Outcomes of management of intestinal obstruction at an urban tertiary hospital in sub Saharan Africa: a cross-sectional study

Abstract

Background Intestinal obstruction (IO) is a common cause of acute abdomen globally, it remains challenging as it increases surgical financial expenditure while also causing major morbidity. Clinically it presents with nausea, vomiting, colicky abdominal pain and cessation of bowel movements or passage flatus and stool. Diagnosis, especially in resource limited settings, can be clinical but is usually confirmed radiologically. We studied the current diagnosis, management and outcomes of IO in Mulago Hospital. Materials and methods This was a prospective study done at all the surgical units of Mulago from January to May 2014 to assess general diagnosis and management of IO. Ethical approval was got in line with Helsinki declaration, we used pretested and validated questionnaires to collect data. Informed consent was got with eligible and consenting/assenting patients that fitted the inclusion criteria of age and presenting with suspected intestinal obstruction. Uni-variate and bi-variate variables analysis was done plus measures of association. Results We enrolled 135 patients, excluded 25 and recruited 110 patient. We had more males than females i.e. 71.8% males and 28.2% females. Colicky abdominal pain, abdominal distension, and vomiting were commonest symptoms, then abdominal distension, increased bowel sounds and abdominal tenderness were the commonest signs. Most patients’ (51%) were diagnosed radiologically with a lesser number clinically diagnosed. “Dilated bowel loops” was the commonest radiological sign. Surgery was the main stay of management at 72.7% while 27.3% were conservatively managed. Postoperatively the bowels opened averagely on the 3rd post-operative day (POD) with return of bowel sounds occurring on 5th POD. Most discharges (73%) occurred by the 7th POD. Unfavourable outcomes were prolonged hospital stay followed by wound sepsis (surgical site infection) and then Mortality. Conclusion This study noted that In Mulago we mostly diagnosed patients radiologically with most surgically managed and which is similar to regional practices. Postoperatively bowel opening happening on third POD with return of bowel sounds on fifth POD. Prolonged hospital stay followed by wound sepsis and then mortality were commonest unfavorable management outcomes.

Intestinal Obstruction among Patients Admitted in the Department of Surgery of a Tertiary Care Centre: A Descriptive Cross-sectional Study

“…1 , 2 , 6 Our study showed a male predominance (65%) in patients presenting with IO with a male to female ratio of 1.85:1 which is also comparable to the studies done in African countries: Nigeria (Male:Female= 2:1) and Uganda (Male:Female= 2.6:1); but lesser as compared to two independent studies done in South India (Male: Female= 4:1) and East India (Male:Female= 3:1). 12 , 7 , 8 The most common age group affected according to our study was 48-58 years, which is consistent with the studies done in East India (41-50 years) and South India (51-60 years). 1 , 2 …”

Association between clinical and surgical variables with postoperative outcomes in patients treated for intestinal obstruction for non-malignant conditions: a cross-sectional study

“…This is similar to what is found in the literature. Nakanwagi et al 18 evaluated 135 patients who required emergency management for IO, showing that 72.7% of the patients required surgical management with bowel resection and anastomosis, a comparable result with our population 18 . Additionally, a study published by Mancini et al 19 which sought to compare the laparoscopic approach and open surgery for IO, found that 88.6% of patients required open approach and 11.4% required the laparoscopic approach with a conversion rate of 17.2%.…”

Application Effect of Somatostatin Combined with Transnasal Ileus Catheterization in Patients with Acute Intestinal Obstruction and Advanced Gastric Cancer

“…For patients with advanced gastric cancer, distant metastasis of cancer tissues and cells is easy to occur, resulting in a large range of lymph node dissection and large gastrointestinal stimulation during gastric cancer surgery. After surgery, due to the decrease of gastrointestinal motion amplitude and degree, an internal hernia or intestinal loop is generated between the intestines, which eventually leads to acute intestinal obstruction [ 13 ]. Clinical treatment of intestinal obstruction is mostly symptomatic treatment and surgical treatment, among which surgical treatment is more stimulating and damaging to the body and prone to postoperative adverse events [ 14 ].…”