Acute Intestinal Obstruction: A 1-Year Prospective Audit into Causes.

Introduction: Intestinal obstruction is a common surgical emergency that is encountered in general surgery units and it contributes to substantial patient morbidity and healthcare costs. Computed Tomography (CT) has emerged as an invaluable diagnostic tool in the evaluation of bowel obstruction and helps in deciding early surgery. The CT gives information on the cause for obstruction, its location, and complications like closed loop obstruction, bowel ischaemia. Aim: 1. To evaluate the accuracy of CT in diagnosing the presence, level and cause of intestinal obstruction. 2. To detect the presence of complications and demonstrate threatening signs of bowel non-viability. 3. To relate CT findings with intraoperative findings. Materials and Methods: A prospective cohort study was done at the Department of Radiology, Mysore Medical College and Research Institute, Mysore, India from April 2021 to September 2021. A total of 40 patients, ≥18 years of age with clinical suspicion of intestinal obstruction, were subjected to Contrast- Enhanced Computed Tomography (CECT) of the abdomen. The sensitivity , specificity, positive and negative predictive values of Muti-detector Computed Tomography (MDCT) were calculated. Data analysis was carried out using Statistical Package for Social Science (SPSS) version 18.5 software. Results: Total of 40 patients were analysed (25 males and 15 females ; mean age: 50.5 years). Small bowel obstruction constituted 75% of cases and large bowel obstruction constituted 25% of the cases. Ileum was the most common site of obstruction. Adhesions were the leading cause seen. Closed loop obstruction with bowel ischaemia and gangrene were observed in five patients (12.5%). Comparison of CT and per-operative findings showed that CT has a high sensitivity, specificity, accuracy of 97.44%, 100%, 97.50%; 92.31%, 100%, 92.50% and 100%, 94.12%, 95%, respectively for determining the level, cause and complications of obstruction. Conclusion: The MDCT has high diagnostic accuracy in diagnosing the level, cause and complications of intestinal obstruction with the highest of 97.50% for identifying the cause of obstruction. CT is 100% sensitive in picking up complications like bowel ischemia. Thus, MDCT were in concordance with intra operative findings for the diagnosis of intestinal obstruction and can guide surgeons in the management of these patients.

Background: Mechanical intestinal obstruction is a common surgical emergency. The causes of intestinal obstruction include hernias, postoperative adhesions, malignancy, strictures etc. The etiology of this condition varies in different parts of the world and within same country. Methods: This prospective descriptive study was conducted in department of surgery at a tertiary care teaching hospital. All the adult patients, irrespective of sex with diagnosis of dynamic intestinal obstruction undergoing exploratory laparotomy were included in the study. Laparotomy findings were recorded and in the postoperative period patients were followed up for detection of complications and treatment. Results:45 patients were treated for mechanical intestinal obstruction. Mean age was 49.5 years and male to female ratio was 1.81:1. Most common cause of small bowel obstruction is Small bowel adhesions i.e. 13 patients (39.39%) ; while the most common cause of large bowel obstruction is malignancy arising from different parts of large bowel i.e. 66.67% of patients (8 patients) Wound infection was the commonest postoperative complication. There were 12 deaths in this study giving mortality rate of 26.6%. Conclusions: Bowel Adhesion is the leading causes of mechanical intestinal obstruction in our region.

ObjectiveTo determine the role of multidetector computed tomography (MDCT) with multiplanar (MPR) and curved multiplanar reformations (CMPR) in the detection of the cause of intestinal obstruction.Materials and methodsA retrospective analysis of 200 patients with a clinical suspicion of intestinal obstruction referred to the department of radiology, Dr. Ziauddin University Hospital, Clifton campus, from September 2016 to October 2019, was done. All patients who underwent an MDCT scan with oral and intravenous (I/V) contrast were included in the study. Patients with deranged serum creatinine and an allergic reaction to contrast were excluded from the study. MPR and CMPR images were acquired in each patient in addition to routine axial images. The causes of intestinal obstruction as determined by a computed tomography (CT) scan were confirmed on surgery and colonoscopy. The CT scans were analyzed by an independent radiologist with five years of experience blinded to the surgical and colonoscopy findings in detecting the cause of bowel obstruction using the axial, MPR, and CMPR images. Data analysis was done on IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY).ResultsOut of 200 patients with a clinical suspicion of intestinal obstruction, 120 patients with intestinal obstruction was confirmed on CT scan. Fifty-eight patients were males (48.33%) and 62 patients were females (51.66%) with a male-to-female ratio of 1:1.06. The mean age of the patients was 54.7 years (age range from 06 years to 85 years). Abdominal distension was the most common presentation seen in 37 patients (30.83%) followed by vomiting in 25 patients (20.83%). Small bowel obstruction was seen in 96 patients (80.00%) with the ileum being the most common site of obstruction seen in 76 patients (63.33%). Among the patients with the ileum being the site of obstruction, distal ileal obstruction was seen in the majority of patients (30 patients, with a frequency of 25.00%). Twenty-three patients (19.16%) had a large bowel obstruction, with sigmoid colon involvement seen as the most common site in 10 patients (8.33%). Adhesions were the leading extrinsic cause of bowel obstruction seen in 32 patients (26.6%). Intraluminal causes of obstruction were seen in 36 patients (30.0%) with carcinoma being the commonest cause (12 patients with a frequency of 10.0%). A foreign body is the primary cause of intraluminal obstruction (three patients, with a frequency of 2.5%). The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT were 86.2%, 92.7%, 90.1%, and 96.4%, respectively.ConclusionMDCT has high sensitivity and specificity to diagnose and determine the cause of bowel obstruction. It not only determines the site of obstruction but also the cause of obstruction, including intrinsic, extrinsic, and intraluminal causes.

Intestinal obstruction is a failure of craniocaudal propagation of intestinal contents and may be due to a mechanical or functional pathology. Acute mechanical intestinal obstruction is one of the leading causes of surgical admissions in most emergency departments worldwide and is a significant cause of morbidity and mortality, especially when associated with bowel gangrene or perforation. It accounts for 15% of all emergency visits from acute abdominal pain. In Nigeria and most of Africa, external hernias were the main causes of intestinal obstruction throughout the 20th century; however, at the onset of the 21st century, some reports have shown a rising frequency of adhesive obstruction in our environment. We conduct this narrative review to determine if there is a changing pattern of adult intestinal obstruction in Nigeria. Literature search was conducted by two independent reviewers. The keywords used were “adult,” “intestinal obstruction,” “cause,” and “Nigeria.” The keywords were combined using the Boolean logic. The keywords were searched in PubMed and Google Scholar. The overall mean age of the study population is 44.3 years, with a male-to-female ratio of 3.6:1. Of the 1435 cases of intestinal obstruction reported in the studies selected, post-operative adhesive intestinal obstruction was responsible for 590 of them, which is equivalent to 41.1% of all the obstruction. Obstructed external hernias were responsible for 357 cases of obstruction, which is equivalent to 25.9%. The most common cause of intestinal obstruction in Nigeria is post-operative adhesion.

This study aimed to determine the type of neonatal intestinal obstruction, their mortality, and the significance of the direct causes of death. A retrospective study of all neonates managed for neonatal intestinal obstruction (total number studied was 161 child) at Basrah Children's Specialty Hospital (BCSH) between June 2012 and June 2014. Data were collected from patients’ hospital records (neonatal intensive care unit) and analyzed for age, sex, clinical features, diagnosis, surgical procedure performed, prematurity, birth weight, duration of symptoms, complications and their management. The mortality due to neonatal intestinal obstruction is still high in our setting (25.5%). The significant factors associated with mortality were prematurity, birth weight, sepsis; reoperation, short bowel syndrome, and proximal intestinal stoma. Certain causes of neonatal intestinal obstruction were associated with high mortality e.g. jejunoileal atresia (52.6%), meconium ileus (50%), perforated viscus (46%), and duodenal atresia. Male are affected more than female with M:F ratio of 2.4:1. The most common cause of intestinal obstruction in neonates in this series was anorectal malformations (33.5%). Other causes of neonatal intestinal obstruction included Hirschsprung’s disease (24.2%), small intestinal atresias (11.8%), intestinal malrotation with or without volvulus (9.3%), perforated viscus (8.1%), meconium ileus (7.5%), duodenal aresia (2.5%), annular pancreas (1.2%), and meconium plug syndrome, necrotizing enterocolitis and segmental dilatation (0.6%, each). In conclusion, neonatal intestinal obstruction is a common cause of admission accounting for 28.2% of all admission. Mortality from intestinal obstruction is still high in our society and strict measures regarding prenatal, natal and postnatal management should be addressed to save those neonates.

Background: Intestinal obstruction is one the major cause that patients underwent emergency operations and which might lead to complications that could be turn fatal. Prompt evaluation and treatment prevents mortality and morbidity of post-operative patients. Methods: Prospective study conducted between 01 April 2020 to 31 March 2022 in 50 patients of intestinal obstruction operated in emergency according to inclusion criteria. Pre-operative, intraoperative, and post-operative assessment and recording of data done. Results: In 50 cases of intestinal obstruction, commonest age group is 41 to 60 years, pain and obstipation remains major presenting symptoms and tenderness, guarding and rigidity were most common signs. The commonest cause of intestinal obstruction in the adults in this study was postoperative adhesions (44%) followed by Koch’s abdomen (30%). Malignancy of the large bowel was seen in 6 cases constituting 12% of cases, obstructed hernia in 5 cases (10%), intussusception in 3 cases (6%) and gut malrotation in 1 case (2%). Comorbidity like hypertension and diabetes were main causes of post-operative complications. Conclusions: Maximum incidence of intestinal obstructions were reported in Age group 41-60 years with male predominance. Abdominal pain was the consistent symptoms followed by obstipation. Post-operative adhesion were the most common cause of the intestinal obstruction. Malignancy and multiple comorbidity remains the major risk factor for the post-operative complications and mortality.

Background: Paediatric intestinal obstruction is a common surgical emergency and is associated with lots of morbidity and mortality especially in developing countries. Paediatric intestinal obstruction differs from adult intestinal obstruction in terms of aetiology, presentation, management and outcome. This study reports the demography, diagnosis, management and outcome of paediatric intestinal obstruction in pediatric surgical unit of a tertiary hospital in Enugu, Nigeria. Methodology: This was a retrospective study of paediatric patients who presented with intestinal obstruction to the paediatric surgical unit of Enugu State University Teaching Hospital (ESUTH) Enugu, South East Nigeria. Children above one month of age but below 15 years, who presented with symptoms and signs of intestinal obstruction, were recruited for the study. Intestinal obstruction in neonates was excluded from this study. The study period was for one year, from January 1^st 2018 to December 31^st 2018. Result: During the period of the study 45 cases, 30 (66.7%) males and 15 (33.3%) females were managed. The mean age of the patients was 52.2 months. Abdominal pain was the most common presenting symptom and intussusception was the most common cause of intestinal obstruction. Forty two patients (93.3%) did well and were discharged. Two patients (4.4%) died while one patient (2.2%) was discharged against medical advice. Conclusion: Intussusception was the most common cause of intestinal obstruction in the current study. The mortality of 4.4% recorded in this study can be improved upon.

Intestinal obstruction due to fecolith is a rare cause of small bowel obstruction. A 40 years old lady presented with the features of intestinal obstruction of 6 days duration. She had H/O laparatomy for DU perforation and hysterectomy. Clinical examination and investigations pointed to intestinal obstruction because of intestinal adhesions from previous surgeries. Conservative treatment did not give relief to the patient. Diagnostic laparoscopy revealed ascites and moderate adhesion A lump with hard consistency was detected in the terminal ileum. A diagnosis of lymphoma was made and hemicolectomy was planned. After mobilizing the caecum and part of ascending colon laparoscopically, small transverse incision was made in RIF. Whole mass and caecum was delivered through the wound. The mass in the ileum was felt moving proximally on traction. The mass was pushed proximally and enterotomy was made to take out the lump. It was a 6 x 4 x 2 cm fecolith (fig-3). There was no other abnormality or cause of intestinal obstruction except mild adhesion at the terminal ileum.DOI: 10.3329/pulse.v3i1.6555Pulse Vol.3(1) July 2009 p35-37

Acute abdomen: intestinal obstruction

Acute abdomen: intestinal obstruction

Small intestinal volvulus (SIV) is a common surgical emergency encountered in many countries. It was reported as the most common cause of intestinal obstruction in the southern part of Ethiopia. This study was intended to evaluate the magnitude and treatment outcome of SIV in a rural hospital. Retrospective study. A rural general hospital with 250 beds. Ninety eight of 235 patients operated on for acute intestinal obstruction. There were 88 males and 10 females (age range of 16-65 years). All patients who were operated on for acute intestinal obstruction during 1992-1996 were included. Age of patients, duration of the illness and extent of the bowel involved, treatment, and complications were the main outcome measures. Of the 235 patients with acute intestinal obstruction, 98 (41.7%) had SIV. The mean age was 34 years (range 16-65 years). The male to female ratio was 8.8:1.0. SIV occurred mostly among young adults most of whom were farmers. Postoperative complications occurred in 36 cases. The mortality rate was 13.3%, sepsis being the most frequent cause of death. Small intestinal volvulus was the leading cause of intestinal obstruction in this series. Early diagnosis and prompt operative intervention minimises the morbidity and mortality rate.

Intestinal obstruction: Role of multi-slice CT in emergency department

Intestinal obstruction is a common surgical emergency encountered almost in every casualty. Though adhesions, hernias and malignancies are the common causes of obstruction, various articles describe unusual causes of intestinal obstruction which needs timely surgical interventions to prevent morbidity and mortality. In this case report we present the history of a 50year old sub-fertile woman who presented with features of intestinal obstruction and confirmed radiologically with both plain x-ray and computed tomography. After conservative management and as the imaging didn't show the cause of obstruction, exploratory laparotomy was performed. There we found have encircling of left fallopian tube around mid-ileum with gangrenous part. Left salphingectomy and bowel resection with side-to-side anastomosis resulted in a favorable outcome. Intestinal obstruction can compromise blood flow to bowel loops leading to gangrene, perforation and death. Awareness, early recognition and timely intervention in intestinal obstruction is mandatory to prevent poor outcomes, especially in cases of unknown cause and not responding to conservative management. The real surgical challenge is not the decision whether to perform surgery, but the decision when and how to perform it.

Bezoars are an unusual cause of acute intestinal obstruction in children. Most cases are trichobezoars in adolescent girls who swallow their hair. Lactobezoars are another unusual but occasionally reported cause...

Anomalous congenital bands are rare causes of intestinal obstruction in children, adults, and neonates. They are rarely reported, and their etiopathogenesis is unknown, without malrotation in children. Their presentation and radiographic features are similar to any acute intestinal obstruction. The author found approximately 50 similar cases in the literature; however, during and after COVID-19 pandemic, this is the first case of anomalous congenital obstructing band without mal rotation to be reported to date. This is a rare case of infantile intestinal obstruction managed during COVID-19 pandemic. Acute intestinal obstruction due to a congenital anomalous band is rare in infants and children, and if not treated promptly, can lead to morbidity and mortality. Various reasons, such as congenital, acquired, and extrinsic or intrinsic pathologies in children and adults, may be the cause for acute intestinal obstruction. Congenital anomalous bands account for 3% of the intestinal obstructions in infants and children. These bands may cause ischemia and gangrene of the bowel without timely intervention.