Surgical outcomes of mechanical intestinal obstruction due to neoplasms at Moi Teaching and Referral Hospital, Eldoret, Kenya

Authors

  • Nicholas Kisilu Moi University School of Medicine, Eldoret, Kenya
  • Dan Ndiwa Moi University School of Medicine, Eldoret, Kenya
  • Simiyu Tabu Moi University School of Medicine, Eldoret, Kenya; Moi Teaching and Referral Hospital, Eldoret, Kenya

DOI:

https://doi.org/10.18203/2349-2902.isj20241733

Keywords:

Mechanical intestinal obstruction, Neoplasms, Surgical outcomes, Adults

Abstract

Background: Mechanical intestinal obstruction (IO)c due to neoplasms is associated with high morbidity and mortality rates worldwide. High rates of advanced stage cancers upon presentation in a resource-limited settings result in increased rates of IO, but the outcomes following surgical management are unknown. There was need to assess the surgical outcomes in our set up. Objective of the study was to assess the surgical outcomes of mechanical intestinal obstruction due to neoplasms in adults.

Methods: We conducted a prospective, mixed-methods study utilizing data forms and patient interviews. We enrolled patients through census sampling from January to December 2023. Categorical data was summarized as frequencies and their corresponding percentages while the numerical data was summarized as means and standard deviation. Bivariate analysis was used to determine variable associations.

Results: 59 patients were enrolled in the study, with an average age of 51 years and 64.4% being male. The tumor size (T) of T4 was the most common presentation (83%, n=49) with nodal involvement (77.9%, n=46) and metastatic (57.6%, n=34). The most common surgical intervention offered was creation of a diversion stoma (57.6%, n=34). The commonest postoperative complication was the surgical site infection (28.7%, n=29). The median length of hospital stay was 10 days. Moderately differentiated malignant neoplasms and large bowel obstruction were associated with higher risk of developing complications (p<0.001). The 30-day postoperative mortality rate was 10.8%.

Conclusions: Majority of the neoplasms causing acute mechanical intestinal obstruction in adults were large bowel adenocarcinomas presenting at advanced stages.

References

Ooko PB, Sirera B, Saruni S, Topazian HM, White R. Pattern of adult intestinal obstruction at Tenwek hospital, in south-western Kenya. The Pan African Med J. 2015;20:31.

Ohene-Yeboah M, Adippah E, Gyasi-Sarpong KJGmj. Acute intestinal obstruction in adults in Kumasi, Ghana. 2006;40(2):50.

Capona R, Hassab T, Sapci I, Aiello A, Liska D, Holubar S, et al. Surgical intervention for mechanical large bowel obstruction at a tertiary hospital: Which patients receive a stoma and how often are they reversed? Am J Surg. 2021;221(3):594-7.

Winslet M, Barraclough K, Campbell Hewson G. Subacute small bowel obstruction or chronic large bowel obstruction. BMJ (Clinical research ed). 2021;374:n1765.

Tuca A, Guell E, Martinez-Losada E, Codorniu N. Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res. 2012;4:159-69.

Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007;13(3):432-7.

Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am. 2008;92(3):575-97.

Vallicelli C, Coccolini F, Catena F, Ansaloni L, Montori G, Saverio SD, et al. Small bowel emergency surgery: literature's review. World J Emerg Surg. 2011;6(1):1.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49.

Wismayer R. Colorectal adenocarcinoma in East Africa: a narrative literature review. J Adv Med Med Res. 2020;32(6):1-11.

Saidi H, Abdihakin M, Njihia B, Jumba G. Clinical outcomes of colorectal cancer in Kenya. Ann Afr Surg. 2011;7:42-9.

Kube R, Granowski D, Stübs P, Mroczkowski P, Ptok H, Schmidt U, et al. Surgical practices for malignant left colonic obstruction in Germany. Eur J Surg Oncol. 2010;36(1):65-71.

Meyer JE, Narang T, Schnoll-Sussman FH, Pochapin MB, Christos PJ, Sherr DL. Increasing incidence of rectal cancer in patients aged younger than 40 years: an analysis of the surveillance, epidemiology, and end results database. Cancer. 2010;116(18):4354-9.

Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Current Problems Surg. 2019;56(2):49-90.

Aparicio T, Pachev A, Laurent-Puig P, Svrcek M. Epidemiology, Risk Factors and Diagnosis of Small Bowel Adenocarcinoma. Cancers. 2022;14(9).

Low RN, Chen SC, Barone RJR. Distinguishing benign from malignant bowel obstruction in patients with malignancy: findings at MR imaging. Radiology. 2003;228(1):157-65.

Irabor D, Adedeji OJEjocc. Colorectal cancer in Nigeria: 40 years on. A review. Eur J Cancer Care (Engl). 2009;18(2):110-5.

Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg. 2009;249(1):63-71.

Yu K, Liu L, Zhang X, Zhang Z, Rao B, Chen Y, et al. Surgical and conservative management of malignant bowel obstruction: outcome and prognostic factors. Cancer Manag Res. 2020;12:7797-803.

Adhikari S, Hossein MZ, Das A, Mitra N, Ray U. Etiology and outcome of acute intestinal obstruction: a review of 367 patients in Eastern India. Saudi J Gastroenterol. 2010;16(4):285-7.

Etissa EK, Assefa M, Ayele BT. Prognosis of colorectal cancer in Tikur Anbessa Specialized Hospital, the only oncology center in Ethiopia. PloS One. 2021;16(2):e0246424.

Polite BN, Dignam JJ, Olopade OIJJoCO. Colorectal cancer model of health disparities: understanding mortality differences in minority populations. J Clin Oncol. 2006;24(14):2179-87.

Ferguson HJ, Ferguson CI, Speakman J, Ismail T. Management of intestinal obstruction in advanced malignancy. Ann Med Surg. 2015;4(3):264-70.

Franke AJ, Iqbal A, Starr JS, Nair RM, George Jr TJJJoop. Management of malignant bowel obstruction associated with GI cancers. J Oncol Pract. 2017;13(7):426-34.

Simachew A, Haile D, Tesfaye B, Kebede T, Nahusenay H, Shimkaw A, et al. Mortality and Its Associated Factors of Bowel Obstruction after Surgical Treatment Among Adult Patients at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia 2021 (Retrospective Cross-Sectional Study). 2021.

Wancata LM, Abdelsattar ZM, Suwanabol PA, Campbell DA, Hendren SJJoGS. Outcomes after surgery for benign and malignant small bowel obstruction. J Gastrointest Surg. 2017;21:363-71.

Krouse RS, Anderson GL, Arnold KB, Thomson CA, Nfonsam VN, Al-Kasspooles MF, et al. Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial. The Lancet Gastroenterol Hepatol. 2023;8(10):908-18.

Okeny P, Hwang T, Ogwang DJE, Surgery CAJo. Acute Bowel Obstruction in a Rural Hospital in Northern in Northern Uganda. East Cent Afr J Surg. 2011;16(1):65-70.

Dijxhoorn DN, Boutall A, Mulder C, Ssebuufu R, Mall AS, Kalungi S, et al. Colorectal cancer in patients from Uganda: a histopathological study. East Cent Afr J Surg. 2014;19(1):112-9.

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Published

2024-06-27

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Original Research Articles