Etiologies, Clinical Presentation and Outcome of Adult Patients Presenting with Bowel Obstruction on a Virgin Abdomen

Abstract

Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the central hospital of Yaoundé in order to better understand the main causes and to better anticipate and improve the diagnosis, management and the evolution of intestinal obstruction on a virgin abdomen. Method: The patients were prospectively included from June 2021 to May 2022, these patients were recruited from the digestive and emergency surgery units of the Yaoundé Central Hospital during the study period and who met the inclusion criteria, with suspicion of partial or total intestinal obstruction or those with an intraoperative confirmed diagnosis were enrolled. Results: We recruited 73 patients including 43 (60.3%) men and 29 (39.7%) women whose mean age was 42.5 years with extremes ranging from 16 to 70 years. Most of them consulted after 72 hours, i.e. 65.2% of cases due to self-medication or even prior consultations in the lower level center at the Central Hospital of Yaoundé. The patients retained for this work presented in majority the symptoms according to the abdominal pains, the stop of the materials and gases; meteorism and vomiting. Abdominal wall hernias with incarcerated intestinal loops were the most common cause of intestinal obstruction in an unscarred abdomen in adults at 38.4% of cases, followed by digestive tumors 23.3% and adhesions 17.8%. Exceptionally, a cluster of roundworms was found as the cause of intestinal obstruction in two of our patients. Complications occurred in 25 patients or 31.5% of cases and were dominated respectively by nausea and hematoma (36%), local infections (24%) and malaria (24%). Death occurred in 5 of our patients, or 6.8% of cases, and was mostly caused by hypovolemic shock (40%) and pulmonary embolism (40%). Conclusion: Intestinal obstructions on the abdomen without scarring remain the prerogative of young adults and are caused by strangulated hernias with incarcerated intestinal loops, tumors and adhesions. The rate of complications remains high and they are dominated by infectious pathology. Their mortality is clearly improving.