Small Bowel Obstruction- Clinical Features, Biochemical Profile and Treatment Outcome

Abstract

BACKGROUND Small bowel obstruction is defined as failure in forward propulsion of the contents in the intestine either due to dynamic or adynamic cause. It is a common surgical emergency requiring early diagnosis and corrective surgery. It presents a challenge to the surgeon. Studies in the west have shown that bowel obstruction accounts for at least 20% of all admissions to the surgical service. Aim: In view of varying aetiologies, intense study and clinical evaluation regarding trends and patterns of small bowel obstruction is worthwhile. MATERIALS AND METHODS The case series was conducted on 82 patients admitted in the Department of Surgery, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, from October 2013 to September 2015. Study was done through questionnaires and clinical examination, biochemical investigations including renal function tests, liver function tests, serum electrolytes, CT scan and CRP levels. Treatment modality was planned once the definitive diagnosis of bowel obstruction was made and data analysed using SPSS version 21. RESULTS 63 (76.82%) cases were male, while 19 (23.17%) were female giving a ratio of 3.3: 1. The mean age was 37.50 years ranging from 13-94 years. Mechanical obstruction was the commonest type 92.68% followed by paralytic ileus in 6.1% cases. Abdominal distension was the commonest finding in 73%, abdominal tenderness in 68.5% and elevated bowel sounds in 59.2%. Previous abdominal scars were found in 32.4%, while reduced bowel sounds were recorded in 26.1%. Overall, adhesions and bands were the commonest cause of obstruction found in 56 (68.29%) patients followed by strangulated hernias in 13 (15.85%) patients and ileocaecal TB peritonitis in 8 (9.76%) patients was the main cause of paralytic ileus. 45.12% patients had hyponatraemia, 13 (15.85%) patients had hypokalaemia and 10 (12.20%) patients had hyperkalaemia. CONCLUSION 21-40 years' age group accounted for more than half of the patients, the most common cause being adhesions from previous abdominal surgeries followed by strangulated hernias. Plain abdominal x-rays were diagnostic in more than 60% of cases. Operative management was the mainstay of treatment in more than 2/3 rd of cases.

Prediction and management of strangulated bowel obstruction: a multi-dimensional model analysis

“…Similar to our findings, the levels of WBC and NE% were much higher in the StBO group, and the symptom of peritonitis with rebound tenderness was confirmed as an independent risk factor for StBO. An imbalance between the absorption and secretion of impaired intestinal mucosa also triggers electrolyte disturbances[ 2 , 38 ]. In our multi-dimensional model, we defined hyponatremia, hypokalemia and rising levels of BUN as independent risk factors for StBO.…”

“…In addition, insufficient renal perfusion due to extrasecretion in the intestinal lumen and the accumulation of lactic acid produced by intestinal anaerobic glycolysis deteriorate renal function with increasing levels of BUN in peripheral blood[ 22 , 39 ]. Consequently, the distal convoluted tubule response to aldosterone results in the reabsorption of Na + by exchanging K + or H + , thus, hyponatremia and hypokalemia occur[ 2 ]. Usually, unlike a long pain duration indicating a chronic and reversible phase of disease, a short pain duration might indicate a status of acute and severe inflammation.…”

“…SBO can be divided into simple bowel obstruction (SiBO) and strangulated bowel obstruction (StBO). SiBO is usually resolved by nonoperative management, including bowel rest, nasogastric tubes and tube decompression, reducing the risk of emergency surgery[ 2 ]. Conversely, StBO requires immediate surgical intervention[ 3 ], as StBO may result in severe complications, including bowel perforation, peritonitis and septic shock, which increase the mortality of SBO up to 25%[ 4 , 5 ].…”