Kannan, K (2006) A study of intestinal obstruction in Tirunelveli Medical College, Tirunelveli. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
INTRODUCTION: Intestinal obstruction is one of the most common problems faced by the general surgeons. Intestinal obstruction was observed and treated by Hippocrates. The earliest recorded observation for intestinal obstruction was performed by Praxagoras (350 B.C.) who created an entercutaneous fistula to relieve the obstruction. However non-operative treatment has remained the general rule, including reduction of hernias, opium for pain, orally administered mercury or lead shot in an attempt to open up the occluded bowel, electrical stimulation & gastric lavage. AIMS OF THE STUDY: 1. To study the incidence of Intestinal obstruction due to mechanical causes in the cases admitted in Tirunelveli Medical College Hospital during the period of July 2003 to January 2006. 2. To study the relative incidence of the various causes of intestinal obstruction. 3. To find out various etiological factors involved. 4. To note the clinical presentations of various types of intestinal obstruction. 5. To study the lines of management adopted with special emphasis on surgical technique employed. 6. To study the prognosis, morbidity and mortality of the various causes of intestinal obstruction. MATERIALS AND METHODS: a) Cases admitted in the Department of Surgery, Tirunelveli Medical College Hospital, between July 2003 to January 2006 forms the materials of this study. b) Case sheets of above mentioned cases and their investigations report also forms the materials of this study. c) Clinical examinations, biochemical, radiological and other investigations, observations during surgery of above cases and their follow up are methods used in this study. “Most of the life’s problems are better understood in retrospect than in prospect to which understanding the intestinal obstruction is no exception. All patients in whom a diagnosis of Intestinal Obstruction was established on admission and confirmed during operation between July 2003 to Jan 2006 were included in this study. Patients admitted with the diagnosis of Intestinal Obstruction but went against medical advice without any operative intervention and paediatric group were excluded. A total of 123 patients satisfied this criteria. The diagnosis was established by the admitting surgeon, based on clinical picture and supported by radiological evidence (ultrasonogram, plain abdominal radiograph together with contrast studies if indicated) and confirmed when appropriate at operation. Surgery was defined as urgent (less than 6 hrs between admission and operation), and delayed (at a later time during the same hospital admission). Operative details included the cause of obstruction, presence or absence of strangulation and nature of operation performed. Mortality was defined as death following surgery while post operative morbidity was defined in terms of the duration of hospital stay and associated complications following surgery. SUMMARY AND CONCLUSION: This study mainly dealt with those forms of intestinal obstruction, which were managed surgically excluding paediatric cases. 123 cases were operated during this study. Adhesions and bands accounted for 29.3% of cases in this series. Most of them were postoperative. Rough handing of bowel, failure to reperitonealise raw areas and use of too tight sutures were found to be some of the aetiological factors. Groin hernias accounted for 28.5% of this series. The constricting agent in the inguinal hernia is external inguinal ring in most of our cases. Volvulus was responsible for 13.8% of cases. Surgical treatment preferably one stage resection is recommended. Chance of recurrence is high in case of conservative treatment and sigmoidopexy. Volvulus was more common in Muslims and that too at the end of fasting season. Most of the patients were elderly males, and were habitually constipated. Intussusception formed 3.3% of our cases. This is more common in paediatric age group. In adults the main aetiological factors are submucous polyps, Meckel’s diverticulum, and inflammation. Early intervention and appropriate surgical correction is the treatment of choice. Plication of the terminal ileum to the ascending colon combined with caecopexy is a useful method to prevent recurrence. However in adults all cases go for resection and anastomosis of involved segments as appropriate treatment. Tumours of the large and small bowel accounted for 13.8% of our cases. In most of these cases there were some symptoms predating the onset of the present complaints. Surgical treatment with primary resection and end-to-end anastomosis is ideal. But some cases will be too much advanced for curative procedure. We had 7 cases of ileocaecal tuberculosis and one case was treated by segmental resection and end-to-end anastomosis. Ileocaecal tuberculosis without intestinal obstruction doesn’t require surgical treatment. Only medical management with anti-tuberculosis drugs gives satisfactory results. Dehydration was there in almost all cases of intestinal obstruction and was severe with small bowel obstruction. Serum electrolyte study revealed low sodium, and potassium levels in proximal small bowel obstruction and low sodium with low normal potassium levels in the distal small gut obstruction. There was not much of electrolyte imbalance in cases with large bowel obstruction. The mortality and morbidity rate is influenced by the time factor, viability of the bowel, comorbid illness and age of the patient. In old patients with gangrenous bowel the mortality rate is high. Primary Resection and anastomosis of the bowel is the mainstay of treatment in all cases of gangrenous bowel and resectable growth. The recent advances in surgery, the modern surgical techniques aseptic and antiseptic measures, the recent advance in anaethesiology, the improvement made and enthusiasm shown by the allied departments like Radiology, Blood Bank and Bio-chemistry have definitely made the patients with intestinal obstruction safer for emergency surgery. The mortality and morbidity are very much reduced by the adequate correction of electrolyte imbalance and the replacement of lost blood and by the proper surgical techniques employed. The observer was present in 55 cases through out the initial evaluation, resuscitation and surgical procedure, Information of the rest of 68 cases were obtained from case records. 1. Identification particulars viz, Name, Age, Sex, IP No etc. 2. Clinical features and abdominal findings. 3. Radiological findings and contrast studies. 4. Time of surgery after admission. 5. Operative findings. 6. Procedure done. 7. Postoperative complications. 8. Follow up. Patients were followed up till the time of their discharge from hospital or two years following surgery.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | intestinal obstruction ; Tirunelveli Medical College ; Tirunelveli. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 17 Jul 2017 06:19 |
| Last Modified: | 09 Jun 2018 16:05 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1778 |
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