Abstract
Acute Intestinal Obstruction remains one of the most common intra-abdominal problem faced by General Surgeon Its early recognition and aggressive treatment can prevent irreversible ischaemia and trans-mural necrosis, thereby reducing mortality and morbidity. Overall mortality rate for bowel obstruction rises many a fold if gangrene in obstructed segment ensues, which is 3% in simple obstruction compared to 30% in strangulated obstruction. Early resuscitation and surgical exploration may minimize morbidity and mortality in such patients. A number of clinical, haematological, biochemical or radiological marker to differentiate between simple and strangulated intestinal obstruction. Research are ongoing to clearly define their diagnostic use and potential role in determining which patient should be managed surgically. C-reactive protein is acute phase reactant synthesised in liver whose level rapidly increases in response to stress, tissue Injury, ischaemia, and other inflammatory conditions. CRP is used as marker of cardiac ischaemia in acute coronary syndromes and its prognosis, thus it is likely to be elevated in comparatively greater level in bowel ischaemia. We conducted study on 83 patients with diagnosis of acute intestinal obstruction which were greater than 14 years of age to evaluate usefulness of CRP. Semi quantitative CRP evaluation was done in subjects at time of presentation and preoperatively. Then statistical test chi square test and Pearsons correlation coefficient was applied on CRP results. On completion of study and application of statistical tests it was found that60% of patients with strangulated bowel obstruction have a positive serum CRP and was not raised in 73.6% patients with simple obstruction. The chi-square value was 9.121 and p-value was also significant (p=0.003).The mean CRP levels in patients of intestinal obstruction on admission was 8.80(+/-4.007) with non gangrenous bowel and was 20.16(+/-10.6097) with gangrenous bowel. It was statistically significant with a p value of 0.001.However the preoperative CRP level in patients with non gangrenous bowel was 12.68(+/-6.131) while with gangrenous gut was 20.80(+/-10.54) and this also showed correlation which was statistically significant with a p value of 0.01(p<0.05). The Pearson’s correlation coefficient between serum CRP on admission and length of gangrenous bowel were observed to be 0.10 and shows a positive but weak correlation and this was statistically significant. So it appear that serum CRP can be used as objective indicator to diagnose irreversible bowel ischaemia/ gangrene, as serum CRP can be measured noninvasively ,is readily available, cheaper, needs no expertise and results are reproducible.
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Corresponding Author
Dr Chandan Tiwari
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DOI: https://dx.doi.org/10.18535/jmscr/v6i4.164
