A study on the surgical management of acute intestinal obstruction in adults

Aquinas, B (2014) A study on the surgical management of acute intestinal obstruction in adults. Masters thesis, Thanjavur Medical College, Thanjavur.


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BACKGROUND AND OBJECTIVES: Intestinal obstruction remains as one of the most common intra-abdominal pathologies encountered by surgeons whether it is caused by hernia, neoplasm, adhesions or any biochemical disturbances. Intestinal obstruction of the small or large bowel continues to be an important cause of morbidity and mortality. The objective of this study is to analyse the clinical features, treatment and outcome of patients with acute intestinal obstruction along with the cause of obstruction and causes of bowel ischaemia, necrosis and perforation. The following are the objectives of the study: 1. To study various patterns of presentation, various causes, significance of early recognition, diagnosis and treatment. 2.To study various influencing factors like age, sex, diet and socio-economic status in the pathogenesis of acute bowel obstruction. 3. To study morbidity and mortality rates in acute intestinal obstruction. METHODS: The materials for the clinical study of bowel obstruction were collected from various Cases getting admitted to various surgical wards. 50 cases of acute intestinal obstruction have been studied. Patients were belonging to the age groups from 12 years to 85 years, paediatric age group (<12 yrs) is excluded from this study. The case selection criteria was based on history, physical findings, radiological findings and haematological parameters. The study has been divided into Clinical study, Investigations and Treatment. Postoperative Follow-up was done in majority of the patients upto six months after the discharge of patients. The results have been tabulated stressing on following points: age, sex, symptoms, clinical findings, investigations, abnormalities, possible causative factors, operative findings and operative procedure done and complications if any occurred. RESULTS: The study group had 50 cases of acute bowel obstruction in the adult age group from 12 years to 85 years. The prevalent age groups are 31-40 and 51-60 age group with around 20% each in the total study. The most common cause of acute intestinal obstruction in the adults in this study series has been post-operative Adhesions (40%) and the next being obstructed Hernia (30%). The clinical features of abdominal pain, vomiting, constipation have been the main symptoms in this study. Abdominal Tenderness, guarding, rigidity, rebound tenderness and shock have been the cardinal features of strangulated obstruction. The commonest type of obstruction has been due to adhesions or band arising from the previous surgeries. This has constituted to about 40% of the cases of the study group. The second most common type of bowel obstruction is due to obstructed/strangulated external hernia. Salient features had been pain in the groin swelling, acute onset of swelling which is tender, not reducible and without cough impulse. Obstructed hernia constituted about 30% of the total cases studied. Volvulus of the sigmoid colon was 4% in this series. Conservative measures included insertion of ryle’s tube and iv fluids but all the cases underwent laparotomy due to failure of the recovery of symptoms. Derotation of the volvulus and sigmoidopexy was done in one case and in one case with vascular compromise, resection and anastamosis was done. Malignancy of the colon was seen in 7 patients constituting 14% of cases. 65% of the malignancies were in the age group of 35-75 years. Of these 2 patients have been managed with Hartman’s procedure. One case has been managed with loop transverse colostomy and remaining patients were managed with resection and anastamosis. Most of the deaths occurred those with malignancy. Although pulmonary tuberculosis is more prevalent in India, due to the use of antitubercular drugs, abdominal tuberculosis is becoming less prevalent. In this study incidence of ileocaecal tuberculosis was 4% and both patients were managed with resection and anastamosis. In this study intussusception causing intestinal obstruction was 6%. One case was managed with simple reduction and the remaining two patients underwent resection and anastamosis. One case of mesenteric ischaemia was recorded is our study. This patient was managed with resection and anastamosis but patient expired due to septicemia. The complication rate in this study was 18%. Overall mortality of this study was 14%. The results obtained from this study was comparable to various other studies. Malignancy and mesenteric ischemia had more mortality than simple obstruction due to postoperative adhesions. The poor prognosis of the disease was because of late presentation to the hospital with a high incidence of bowel damage with associated faecal peritonitis. The morality in the postoperative period was mostly due to faecal peritonitis, pneumonia and respiratory tract infection. INTERPRETATION AND CONCLUSION: Acute intestinal obstruction remains to be an important surgical emergency in the surgical field. Success in the treatment of acute bowel obstruction depends mainly on the early diagnosis and efficient management and treating the pathological effects of the obstruction as much as the treatment of the cause itself. Erect abdomen X-ray is a valuable tool in the diagnosis of acute intestinal obstruction. Postoperative adhesions have been the most common cause to produce bowel obstruction. Clinical, radiological and operative findings when put together can diagnose the intestinal obstruction. Mortality is still significantly high in acute intestinal obstruction in adults.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Blood pressure ; Computed tomography ; Central venous pressure ; Superior mesenteric artery ; Acute intestinal obstruction ; Extra cellular fluid ; Intravenous fluids.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 24 Jun 2018 18:10
Last Modified: 24 Jun 2018 18:10
URI: http://repository-tnmgrmu.ac.in/id/eprint/8611

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