Validation of AGESS-SBO scoring system for the prognosis and outcome of small bowel obstruction

Udhayasuriyan, R (2018) Validation of AGESS-SBO scoring system for the prognosis and outcome of small bowel obstruction. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Small bowel obstruction represents a significant health care burden in the United States. SBO is a life threatening and surgical emergency condition. The only factor shown to decrease monitoring in various studies done so far is early surgical intervention. However it is difficult to differentiate from other acute abdomen condition. It may remain under diagnosed and untreated. AGESS – SBO SMALL BOWEL OBSTRUCTION (ACUTE GENERAL EMERGENCY SURGICAL SEVERITY) is the only scoring system available so far to help us towards making an accurate diagnosis. So scoring system which is easy to follow and cost effective method to estimate prognosis and outcome of SBO and ability to predict in Hospital complication, one such scoring (AGESS – SBO Scoring system is devised by Patrice Wend ling in 2015. Hence we would like to validate this scoring system in our patients for prognosis, severity and outcome of Small Bowel Obstruction). MATERIAL AND METHODS: Study Centre: Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai Ethical Committee Approval: Ethical committee clearance obtained from Institutional Ethical Committee of Madras Medical College held on 31.01.2017. Study Design: Hospital based observational study. Duration of Study: February 2017 to September 2017 (8 Months). Study Population: Fifty patients. Inclusion Criteria: 1. Patients presenting to Rajiv Gandhi Govt. General Hospital with symptoms suggestive of Small Bowl Obstructions the study period. RESULTS: A total of 50 patients were treated for SBO during the study period with mean age of 52 (+/- 5) yrs. Women accounted for 46% and men accounted for 54% in the study period. A total 46 patients 92% were managed operatively, whereas the remaining 4 patients 8% managed conservatively. The most common cause for Small bowel obstruction was Adhesion – 46% (23 patients). The second most common cause for small bowel obstruction was obstructed Hernia – 20% (10), followed by Ilecaecal TB – 18%(9 patients), Intussusception/Volvulus-10% (5 patients) and Tumours - 6% (3 patients) The median duration of hospital stay for Complicated patients – 12.50 days. Uncomplicated patients – 11.61 days. The overall median AGESS SBO SCORE – 1.2 (Range 1-2). CONCLUSION: The most common cause of small bowel obstruction in this study were Adhesion and obstructed hernia. Delayed presentation, late diagnosis intraoperatively presence of bowel gangrene and AGESS-SBO >2 was associated with higher morbidity and mortality rate. Validation of AGESS-SBO scoring system useful to work out a concept of multidisciplinary approach for planning and conducting diagnostic and therapeutic measures in this category of patients. The main pathogenic cause leading to the development of polyorganic insufficiency and death of early post operative period is BIS (Bowel insufficiency Syndrome). Laparotomy was the most common surgery of SBO management, while Adhesiolysis, bowel resection / anastomosis and intra-operative hernia reduction were the most common intra operative procedure. The most commonly encountered postoperative complications were gastro intestinal - ileus, SSI followed by Pneumoninfection and Electrolyte imbalance. Mean average Length of Hospital stay was 11.5 6 days.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Validation of AGESS-SBO scoring system ; prognosis and outcome ; small bowel obstruction.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 05 Aug 2018 12:36
Last Modified: 05 Aug 2018 12:36

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