Etiologies, patterns and management outcomes among adult patients with intestinal obstruction: a 5 years’ retrospective observation at a regional referral level hospital, Eastern Zone, Tanzania
DOI:
https://doi.org/10.18203/2349-2902.isj20250558Keywords:
Aetiology, Pattern, Intestinal obstruction, Retrospective study, Drip and suckAbstract
Background: Despite having centuries of existence, intestinal obstruction is still the commonest culprit among the existing causes of surgical admissions especially on emergency bases. Its persistence and piling up nature of the risk factors with the untoward management outcomes are great concerns considering the negative impacts brought down to the individual and the existing health care system.
Methods: This was a retrospective hospital based observational study of patients with intestinal obstruction for over a period of five years from January 2015 to January 2020. A standardized checklist was used to secondarily collect data from the health management information system (HMIS) books. We relied on the descriptive statistics, univariate analysis was done to check for statistical association to the outcomes of interest.
Results: We enrolled 423 patients, 23 excluded as per criteria and 400 recruited for the study. Males were more than females at a ratio of 2:1 with the mean age of 45 years (16 SD). Obstructed or strangulated abdominal wall hernia was the commonest etiology (43.4%) followed by intraperitoneal adhesions (22.1%). Patient’s age, diagnosis and management modality all influenced occurrence of the outcomes of interest with the p values of 0.03, 0.04 and <0.001 respectively.
Conclusions: Most patients in our study had complicated abdominal wall hernia followed by intraperitoneal adhesions. Given their modifiability, we recommend for an early elective intervention to patients with abdominal wall hernia but also encouraging the use of all necessary adhesion prevention strategies in all abdominal and pelvic surgeries.
Metrics
References
Soressa U, Mamo A, Hiko D, Fentahun N. Prevalence, causes and management outcome of intestinal obstruction in Adama Hospital, Ethiopia. BMC Surg. 2016;16:1-8. DOI: https://doi.org/10.1186/s12893-016-0150-5
Catena F, De Simone B, Coccolini F, Di Saverio S, Sartelli M, Ansaloni L. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg. 2019;14(1):20. DOI: https://doi.org/10.1186/s13017-019-0240-7
Alanazi SN, Alanazi ST, Alonezy AA, Elmisbah HO. Intestinal Obstruction Etiology, Diagnosis and Management. J Pharm Res Int. 2022;12:33-41. DOI: https://doi.org/10.9734/jpri/2022/v34i23A35873
Jackson PG, Raiji M. Evaluation and management of intestinal obstruction. Am Fam Physician. 2011;83(2):159-65.
Griffiths S, Glancy DG. Intestinal obstruction. Surgery (Oxford). 2023;41(1):47-54.
Detz DJ, Podrat JL, Castro JC, Lee YK, Zheng F, Purnell S, et al. Small bowel obstruction. Cur Problems Surg. 2021;58(7):100893. DOI: https://doi.org/10.1016/j.cpsurg.2020.100893
Nelms DW, Kann BR. Imaging modalities for evaluation of intestinal obstruction. Clin Colon Rectal Surg. 2021;34(04):205-18. DOI: https://doi.org/10.1055/s-0041-1729737
Pqdziwiatr M, Budzynski P, Stanek M, Mattok M, Major P, Wierdak M, et al. Mechanical bowel obstruction-changes in aetiology over the past 145 years: a single centre retrospective cohort study. Acta Chirurgica Belgica. 2015;115(6):397-403. DOI: https://doi.org/10.1080/00015458.2015.11681140
Arshava EV. The Acute Abdomen. In: Hamilton Bailey’s Demonstrations of Physical Signs in Clinical Surgery. CRC Press. 2016;577-614. DOI: https://doi.org/10.1201/9780429154331-44
Rana SV, Bhardwaj S. Small intestinal bacterial overgrowth. Scand J Gastroenterol. 2008;43(9):1030-7. DOI: https://doi.org/10.1080/00365520801947074
Nakanwagi AM, Kijjambu SC, Ongom P, Luggya TS. Outcomes of management of intestinal obstruction at an urban tertiary hospital in sub–Saharan Africa: a cross-sectional study. BMC Surg. 2021;21:1. DOI: https://doi.org/10.1186/s12893-021-01405-x
Bargaje P, Wasnik N. Acute intestinal obstruction in adults: etiology, clinical presentation, investigations and management: a longitudinal study. Int Surg J. 2021;8(1):170-5. DOI: https://doi.org/10.18203/2349-2902.isj20205876
National Audit of Small Bowel Obstruction Steering Group and National Audit of Small Bowel Obstruction Collaborators, West Midlands Research Collaborative. Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit. BJS Open. 2020;4(5):924-34.
Bankole AO, Osinowo AO, Adesanya AA. Predictive factors of management outcome in adult patients with mechanical intestinal obstruction. Niger Postgrad Med J. 2017;24(4):217-23. DOI: https://doi.org/10.4103/npmj.npmj_143_17
Lee MJ, Sayers AE, Drake TM, Singh P, Bradburn M, Wilson TR, et al. Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit. BMJ Open. 2019;9(7):e029235. DOI: https://doi.org/10.1136/bmjopen-2019-029235
Ntakiyiruta G, Mukarugwiro B. The pattern of intestinal obstruction at Kibogola Hospital, a Rural Hospital in Rwanda. East Central Afr J Surg. 2009;14(2):103-8.
Irabor DO, Ladipo JK, Aghahowa M, Ogunmodede IA, Aisudionoe-Shadrack OI. The" Ibadan intussusception"; now a myth? A 10-year review of adult intestinal obstruction in Ibadan, Nigeria. West Afr J Med. 2002;21(4):305-6. DOI: https://doi.org/10.4314/wajm.v21i4.28005
Adisa AC, Mbanaso AU. Pattern of mechanical intestinal obstruction in Aba. J Med Investig Pract. 2001;3:44-8.
Garzali IU, El-Yakub AI. Changing pattern of adult intestinal obstruction in Nigeria: A narrative review. Niger J Basic Clin Sci. 2021;18(1):1-4. DOI: https://doi.org/10.4103/njbcs.njbcs_14_20
Emegoakor CD, Iloabachie IC, Nzeako HC, Anyanwu SN. Changing pattern of intestinal obstruction at Nnewi, South-Eastern Nigeria. Niger J Surg Sci. 2018;28(1):11-4. DOI: https://doi.org/10.4103/njss.njss_12_18
Rami Reddy SR, Cappell MS. A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep. 2017;19:1-4. DOI: https://doi.org/10.1007/s11894-017-0566-9
Neri V. Management of intestinal obstruction. Actual Problems of Emergency Abdominal Surgery. 2016;21. DOI: https://doi.org/10.5772/63156
Griffiths S, Glancy DG. Intestinal obstruction. Surgery (Oxford). 2023;41(1):47-54. DOI: https://doi.org/10.1016/j.mpsur.2022.10.013
Pandey Y. A prospective study of cases of intestinal obstruction and role of conservative expectant management. Int Surg J. 2018;5(6):2191-4. DOI: https://doi.org/10.18203/2349-2902.isj20182220
Meier RP, de Saussure WO, Orci LA, Gutzwiller EM, Morel P, Ris F, et al. Clinical outcome in acute small bowel obstruction after surgical or conservative management. World J Surg. 2014;38:3082-8. DOI: https://doi.org/10.1007/s00268-014-2733-6
Hajibandeh S, Hajibandeh S, Panda N, Khan RM, Bandyopadhyay SK, Dalmia S, et al. Operative versus non-op.erative management of adhesive small bowel obstruction: a systematic review and meta-analysis. Int J Surg. 2017;45:58-66. DOI: https://doi.org/10.1016/j.ijsu.2017.07.073
Mariam TG, Abate AT, Getnet MA. Surgical management outcome of intestinal obstruction and its associated factors at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2018. Surg Res Pract. 2019;2019(1):6417240. DOI: https://doi.org/10.1155/2019/6417240
Girma H, Negesso M, Tadese J, Hussen R, Aweke Z. Management outcome and its associated factors among surgically treated intestinal obstruction cases in Dilla University Referral Hospital, Southern Ethiopia. A cross-sectional study. Int J Surg Open. 2021;33:100351. DOI: https://doi.org/10.1016/j.ijso.2021.100351
Derseh T, Dingeta T, Yusouf M, Minuye B. Clinical Outcome and Predictors of Intestinal Obstruction Surgery in Ethiopia: A Cross‐Sectional Study. BioMed Res Int. 2020;2020(1):7826519. DOI: https://doi.org/10.1155/2020/7826519
Adane F, Dessalegn M. Magnitude and predictors of unfavorable management outcome in surgically treated patients with intestinal obstruction in Ethiopia: a systematic review and meta-analysis. BMC Surg. 2023;23(1):132. DOI: https://doi.org/10.1186/s12893-023-02017-3