Gowtham Shankar, A (2020) Clinical Outcome in Acute Adhesive Small Bowel Obstruction After Surgical or Conservative Management. Masters thesis, Government Mohan Kumaramangalam Medical College, Salem.
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Abstract
INTRODUCTION AND METHODS: Acute Small Bowel Obstruction is a surgical emergency that constitutes 20% of the surgical emergencies reported in the west. This present research was to study the clinical outcome in acute adhesive small bowel obstruction after surgical or conservative management. From July 2017 to June 2019, a Prospective Single Center Study was done among 60 patients admitted with an episode of adhesive small bowel obstruction in GMKMC hospital. The following data was collected using a structured questionnaire: age, demographic characteristics, socio economic status, patients complaints and duration of complaints. A detailed general examination was done. Systemic examination and basic investigations were done. RESULTS: Forty-five patients were managed using surgical methods while fifteen of them were managed through conservative measures. The mean age of the patients in surgery group (n=45) is 50.2 years (S.D=11.78) [range= 28-75 years] while the mean age of the patients in the conservative group (n=15) is 50.73 years (S.D=11.11) [range=37-72 years]. The overall (N=60) mean age was 50.33 years (S.D=11.52) [range=28-75]. Majority of the patients were males (n=42, 70%) while others were females (n=18, 30%). The mean pain score among 60 patients was 4.85 (S.D=2.02) [range=1-10]. All of them had past history of previous surgery. On inspection, abdominal distension with guarding present in 45 of them (75%). CECT showed free fluid in 45 of the patients (75%). Among 60 patients, twenty-six of them were readmitted, of which, ten of them were surgically managed and 16 of them were conservatively managed. The mean duration of hospital stay was 8.75 days (S.D=3.63). The hospital stay was higher in the conservative group with a mean of 14.53 days (S.D=2.29) ranging between 12-18 days while the surgery group had a lower duration of hospital stay of 6.82 days (S.D=0.89) ranging between 6-8 days. CONCLUSION: Patients with SBO who undergo surgery are at lower risk of recurrence. Patients with SBO who undergo surgery are at lower risk of repeated hospitalisations. The recurrence of symptoms is also lower in the patients who were treated surgically. Patients with three or more of the following criteria (pain duration C4 days, abdominal guarding, leukocyte C10 9 109/l, C-reactive protein C75 mg/l, free fluid C500 ml on CT scan, or reduced contrast enhancement on CT scan) should undergo prompt surgical intervention as it allows both obstruction removal and long-term reduction of recurrent SBO episodes. The decision to operate should also take into account the evolution of the clinical status and laboratory values, additional CT findings (e.g., volvulus, transition zone, reduced contrast enhancement, small bowel feces sign), as well as the patient’s general condition, comorbidities, and surgical history.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711403 |
| Uncontrolled Keywords: | Clinical Outcome, Acute Adhesive Small Bowel Obstruction, Surgical or Conservative Management. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 11 Feb 2021 03:37 |
| Last Modified: | 11 Feb 2021 03:37 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14051 |
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