Etiology, clinical profile, management, and outcomes of intestinal obstruction in a resource-limited setting: a prospective study.

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.

Background: Longer life expectancy has created an increasing demand for surgical care of the elderly. In addition, abdominal surgical emergencies are potentially serious and life threatening for this age group of patients. Aim: The aim of this study is to know the type of common surgical abdominal emergencies, mode of treatment, complications and outcome in elderly patients. Patients and methods: One hundred patients aged 60 years and above who had been admitted to the surgical department in Basrah General Hospital were prospectively evaluated according to the demographic features, causes of abdominal emergencies they presented with, post operative clinical course and outcome. Results: Out of 100 patients included in the study 60% were males and 40% were females, with an average age of 67.39 years (range from 60-83 years). The causes of acute surgical abdominal emergencies were intestinal obstruction (55%), hollow viscus perforation (17%), acute cholecystitis (12%), mesenteric vascular occlusion (9%), and acute appendicitis (7%). Most of the cases of intestinal obstruction were due to adhesion, while perforated DU was the main cause of hollow viscus perforation. Twenty patients (20%) died in the early post operative period with mesenteric vascular occlusion being the leading cause of death (35%). Conclusions: Acute intestinal obstruction and hollow viscus perforation appear to be the main causes of acute abdominal surgical emergencies. Obstructed hernia which constituted 14% of the causes is generally preventable. Acute mesenteric ischaemia and bowel obstruction secondary to colonic tumour had a worse prognosis in elderly patients.

BACKGROUNDAcute intestinal obstruction is a common surgical emergency with high mortality, requiring efficient multidisciplinary collaboration to improve outcomes.AIMTo explore the optimization of nursing pathways for patients with acute intestinal obstruction using the multidisciplinary team (MDT) model.METHODSA total of 176 patients with acute intestinal obstruction admitted to the Emergency Department of our hospital between December 2023 and February 2025 were randomly divided into a control group (n = 88) and an intervention group (n = 88) using a random number table. The control group received routine emergency nursing interventions, whereas the intervention group received emergency nursing pathway interventions under the MDT model. The groups were compared in terms of emergency treatment efficiency, improvement of clinical symptoms, 36-Item Short Form Health Survey (SF-36) scores, nursing satisfaction, and early (within 72 hours) intestinal obstruction–related complications-specifically, electrolyte disturbance, strangulated obstruction, and intestinal necrosis/perforation.RESULTSThe intervention group had significantly shorter triage, condition assessment, and emergency treatment times (all P < 0.001), faster relief of abdominal pain and vomiting, and earlier return of bowel function (all P < 0.001). The rate of early complications was lower in the intervention group (2.27% vs 10.23%, P = 0.029). Nursing satisfaction was higher (96.59% vs 81.82%, P = 0.002), and post-intervention SF-36 scores were significantly higher (P < 0.05).CONCLUSIONThe MDT-based emergency nursing pathway improves emergency efficiency, relieves clinical symptoms, enhances quality of life and satisfaction, and reduces early intestinal obstruction–related complications in patients with acute intestinal obstruction.

Abstract. Introduction. The initial manifestations of intestinal insufficiency syndrome in acute intestinal obstruction are a pronounced inhibition of intestinal motor activity, which may be a reflex consequence of a previously developed pathological process. The surgical intervention performed against this background becomes another factor that increases the inhibition of intestinal motility. These disorders are based on a change in the “balance” of sympathetic and parasympathetic nervous influences and humoral factors. The aim of the study was to improve the treatment outcomes of patients with acute intestinal obstruction by developing and improving enteral therapeutic measures. Materials and methods. An analysis of the treatment results of 119 patients with acute mechanical intestinal obstruction of non-neoplastic genesis who were admitted to the surgical department during 2021-2024 was conducted. The age of the studied patients ranged from 18 to 80 years. Among them, 74 (62.2%) were men, and 45 (37.8%) were women. The control group consisted of 56 patients, the main group consisted of 63 patients. Results and discussion. In the main group, postoperative complications were observed in 8 (12.6%) patients. Mortality was 3.3% (2 patients died). Thus, the supplemented complex of traditional treatment measures with intra- and postoperative intestinal decompression, intestinal lavage and enterosorption is an important stage in intestinal insufficiency syndrome interrupting the pathogenetic chain of development in patients with acute intestinal obstruction. It contributes not only to the prevention of intestinal insufficiency syndrome, but also to the reduction of endogenous intoxication, the restoration of all intestinal functions, and also creates conditions for the early activation of patients and the reimbursement of energy costs and the body’s needs for plastic materials in a natural - enteral way. Conclusions. Timely and adequate implementation of enteral therapeutic measures: intra- and postoperative intestinal decompression, intestinal lavage, as well as enterosorption, which is an important stage of the comprehensive treatment of patients with acute intestinal obstruction and the prevention of intestinal insufficiency syndrome, contributes to the reduction of postoperative complications from 33.8% to 12.6% and mortality from 7.2% to 3.3%.

Background: Small bowel obstruction is defined as a mechanical or functional obstruction of the intestine preventing the normal transit of product of digestion. It can occur at any level distal to the duodenum and is considered to be a medical emergency. Acute intestinal obstruction has attracted wide attention and extensive research. As a consequence of experimental research, a considerable decline has been observed in the mortality of acute intestinal obstruction. The aim of this study was to observe the causes, evaluation and surgical management of small bowel obstruction among cases presenting with the same in the Department of General Surgery of Katihar Medical College. Methods: Eighty cases of small bowel obstruction were observed in this study. The cases were selected among patients visiting the outdoor clinic of General Surgery in Katihar Medical College. The selected cases belonged to different aetiology, age groups and sex. Results: Abdominal tenderness was the commonest finding during per abdomen examination. Adhesion was the commonest aetiology observed in this study followed by obstructed hernia. General trend of reporting to the hospital was observed to be on the third day of onset. Higher incidence of small bowel obstruction was observed in cases in sixth decade of life. There was predominance among the males and in cases belonging to lower socio-economic class. Conclusions: Mechanical obstruction of the small intestine due to extrinsic causes constituted a major part among the presenting cases in this study. The degree of distension has a direct relation with the duration of the symptom. Small bowel obstruction can be confirmed using a radiogram in erect posture. Mortality due to small bowel obstruction can be reduced if timely intervention is sought by the presenting cases. Early diagnosis, effective resuscitation and timely surgery are the main treatment options that should be considered.

Introduction: Sub-acute intestinal obstruction (SAIO) is a partial blockage of the intestines causing abdominal pain, nausea, vomiting and obstipation. Diagnosing SAIO can be difficult, and CT scans are more accurate than plain X-rays. Treatment involves conservative measure initially, but surgery may be necessary if symptoms persist after 24-48 hours. This study aimed to assess the clinical profile and outcome of patients with SAIO. Methods: This was a descriptive cross-sectional study conducted in department of surgery at KIST Medical College and Teaching Hospital from 2022 to 2023 after getting ethical clearance. Fifty patients admitted with clinical feature suggestive of SAIO were enrolled for study. Predesigned proforma was used to record information that assessed demographic, clinical and treatment profile. SPSS version 26 was used for data analysis to generate descriptive statistical findings. Results: Abdominal pain was the most prevalent symptom observed in 39 (78%) patients while exaggerated bowel sound was most common clinical findings that was observed in 31 (62%). Pervious abdominal surgeries were present among 30 (60%) patients. Plain X-Ray showed feature suggestive of SAIO in 49 (98%) patients. Majority patients 35 (70%) were managed successfully with conservative treatment. Conclusion : In SAIO, abdominal pain was the most prevalent symptom while alteration in bowel sound is important clinical finding that is consistent with intestinal obstruction. Previous abdominal surgeries are an important risk factor to be considered for intestinal obstruction. Plain x-ray findings play important role to make diagnosis of intestinal obstruction. Conservative treatment resolves obstruction in majority of patients.

Objective To investigate the diagnosis and treatment of acute intestinal obstruction in aged patients over 80. Methods Data of 151 patients over 80 with acute intestinal obstruction admitted from January 2010 to March 2014 were retrospectively analyzed. Results 136 of 151 cases were mechanical intestinal obstruction, including 95 cases of adhesive ileus, 13 cases of tumorous ileus, 11 cases of bezoar ileus, 4 cases of abdominal internal hernia, 3 cases of intestinal volvulus, 2 cases of incarcerated oblique hernia, 1 cases of duodenal stenosis, 1 case of sigmoid stenosis, 1 case of anastomotic obstruction after radical resection of rectal cancer because of barium, the cause of ileus was unknown in 5 cases. 14 of 151 were dynamic obstruction and 1 of 151 was vascular intestinal obstruction. Conservative treatment was performed in 114 cases and 1 patient died. 30 cases received operation, including 14 cases of enterodialysis, 6 cases of enterostomy, 4 cases of enterotomy, 3 cases of enterectomy, 1 case of right hemicolectomy, 1 case of reduction of volvulus of intestine, 1 case of gastronesteostomy, and 1 patient died. 7 of 151 were against-advice discharged. 12 cases of complications occurred after surgery, including 5 cases of incisional wound infection, 2 cases of heart failure, 1 case of pulmonary infection, 1 case of anastomotic fistula, 1 case of infective shock, 1 case of early postoperative inflammatory bowel obstruction and 1 case of postoperative delirium. Conclusion Adhesive ileus is the most common cause in aged patients over 80 with acute intestinal obstruction. Rational treatment should be carried out according to different conditions. Conservative treatment is often performed and with active perioperative management, most patients will have satisfied results of surgery. Key words: Aged; Intestinal obstruction; Diagnosis; Therapy

Background: Intestinal obstructions are the most common surgical emergencies in the neonatal period. Neonatal intestinal obstruction occurring during the first month of life. Early and accurate diagnosis of intestinal obstruction is important for proper patient management. This presentation is a brief review of studies in Pubmed and Google scholar. For evaluation and diagnosis, intestinal obstruction in neonates can be divided into either high or low obstruction on the basis of dilated bowel loops present on abdominal radiographs. A few dilated bowel loops are seen with high intestinal obstruction and several bowel loops are generally seen with low intestinal obstruction. High intestinal obstructions are defined as occurring proximal to the ileum with differential diagnosis and radiographic appearance as below: 1) Gastric atresia: in microgastria a distended esophagus and a small midline stomach and In gastric atresia single bubble with no distal gas. 2) Duodenal atresia: double bubble sign 3) Malrotation with Ladd bands and midgut volvulus can be partial or complete obstruction: the abdominal radiograph in malrotation is nonspecific. It may be normal or may show a proximal bowel obstruction pattern, or show dilatation of multiple bowel loops. 4) Duodenal web partial obstruction with small amount of distal bowel gas. 5) Annular pancreas. 6) Preduodenal portal vein. 7) Jejunal atresia: triple-bubble sign with no gas in the distal bowel. Dilatation of the duodenum is a sign of chronic obstruction, therefore seen in duodenal atresia, duodenal web and annular pancreas. When obstruction occurs acutely after birth in midgut volvulus, the duodenum is not usually dilated on plain film. In complete obstruction in the high jejunum, no further roentgenographic studies are required, however, in partial obstruction (small amount of distal gas) upper GI study may be helpful to distinguish between duodenal web and malrotation with Ladd bands or midgut volvulus. The classic upper gastrointestinal appearance of malrotation with volvulus consists of an abnormal course of the duodenum that fails to cross the midline combined with a corkscrew appearance. In contrast, low intestinal obstructions involve the distal ileum or colon and typically result in diffuse dilatation of multiple small-bowel loops. If distal small bowel obstruction is suggested, a contrast enema usually is necessary. It is not possible to differentiate distal small bowel from colonic obstruction on the basis of plain abdominal roentgenograms, and consequently, contrast enema is necessary to clarify microcolon in ileal atresia and meconium ileus and differentioation from other pathology as below: 1) Meconium ileus: unused colon (i.e., microcolon), within which are multiple small filling defects representing meconium concretions. If there is reflux of contrast material beyond the ileocecal valve, multiple small filling defects (meconium concretions) also may be seen in the terminal ileum. 2) Ileal atresia: Microcolon and blind ending ileum on contrast enema. 3) Meconium plug and small left colon syndrome: multiple filling defects (i.e., meconium plugs) is seen in splenic flexure with left sided microcolon and with normal rectum. 4) Hirschsprung disease: abnormal rectosigmoid ratio (< 1), transition zone of rectal narrowing, irregular rectal contraction and retained contrast material on delayed radiographs, 5) Colonic atresia: contrast enema study typically shows a distal unused colon (i.e., microcolon), with the more proximal markedly dilated colon ending in a blind pouch.6) Anorectal malformation. In any of these cases, if intestinal perforation occurs meconium peritonitis can result and peritoneal calcifications can be seen on plain films. Conclusions: Intestinal obstructions are the most common surgical emergencies in newborn infants which require early and accurate diagnosis. An understanding of the characteristic imaging appearance of various causes of neonatal bowel obstruction on abdominal X-ray can lead to correct diagnosis or leading a guide to the next appropriate step. After abdominal X-ray that shows the presence of a neonatal high intestinal obstruction, an upper gastrointestinal series is typically performed for further evaluation. However, neonates with classic radiographic findings of high intestinal obstruction, such as duodenal atresia, may undergo surgery without any additional imaging study. An enema examination is used for further investigation of low intestinal obstruction in neonates.

Intestinal obstruction is a common general surgical emergency with high morbidity and mortality. Its aetiology varies widely between and within geographic regions, with gender, age, and time. Obstructed inguinal hernia is still considered the most common cause of intestinal obstruction in Sub-Saharan Africa and other low-income countries, but its incidence appears to be on the decrease as other causes of intestinal obstruction become more common in a particular society. To examine the spectrum of causes of intestinal obstruction in a tertiary hospital in southern Nigeria and compare the results with earlier studies in the region and Nigeria. A cross sectional, single-hospital study of adults diagnosed with and having clinical and radiological features of acute intestinal obstruction. Seventy patients were enrolled in the study, comprising of 35 (50%) males and 35 (50%) females, M:F = 1:1. The mean patient age was 44.8 years. Two peak age incidences of intestinal obstruction were observed in the 36-45 and 56-65 years age groups. Post-operative adhesion 13 (18.5%), obstructed external abdominal hernia 13 (18.5%), colonic cancer 11 (16%), and intussusception seven (10%) were the primary causes of intestinal obstruction. Obstructed inguinal hernia was commonly encountered in males while adhesions and colonic cancers were common in females. Obstructed external abdominal hernias and post-operative adhesion are at par as the main primary causes of intestinal obstruction. Colon cancer and intussusception are increasingly causing more obstructions.

Introduction We report the use of preoperative radiotherapy in a moribund patient with advanced carcinoma colon with complete intestinal obstruction who had undergone colostomy for a previous episode of intestinal obstruction. Methods Fifty-five-year-old man presented in Dec 2016 with acute intestinal obstruction with pain in abdomen and vomiting for 3 months. On exploratory laparotomy, a 12x15 cm hard mass in splenic flexure of colon was found involving root of mesentery, superior mesenteric vein and third part of duodenum and abutting tail of pancreas. Finding it unresectable, loop transverse colostomy was performed. He was started on Capecitabine. In Mar 2017, he presented to us in emaciated condition weighing 28 kilograms with acute intestinal obstruction with a large abdominal mass. He was started on nasogastric aspiration with total parenteral nutrition. Imaging revealed a 14x19 cm large abdominal mass involving pancreas, duodenum, spleen and transverse colon with dilated stomach. In view of poor general condition and advanced disease, the prognosis was discussed with the family and the idea of radiotherapy to relieve intestinal obstruction was discussed with family. After taking the consent, he was started on radiation therapy with 1.8 Gy per fraction after three-dimensional conformal radiation planning to spare maximum bowel. After 11 fractions, the patient started passing stools through the stoma. He was gradually started on enteral nutrition and was discharged to continue radiation therapy on outpatient basis. After 15 fractions, planning PET-CT scan was taken for adaptive therapy to make changes as per the reducing tumor size. He was also started on capecitabine as he was taking orally well. He completed 45 Gy in 25 fractions over 5 weeks. One month after completion of radiation therapy, he was found to be doing well and was planned for definitive surgery. Six weeks after the radiation therapy completion, extended left hemicolectomy with distal pancreatico-splenectomy and colostomy closure was performed. Histopathology showed residual viable poorly differentiated adenocarcinoma invading full thickness of colonic wall into pericolic soft tissues with a discontinuous microscopic nodular tumor deposit in pericolic soft tissue with all margins and nodes negative. Postoperatively, he developed biliary leak which healed with conservative management. Six weeks after the surgery, he recovered completely and was started on adjuvant Capecitabine. Five months after the surgery, he is doing well and is on oral Capecitabine. Conclusion To our knowledge, this is the first reported case of preoperative radiation therapy in advanced carcinoma colon and also in the setting of intestinal obstruction. Radiotherapy should be further tested in setting of malignant intestinal obstruction due to unresectable carcinoma colon and may spare patients with ileo/colostomy. Citation Format: Amit Jain, Elumalai L, Punam Goswami. Preoperative radiation therapy in advanced carcinoma colon with post-colostomy intestinal obstruction: The first report [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 673.

Relevance . Acute intestinal obstruction (AIO) remains the focus of clinicians’ attention. The mortality rate in this pathology is 5.1–8.4 %, occupying one of the leading places among all urgent diseases. The diagnosis and treatment of patients with intestinal obstruction remain relevant. Objective . Assessment of AIO treatment results based on an improved set of therapeutic measures. Materials and methods . This study enrolled 1279 patients aged 20–90 years with various AIO course variants. The dynamics of water and electrolyte metabolism, endogenous intoxication, and treatment outcomes in different age groups were studied depending on the etiology, stage of intestinal obstruction, and volume of surgical intervention. Results . Studies have shown increasing changes in water and electrolyte metabolism during the stage of enteral hypertension, with the most significant changes in the development of peritonitis and multiple organ failure. The progressive accumulation of toxic metabolic intermediates, noted at the very beginning of the disease, also depended on the intestinal obstruction stage. The episode of adhesive intestinal obstruction was conservatively resolved in 68 % of patients. The average mortality rate among all patients was 8.7 %. Intestinal resection was required in 20.1 % of patients, which increased the mortality rate to 23.2 %. The incidence of death in cases of tumor obstruction was 3.8 times higher than that in patients with non-tumor genesis of the disease. The addition of multiple organ failure was accompanied by an increase in mortality by more than 10 times. Conclusions . In AIO, age &gt;75 years, the need for intestinal resection, and the development of multiple organ failure syndrome are prognostic risk factors for an adverse outcome, regardless of hospitalization duration.

To develop an experimental model of intestinal ischemia and obstruction followed by surgical resection of the damaged segment and reestablishment of intestinal transit, looking at bacterial translocation and survival. After anesthesia, Wistar rats was subject to laparotomy, intestinal ischemia and obstruction through an ileal ligature 1.5cm of ileum cecal valve; and the mesenteric vessels that irrigate upstream of the obstruction site to approximately 7 to 10 cm were ligated. Abdominal wall was closed. Three, six or twenty-four hours after, rats were subject to enterectomy followed by an end to end anastomosis. After 24h, mesenteric lymph nodes, liver, spleen and lung tissues were surgically removed. It was studied survival rate and bacterial translocation. GraphPadPrism statistical program was used. Animals with intestinal ischemia and obstruction for 3 hours survived 24 hours after enterectomy; 6hx24h: survival was 70% at 24 hours; 24hx24h: survival was 70% and 40%, before and after enterectomy, respectively. Culture of tissues showed positivity on the 6hx24h and negativity on the 3hx24h. The model that best approached the clinic was the one of 6x24h of ischemia and intestinal obstruction, in which it was observed bacterial translocation and low mortality rate.

BackgroundAcute intestinal obstruction during pregnancy is a rare digestive surgical emergency with significant maternal and fetal mortality. Diagnosis is difficult, often delaying the management. Here, we report an exceptional association of mechanical acute intestinal obstruction due to compression by previa uterine leiomyoma, and a ruptured ectopic pregnancy.Case presentationThis is the case report of a 43-year-old primiparous black woman from a rural area, who was admitted to the surgical emergency department for acute intestinal obstruction.At examination on admittance, our patient had a bad general condition with clinical anemia. She had an occlusive syndrome that had been evolving for 3 days. A physical examination of her abdomen showed a widespread distension with an irregular and polylobed solid mass occupying the whole of the lower-umbilical and hypogastric area. A rectal examination found an empty rectum, and the mass was perceptible in Douglas’s pouch. At the vaginal examination, we found the same mass and a finger holster was clean. The diagnosis of intestinal occlusion by a tumor was retained. The laparotomy revealed a distended intestine, a ruptured right tubal ectopic pregnancy and a polymyomatous uterus. The most massive previa leiomyoma was adhering and compressing the rectal and sigmoidal hinge. A total hysterectomy was performed and histopathological examination of specimens confirmed myoma and ectopic pregnancy. The surgical follow-up was uneventful, and our patient was discharged on postoperative day 12.ConclusionsThe etiological diagnosis of acute intestinal obstruction during pregnancy is not easy, especially in the context of a low-income country where the means of biological and radiological diagnosis are lacking. A laparotomy is required before diagnosis of acute surgical abdomen and its management will depend on the intraoperative findings and the condition of the patient.

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.

Neurokinin B is a potential target for treating disruption of intestinal mucosal barrier in acute mechanical intestinal obstruction.