Abstract
Background: Acute intestinal obstruction is one of common abdominal emergencies and is associated with significant morbidity and mortality, especially if it progresses to bowel ischemia. The aim of this study is to analyse various modes of presentation of acute intestinal obstruction in both children and adult age group, etiopathogenesis, various therapeutic modalities of treatment and to accomplish operative management and anticipate the post-operative complication.
Aims and Objectives: 1.To analyze the different clinical presentations, causes and treatment options available for intestinal obstruction cases.
- My dissertation includes study of 50 cases of intestinal obstruction on randomized selection.
- To diagnose the intestinal obstruction early so that we can prevent complications caused by delayed diagnosis and treatment.
- To study the follow up and analysis of these patients for 3 months.
Methods: Fifty consecutive patients of all age groups presenting with acute intestinal obstruction were admitted in Andhra Medical College King George hospital were taken randomly and managed between January 2017 to January 2018. A detailed examination was done as per proforma after admission. Plain X-ray erect abdomen was done in all cases except inguinal hernias with obstruction.
Results: Mean age distribution was 45 years. Incidence in male was more compared to female. Pain abdomen was found in 50(100%), vomiting in 44 (88%), distension abdomen in 40 (80%) and constipation in 46 (92%) patients as main complaint. Commonest cause was postoperative adhesions. Mean duration of stay in hospital was between 1-5 weeks (average 2 weeks).
Conclusion: All age groups were involved. More commonly found in males than females. Main complaint was pain abdomen followed by constipation, vomiting, and distension. Plain X-ray abdomen and ultrasonography were important. Pathology ranged from simple bands to malignant obstruction. Postoperative adhesions were the commonest cause of obstruction. Earlier the presentation better the outcome was found.
Keywords: Intestinal obstruction, Intussusception, Resection and anastomosis.
References
- Scott G Houghton, Antonio Ramos De la Medina, Michael G Sarr. Bowel obstruction.11th ed. Chapter 17. In: Maingot‘s Abdominal operations, Michael J Zinner, Stanley W Ashley, eds. New York: McGraw-Hill Medical; 2007.pp. 479-505.
- Baker JW. An historical overview of surgical decompression in advanced intestinal obstruction. Surg Gynesal Obstet. 1984; 158:593.
- David A. McClusky III and John E. Skandalakis. Skandilakis 2004 table 161 789 to 1002
- Wangensteen OH. Historical aspects of management of acute intestinal obstruction. Surgery. 1969; 65:363-383.
- W.Sadler, Langmann medical embryology, 11th edition, chapter 14:209231.
- Bremer JL. Diverticula and duplications of intestinal tract. Arch Pathol 1944; 38:133-140.
- Estrada RL. Anomalies of intestinal rotation and fixation. Springfield IL: Thomas, 1958
- Decker GAG, du Plessis DJ. The duodenum, jejunum and ileum. 12th ed. Chapter 4. In:Lee McGregor‘s Synopsis of Surgical Anatomy. Bombay: Wright Verghese; 1986. p. 30.
- Susan S. Gray‘s anatomy 40th edition, 2009,section 8,chapters 66, 67.
- Mark J. Miller and Rodney D. Newberry. Microanatomy of the intestinal lymphatic system. Ann N Y Acad Sci. 2010 October; 1207(Suppl 1): E21–E28.
- Albert G Nicholls Theodore Kerckring and his ―SPICILEGIUM ANATOMICUM.‖ Can Med Assoc J. 1940 may; 42(5): 480-483. 12. Barrett K E. Gastro Intestinal Physiology Ganong 23rd edition chapter…. 469-478.
- Guyton and Hall Text book of Medical Physiology. 12th edition chapters 62
- Spiller R. recent advances in understanding the role of serotonin in G.I motility in functional bowel disorders. Neurogastroenterol Motil. 2007 Aug;19, 2:25-31.
- Kabaroudis A, Papaziogas B et al. Disruption of mucosal barrier after intestinal occlusion. J Invest surg 2003; 16:23-28.
- Bailey and love 26th
- Shaun McKinzie, Robert D.Fry. small and large bowel obstruction, Sabiston Text book of Surgery, 19th edition, volume 2, chapters 50,52:1227-1381.
- Ali Tavakkolizadeh, Edward E Whang, et al.Small intestine. 9th ed. Chapter 28. In:Schwartz’s Principles of surgery, pp. 980-1011.
- Soo Y Kim, Jon B Morris. Small bowel obstruction. 6th ed. Chapter 68. In:Shackel Ford‘s Surgery of the alimentary tract, Charles J Yeo, ed. Philadelphia:Saunders Elsevier; 2007. pp. 1025-33.
- Souba, Wiley W et al.ACS surgery- principles and practice, 6th edition 2007 gastrointestinal tract and abdomen-4. Intestinal obstruction.
- Norman L Browse. The abdomen. 4th ed. Chapter 15. In: Brown‘s Introduction to the symptoms and signs of surgical disease. USA: Book Power; 2005. p. 413.
- Deutsch A A, Eviatar E et al. small bowel obstruction : a review of 264 cases. Postgrad Med J 1989; 65:463-467.
- Souvik Adhikari, Mohammed Zahid Hossein et al. Etiology and outcome of acute intestinal obstruction: A review of 367 patients in Eastern India. The Saudi Journal of Gastroenterology 2010;16(4):285-7.
- Kadhim Jawad et al, Intestinal obstruction: etiology, correlation between preoperative and operative diagnosis. International journal of Public Health Research 2011,pg: 41-49.
- Naveen N, Avijeet Mukherjee et al. A Clinical Study of intestinal obstruction and its surgical management in Rural Population. Journal of Evolution of Medical and Dental Sciences, May 2013; 2(21): 3636-364.
Corresponding Author
Dr K. Jagadeesh
Postgraduate, Department of General surgery, King George Hospital, Andhra Medical College, Visakhapatnam, India