Maniappan, R (2012) Small bowel gangrene its etiology Pathogenesis management and its outcome. Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
INTRODUCTION: Small bowel gangrene is a major abdominal catastrophy associated with high mortality rate. This increased mortality rate is attributed to difficulty in diagnosing the condition early, the late presentation of the patient to the hospital and non availability of precise diagnostic tool for assessing bowel gangrene. Diagnosis is confirmed only during surgery. Uncomplicated hernias are not given proper importance by the patient and presents to the emergency department with strangulated hernia. As most of the hernias occur commonly in old age, the co morbid conditions that are related to the age add up to the factors influencing the mortality rate of small bowel gangrene. The important step toward reducing the mortality and morbidity of small bowel gangrene is early surgical intervention. Delay in intervention will lead to prolonged exposure of the patients to the lethal toxins and bacteria released by the gangrenous bowel and this will progress to irreversible hypotensive shock. The most common cause of bowel gangrene secondary to mechanical obstruction is strangulated hernia in India and post operative adhesions in developed countries. The strangulated hernia can be prevented by early surgical intervention of uncomplicated hernias. This study was conducted to analyze in detail the various etiology, common presentation, management and their outcome in small bowel gangrene and to discuss the ways in which the incidence of small bowel gangrene and its mortality rate may be reduced. AIM OF THE STUDY: 1. To study the various modes of presentation of small bowel gangrene. 2. To study the etiology of gangrene of small bowel in Coimbatore Medical College Hospital. 3. To study the outcome of the treatment. 4. To study the mortality and morbidity of small bowel gangrene. 5. To analyze the methods to reduce mortality and morbidity associated with gangrene of small bowel. MATERIALS AND METHODS: All the acute abdominal cases admitted in surgical ward of Coimbatore medical college hospital during the period of October 2009 to October 2011 were studied. Out of all the admitted cases small bowel gangrene cases due to various etiology identified and 25 cases of them were included in our study. INCLUSION CRITERIA: 1. Patient presenting with acute abdomen and diagnosed as small bowel gangrene peroperatively. 2. Patients with strangulated hernia and gangrene of small bowel presenting with signs of peritonitis. EXCLUSION CRITERIA: 1. Patients less than 18 years and more than 80 years 2. Pregangrenous bowel which retained its viability intraopertively. All the cases were thoroughly examined . Emphasis was given to the past history of any thromboembolic events, systemic hypertension, heart disease, and diabetes mellitus. Time of presentation after the onset of symptoms was noted. Patient presenting with acute abdomen and irreducible mass abdomen who were later diagnosed as small bowel gangrene per operatively were included in the study. CONCLUSION: 1. Highest incidence seen in 5th decade. 2. Males are more predominantly affected than females. 3. Superior mesenteric vessel occlusion and strangulated abdominal hernias are common cause of small bowel gangrene. 4. Patient presented with chief complaints of abdominal pain and irreducible swelling over the inguino scrotal region. But clinical parameters are less reliable in diagnosis. Suspicion of gangrene can be made when patient present with abdominal pain associated with smoking, systemic hypertension, past H/O of thrombo embolic event, RHD,AF, abdominal guarding rigidity, fever and tachycardia. 5. Most common factor associated with mesenteric vessel occlusion is smoking and alcoholic. 6. Preoperative aspiration showed haemorrhagic fluid in 44%cases of bowel gangrene caused by other than strangulated hernia. 7. Mortality rate is directly proportional to the length of the bowel involved . 8. Delayed hospitalization after the onset of symptoms significantly increase the morbidity and mortality. 9. From this study it is inferred that the delay in hospitalization, length of the bowel involved influence the morbidity and mortality. 10. Early diagnosis and early intervention is the key to reduce the mortality rate.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Small bowel gangrene, etiology Pathogenesis management, outcome. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 08 Jun 2018 17:19 |
| Last Modified: | 23 Mar 2020 07:25 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8331 |
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