Pattern of Acute Intestinal Obstruction Is There A PDF
Pattern of Acute Intestinal Obstruction Is There A PDF
Pattern of Acute Intestinal Obstruction Is There A PDF
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Original Article
Pattern of Acute Intestinal Obstruction: Is There a Change in
the Underlying Etiology?
Arshad M. Malik, Madiha Shah, Rafique Pathan, Krishan Sufi
Acute intestinal obstruction is a common surgical emergency co-authors in the ward. Upon arrival of the patients in the
globally with high morbidity and mortality.[1-5] The most common ward, an immediate fluid and electrolyte resuscitation was
underlying cause of acute bowel obstruction in the West has started on every patient, and necessary investigations were done
always been postoperative adhesions as suggested by many before surgery. Patients with previous laparotomy were initially
reports.[6-8] A number of studies conducted in our part of the put on conservative management comprising of nasogastric
world had found obstructed/ - strangulated hernias to be the most decompression, fluid and electrolyte correction by intravenous
common underlying cause of acute intestinal obstruction.[9-10] route and broad-spectrum antibiotics. Failure of relief of
This was attributed to a general reluctance for surgery due obstruction on this conservative treatment for more than 48
to unawareness, poverty and fear. During the last few years, a hours was followed by laparotomy. Patients with clinical suspicion
change in the etiology of acute intestinal obstruction has been and previous history of tuberculosis were also initially kept on
noted in the developing countries.[11-16] conservative regime. The data collection was started by two of the
co-authors immediately upon arrival of the patient in the ward.
PATIENTS AND METHODS
The variables studied included demographic details, time
A prospective study of 229 patients, presenting with acute between onset of symptoms and arrival in ward, symptoms and
intestinal obstruction, admitted and treated at a teaching signs, imaging studies, initial resuscitation, type of treatment
hospital over a period of five years from 2004 to 2009, was offered, operative findings, cause of obstruction and eventual
undertaken. All patients with radiological and clinical evidence outcome of the treatment offered. The data were collected on a
of acute bowel obstruction admitted and treated in a surgical pro forma sheet of individual patient and statistically analyzed
unit were included in this study regardless of the gender of using Statistical package for social sciences (SPSS, version 14.0;
the patients. However, patients below the age of 10 years and Chicago, IL, USA).
those with incarcerated and irreducible hernia and paralytic
ileus were excluded from the study. All patients were admitted The ethical committee approval was not needed for this
through casualty department and were received by two of the particular study.
Malik, et al.
The mean age of 43.08 years in our study is also consistent adhesive small bowel obstruction. Br J Surg 2000;87:1240-7.
with age incidence in many similar reports.[12,26-27] The most 6. Pickleman J. Small bowel obstruction In: Zinner MJ ed. Maingot’s
Abdominal Operations.10th edn. London: Prentice Hall; 1997. p. 1159-72.
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earlier results in our region, when obstructed inguinal hernia 8. Ihedioha U, Alani A, Modak P, Chong P, O’Dwyer PJ. Hernias are the
was the commonest cause of acute intestinal obstruction.[9,26] most common cause of strangulation in patients presenting with small
It was believed that patients were reluctant for elective bowel obstruction. Hernia 2006;10:338-40.
surgery of hernias due to poverty, lack of education, and 9. Memon AS, Memon JM, Malik A, Soomro AG. Pattern of acute intestinal
obstruction. Pak J Surg 1995;11:91-3.
general fear of surgery. This led to a large number of hernias
10. Kössi J, Salminen P, Laato M. The epidemiology and treatment patterns
presenting as obstructed/ strangulated bowel obstruction. of post-operative adhesions induced intestinal obstruction in Varsinais-
A growing knowledge about hernias and rising fear of likely suomi Hospital District. Scand J Surg 2004;93:68-72.
complications are probably the reasons for an increasing 11. Lawal OO, Olayinka OS, Bankole JO. Spectrum of causes of intestinal
number of hernias repaired electively. There is also a parallel obstruction in adult Nigerian patients. S Afr J Surg 2005;43:34-6.
increase in the number of laparotomies, and this has raised 12. Adesunkanmi AR, Agbakwuru EA. Changing pattern of acute intestinal
obstruction in tropical African population. East Afr Med J 1996;11:727-30.
the incidence of adhesive obstruction in our institute.
13. Naaeder SB, Archampong EQ. Changing pattern of acute intestinal
Maximum numbers of patients with adhesive obstruction obstruction in Accra. West Afr J Med 1993;12:82-8.
(60%, n= 57) in our study had a history of appendectomy 14. Archampong EQ, Naaeder SB, Darko R. Changing pattern of intestinal
and other abdominal operations during the last six months obstruction in Accra,Ghana. Hepatogastroenterology 2000;47:185-93.
to one year. Similar results are also described by many 15. Chen XZ, Wei T, Jiang K, Yang K, Zhang B, Chen ZX, et al. Etiological
authors who have conducted similar trials.[12,27] All patients factors and mortality of acute intestinal obstruction: a review of 705
with adhesive obstruction were initially given a trial of cases. Zhong Xi Yi Jie He Xue Bao 2008;6:1010-6.
16. Ismail, Khan M, Shah A, Ali N. Pattern of dynamic intestinal obstruction
conservative treatment, and this approach is recommended in adults. J Postgrad Med Inst 2005;19:157-61.
and adopted by many other authors in their trials.[28-30] A 17. McEntee G, Pender D, Mulvin D, McCullough M, Naeeder S, Farah S, et al.
total of 76% of patients of adhesive obstruction responded Current spectrum of intestinal obstruction. Br J Surg 2005;74:976-80.
with complete recovery in our study. 18. Menzies D, Parker M, Hoare R, Knight A. Small boission.wel obstruction
due to postoperative adhesions: treatment patterns and associated
Another important and increasingly common cause of acute costs in 110 hospital admissions. Ann R Coll Surg Engl 2001;83:40-6.
19. Madziga AG, Nuhu AI. Causes and treatment outcome of mechanical
bowel obstruction is found to be abdominal tuberculosis.
bowel obstruction in north eastern Nigeria. West Afr J Med 2008;27:101-5.
Our results show a total of 55 (24%) patients of abdominal 20. Tamijmarane A, Chandra S, Smile SR. Clinical aspects of adhesive
tuberculosis presenting as acute intestinal obstruction. intestinal obstruction. Trop Gastroenterol 2000;21:141-3.
This observation is comparable to that in many similar 21. Oladele AO, Akinkuolie AA, Agbakwuru EA. Pattern of intestinal obstruction
local studies in our country and in neighboring countries.[31] in a semi urban Nigerian hospital. Niger J Clin Pract 2008;11:347-50.
There is an overall mortality of 3.49%, which is found directly 22. Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis
D, Giannopoulos P, et al. Acute mechanical bowel obstruction:
related to the delay between onset of obstructive symptoms
Clinical presentation, etiology, management and outcome. World J
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as is evident from our results. 2006;83:333-6.
24. Zubaidi A, Al-Saif F, Silverman R. Adult intussusception: a reterospective
In conclusion, we have found that adhesions are becoming review. Dis Colon Rectum 2006;49:1546-51.
25. Malik K, Ahmed W. Pattern of intestinal obstruction at Jinnah Postgraduate
an ever increasing underlying cause of bowel obstruction.
Medical Centre Karachi. J Coll Physicians Surg Pak 1991;1:32-5.
A trend of elective hernia surgery has reduced the number 26. Perea García J, Turégano Fuentes T, Quijada García B, Trujillo A, Cereceda
of patients of hernias presenting with obstruction of bowel. P, Díaz Zorita B, et al. Adhesive small bowel obstruction: Predictive
Acute bowel obstruction due to abdominal tuberculosis is value of oral contrast administration on the need for surgery. Rev Esp
becoming a common occurrence in our region. Enferm Dig 2004;96:191-200.
27. Foster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction;
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Source of Support: Nil, Conflict of Interest: None declared.
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