Thiruvikkaraman, m (2020) The Retrospective study of Scoring in Acute Intestinal Obstruction -Timing of Surgery. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
BACKGROUND: Intestinal obstruction is one of the most common abdominal problems faced by surgeons in routine practice whether caused by any bowel pathology of either the small or large bowel continues to be a major cause of morbidity and mortality. OBJECTIVES: The objectives are to study the: various modes of presentation, various causes, importance of early recognition, diagnosis and management. influence of various factors like age, sex, diet and socio-economic status in the pathogenesis of acute intestinal obstruction. morbidity and mortality rates in acute intestinal obstruction. METHODS: The materials for the clinical study of intestinal obstruction were collected from cases admitted to various surgical wards. 126 cases of intestinal obstruction have been studied. Patients belonged to the age groups ranging from 12 years to 85 years, paediatric age group is excluded from this study. The criteria for selection of cases was based on clinical history, physical findings, radiological and haematological investigations. The study was divided into Clinical study, Investigations and Treatment. Postoperative follow up after the discharge of patients was done in majority of the patients upto six months. The results are tabulated stressing on following points age, sex, symptoms, examination findings, investigations, abnormalities, probable causative factors, operative findings and operative procedure adopted and complications if any. RESULTS: The study group consisted of 126 cases of acute intestinal obstruction in the adult. The common age group is 31-40 and 51-60 age group with 20% each in the total study. The commonest cause of intestinal obstruction in the adults in this study series was Adhesions (40%) followed by obstructed Hernia (30%). The clinical features of pain abdomen, vomiting, constipation were the main symptoms in this study. Tenderness, guarding, rigidity, rebound tenderness and shock are the cardinal feature of strangulated obstruction. The most common type of obstruction was due to postoperative adhesions or band arising from the previous surgeries. This constituted about 40% of the cases of the study group. The second most common type of intestinal obstruction was due to obstructed/strangulated external hernia. Salient features were pain in the groin lump, acute onset of swelling which is tender, irreducible and absence of cough impulse. Obstructed hernia constituted about 30% of the total cases studied. Volvulus of the sigmoid was 4% in this series. Conservative measures included insertion of flatus tube but many of the cases were undergone laparotomy due to failure in the recovery of symptoms. Derotation and sigmoidopexy was done in one case and in one case where there was vascular compromise, resection and anastamosis was done. Malignancy of the large bowel was seen in 7 cases constituting 14% of cases. 65% of the cases diagnosed as malignancy were in the age group 35-75 years. Of these 2 cases were managed with Hartman’s procedure. One case was managed with transverse loop colostomy and remaining cases were managed with resection and anastamosis. Most of the deaths occurred in malignancy. Although pulmonary tuberculosis more prevalent in India due to advent use of antitubercular drugs incidence of abdominal tuberculosis is becoming less. In our study incidence of ileocaecal tuberculosis was 4% and both were managed with resection and anastamosis. In the present study intussusception causing intestinal obstruction was 6%. One case was managed with simple reduction and the remaining two were undergone resection and anastamosis. One case of mesenteric ischaemia was present is our study. The case was managed with resection and anastamosis but patient died due to septicemia. The complication in this study was 18%. Overall mortality of this study was 14%. The result obtained from this study was comparable to various other studies. Malignancy and mesenteric ischaemia had more mortality outcomes than simple obstruction caused by postoperative adhesions. The poor outcome of the disease were due to late presentation to the hospital which had high incidence of bowel damage with associated faecal contamination of the peritoneum. The morality in the postoperative period was mainly due to faecal peritonitis, bronchopneumonia and respiratory tract infection. INTERPRETATION AND CONCLUSION: Acute intestinal obstruction remains an important surgical emergency in the surgical field. Success in the treatment of acute intestinal obstruction depends largely upon early diagnosis skilful management and treating the pathological effects of the obstruction just as much as the cause itself. Erect abdomen X-ray is valuable investigation in the diagnosis of acute intestinal obstruction. Postoperative adhesions are the common cause to produce intestinal obstruction. Clinical radiological and operative findings put together can diagnose the intestinal obstruction. Mortality is still significantly high in acute intestinal obstruction.So the pattern of scoring criteria remains important to take case immediately for surgery or treat conservatively. Definitive scoring is missing in most standard books. The study includes rising pulse rate,abdomen girth chart,elevated wbc count, multiple air fluid more than 6,nasogastric fecal content with a score of 2 to each of them more than 7 needs surgery.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711167 |
| Uncontrolled Keywords: | Scoring, Acute Intestinal Obstruction, Timing of Surgery, Retrospective study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Feb 2021 16:24 |
| Last Modified: | 10 Feb 2021 16:24 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13994 |
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