Intestinal obstruction in a tertiary care centre in India: are the differences with the Western experience becoming less?

Abstract

Background: Patients with intestinal obstruction consist of a major proportion of emergency room visits and the complication is associated with significant morbidity and mortality. It has a diverse etiology and varies from region to country. In developed countries it is mainly due to adhesions and in developing countries due to obstructed hernias. Although there are numerous studies from the western world there have been few recent publications from the developing world. Method: We retrospectively analyzed all the patients admitted for intestinal obstruction to our department from January 1996 to December 2019. Their demographic data, duration of symptoms before presenting to the hospital and duration of stay before surgery in the hospital were noted along with cause and level of obstruction. The type of procedure, any post-operative complications, mortality or re-exploration were also noted. Post-operative complications were graded as per Clavien Dindo classification. Results: A total of 986 patients presented with intestinal obstruction during this period out of which 743 patients underwent surgery. There were 429 (57.74%) males 314 (42.26%) females who had a mean age of 50.1 years (range 11 to 96 years). The commonest cause of obstruction was adhesions in 273 (36.7%) followed by carcinoma [130(17.5%)], tuberculosis [111(14.9%)], stricture [94(12.7%)] and hernia (5.4%) patients. Colorectal surgery was the most common previous procedure in the adhesive group [85(31.1%)]. Colon cancer was the common cause in carcinoma group. Ileum was the most common site of obstruction [329(44.3%)]. The overall operative mortality was 41 (5.5%). Conclusion: Postoperative adhesions are now the commonest cause of intestinal obstruction in our referral center with a comparable mortality rate with western reports. Though the etiology of intestinal obstruction is shifting towards the western pattern, tuberculosis, obstructed inguinal hernia still consists a major chunk of patients in developing countries.