinal obstruction in western population. [1] According to two studies by Miller et al and Foster et al, hernia caused less than 10% to intestinal obstruction. [5,6] But statistics in this part shows that hernia contributed approximately 29% of cases to intestinal obstruction.…”

Section: Resultsmentioning

confidence: 98%

“…All consecutive patients fulfilling the eligibility criteria and willing to participate in the study were enrolled after getting their consent. The information given in the reference study [1] was used to calculate the sample size. Formula used for sample size estimation: n= (Zα) 2 pq/d 2 , where n=sample size, Zα = 1.96, p = prevalence, q = 100-p, d = 20% of prevalence.…”

Section: Methodsmentioning

confidence: 99%

A Pattern of Intestinal Obstruction Cases – A Tertiary Care Centre Study

Pillai¹,

Benjamin²,

Chisthi³

2017

AIMDR

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Background: Bowel obstruction is a surgical emergency that causes confusion both in the diagnosis and the management. Decision on whether to operate on the patient or to continue with conservative management as well as the timing of intervention often rests upon the treating surgeon and his competence. Objectives: Primary objective of the study was to describe the etiological profile in patients with intestinal obstruction in our institution. Secondary objectives were to study the demographic pattern and the mode of management in these patients. Material & Methods: This was a hospital based Cross sectional study conducted at the General Surgery department, Government Medical College Hospital, Trivandrum. The study period was for 18 months, from April 2014 to September 2015. Study subjects included patients admitted in the Surgical wards with intestinal obstruction. Sample size was calculated to be 204 based on reference study. All values are presented as means and percentages. Results: Males were found to be affected much more than females. In 70% of patients, small bowel was the bowel predominantly involved. Adhesions were the commonest etiological factor followed by obstructed hernias. Most of the patients underwent operative management. Conclusions: Small bowel was the most commonly obstructed part of the bowel while adhesions and hernia form the commonest reasons for intestinal obstruction in our setting. Appendicectomy and laparotomy for perforation peritonitis caused the most postoperative adhesions.

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“…15 Also, Biondo et al noticed that oral Gastrografin reduced the operative rate by 35% (11.4% in the Gastrografin group vs. 17.4% in the control group), increased the success of conservative treatment by 7% (88.6% in the Gastrografin group vs. 82.6% in the control group), and significantly reduced hospital stay by 52% (4.1 vs. 8.5 days). 9,16 Di Saverio et al noticed that oral Gastrografin significantly reduced the operative rate (18.5% in the Gastrografin group vs. 45% in the control group), reduced hospital stay by 59.8% (4.67 vs. 7.8 days), and shortened the time of resolution of obstruction (6.9 vs. 43 h).…”

Section: Resultsmentioning

confidence: 99%

Prospective analysis of the management of small bowel obstruction using oral contrast agent at tertiary care hospital in western Rajasthan

et al. 2018

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INTRODUCTIONIntestinal obstruction is a frequently seen entity in the Emergency Department that represents 25% of abdominal pain consultations. 1 The most frequent causes of intestinal obstruction are postoperative adhesions followed by neoplasms and hernias.2 The estimated rate of adhesions is around 94%-95% after laparotomy. It has recently been demonstrated that this rate is much lower in laparoscopic procedures, although the exact percentage is not known.3 Before the 1990s, the mortality rate associated with intestinal obstruction was 30%-50%, depending on the series. 4 Nowadays, the correct diagnosis of symptoms and adequate treatment can lower the mortality rate to 3%-5%. 4-6During the management of intestinal obstruction, the patient should initially be made to fast and intravenous therapy should be administered, in addition to intestinal decompression with a nasogastric tube. Most of the symptoms will respond to conservative treatment. The indication for surgery is clear when there are data to suspect ischemia or intestinal suffering: fever, tachycardia, abdominal pain, peritonitis and acidosis. The problem lies in knowing how much time should pass before we decide whether the patient is responding to ABSTRACT Background: Intestinal obstruction is a frequently seen entity in the Emergency Department that represents 25% of abdominal pain consultations. Methods: This prospective, randomized, and clinical trial study was designed to determine the value of gastrografin in adhesive small bowel obstruction. The primary end points were the evaluation of the operative rate reduction and shortening the hospital stay after the use of gastrografin. A total of 100 patients were randomized into two groups: the control group received conventional treatment, whereas the study group received in addition of 100 ml gastrografin meal. Patients were followed up within 4 days after admission, and clinical and radiological (if needed) improvements were evaluated. Results: Surgical procedure was performed in 10% of the gastrografin group for whom conservative treatment failed at the end of fourth day. In contrast, surgery was required in 28% of control group. These findings shows that gastrografin decreased the need for surgical management by 18%, but no statistically significant differences were observed. The length of hospital stay revealed a significant reduction from 4.60±1.14 days to 2.64±1.05 days for control and gastrografin groups, respectively. Conclusions: The use of gastrografin in adhesive small bowel obstruction is safe and reduces the length of hospital stay.

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Current spectrum of intestinal obstruction

Cited by 169 publications

References 9 publications

Is surgical repair of an asymptomatic groin hernia appropriate? A review

Is surgical repair of an asymptomatic groin hernia appropriate? A review

A Pattern of Intestinal Obstruction Cases – A Tertiary Care Centre Study

Prospective analysis of the management of small bowel obstruction using oral contrast agent at tertiary care hospital in western Rajasthan

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