A study of surgical management of intestinal obstruction

Authors

  • Sudarshan V. Department of General Surgery, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India
  • Jahid Husain S. Department of General Surgery, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India
  • Kashyap Sai Swathi Choudhary Dream India Network, Shantinilaya Grace Hospital, Bangalore, Karnataka, India
  • Prashanth Kumar N. Department of General Surgery, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20231382

Keywords:

Intestinal obstruction, Resection, Anastomosis

Abstract

Background: Intestinal obstruction is one of the more challenging emergency that a general surgeon can come across. However, mortality ranges from 3% with simple obstruction to as much as 30% when there is vascular compromise/perforation of the obstructed intestine, despite improvements in diagnostic tools, fluid and electrolyte correction immediately, effective antimicrobials, and surgical therapy.

Methods: There were 50 cases of intestinal obstruction studied from October 2020 to October 2022 at MVJMC&RH (Rural Bangalore) and relevant investigations were sent and operative procedures were performed and data was collected.

Results: In this study, intestinal obstruction is more common in the age group of 30-60 year.  Male and female are nearly in equal ratio. Small bowel obstruction is more common.  Pain abdomen and abdominal distension was the most common presentation. Most common etiological factor is postoperative adhesions. Malignant obstruction is more common in large bowel. Most common operation performed was resection-anastomosis. The mortality in intestinal obstruction is high in individuals who developed strangulated/perforated bowel, those present beyond 72 hours and in those are having pre-existing associated diseases and elderly people.

Conclusions: Intestinal obstruction remains still a common and important surgical emergency. Obstruction due to adhesions increasing in incidence due to increased abdominal & pelvic surgeries. The obstruction due to external hernias decreasing due to early elective surgeries. The morbidity and mortality depends on the age of the patient, etiology of obstruction, site of obstruction, state of hydration, viability of the bowel, delay in diagnosis and surgical intervention and associated medical illness.

References

Andrew N. Bailey and Love’s Short practice of surgery. In: Williams N, O'Connell R, ed. Bowel obstruction. 25th ed. Hodder Arnold. 2008:11881203.

Owen H. Wangensteen. Historical aspect of the management of the acute intestinal obstruction. Surgery. 1969;63:363-83.

Kloiber H. Die. Roentgen diagnose Des Ileus Ohne Koutrastmittel. Arch F Klin Chir. 1919;112:513.

Akgun Y. Mesosigmoidop1asty as a definitive operation in treatment of acute sigmoid volvulus. Dis Colon Rectum. 1990;39:579-81.

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;1986:30.

Richard L Drake, Wayne Vogl A, Adam WM Mitchell. Abdomen.2nd ed. Chapter 4. In: Gray’s Anatomy for students. Philadelphia: Churchill Livingstone Elsevier; 2010:300.

William FG. Regulation of gastrointestinal function.19th ed. Chapter 26. In: Review of medical physiology. Philadelphia, USA: Appleton and Lance; 1999:483.

Robert MB. Gastrointestinal regulation and motility. 5th ed. Chapter 31. In: Physiology, Robert M Berne, Mathew N Levy, Bruce M Koeppen, Bruce A Stanton, eds. Mosby Publication; 2008:539.

Souvik A, Hossein MZ, Amitabha D, Nilanjan M, Udipta R. Etiology and outcome of acute intestinal obstruction: A review of 367 patients in Eastern India. Saudi J Gastroenterol. 2010;16(4):285–7.

Deolekar SR, Mahapatra B, Subudhi S, Singhal P. A study of surgical management and its outcome in adult patients with intestinal obstruction. Int Surg J. 2019;6:4370-7.

Tavakkolizadeh A, Ashley SW, Zinner MJ. Small bowel obstruction. Schwartz’s Principles of Surgery. 9th ed. McGraw Hill Inc; 2010:988-991.

David PJ, Brooks DC. Maingot’s abdominal operations. 11th ed. McGraw Hills; 2007: 479-508.

Scott G. Houghton, Antonio Ramos De la Medina, Michael G. Sarr, Maingot’s Abdominal Operation, eleventh ed. Mc Graw Hill; 2007:479-508.

Sannappanavar NA. A study of surgical management of intestinal obstruction (Doctoral dissertation), 2013.

Fevang BT, Jensen D, Svanes K, Viste A. Early operation or conservative management of patients with small bowel obstruction?. Eur J Surg. 2002;168:475-81.

Baerga-Varela Y. Small bowel obstruction. In: Kelly KA, Sarr MG, Hinder RA, eds. Mayo Clinic Gastrointestinal Surgery. 1st ed. Philadelphia: Saunders. 2004: 421-437.

Landscaper J, Cogbill TH, Merry WH, Stolee RT, Strutt PJ. Long-term outcome after hospitalization for small bowel obstruction. Arch Surg. 1993;128:765-71.

Gadhavi JM, Charpot R. Clinical study and surgical management of acute intestinal obstruction in the adults. Inter Surg J. 2020;7(11):3703-6.

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.

Playforth RH. Mechanical small bowel obstruction and plea for the earlier surgical intervention. Ann Surg. 1970;171:783-8.

Vanathi P, Aquinas B, Sundaram MV. Study on surgical management of acute intestinal obstruction in adults. Intern J Contemp Med Res 2017;4(9):1851-5.

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Published

2023-04-29

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Original Research Articles