Etiology of Small Bowel Obstruction in a Culturally Diverse Patient Population

Abstract

Background & Aims: Small bowel obstructions (SBO) are a major cause of morbidity and recurrent hospitalizations worldwide. The leading cause of SBO in the western world is adhesions. The goal of this study was to determine the etiologies of SBO in a large, universityaffiliated hospital with a culturally, ethnically and socioeconomically diverse patient population. Methods: Systematic chart review of all patients hospitalized at Elmhurst Hospital Center with the discharge diagnosis of “bowel obstruction” between January 2005 and October 2012 was conducted. Patients with the diagnosis of SBO were selected from this group. Our cohort included 348 patients accounting for 405 admissions for SBO. Data collected included demographic profile, length of stay, hypothesized etiology of SBO and type of management. Because all data had skewed distributions, we calculated medians and compared several parameters. Results: The etiologies of SBO were found to be adhesions (56%), hernia (10.3%), Crohn’s disease (5.7%), neoplasia (4.9%), tuberculosis (0.9%) and miscellaneous (22.2%). Surgical management was more frequent when a hernia (61.1%) or malignancy causing obstruction (59%) was the cause of SBO. Medical management was more common in Crohn’s disease (72%). Patients with hernia, malignancy or adhesions were older and had a longer median hospital stay after surgical management. There was no specific gender predilection for any cause of SBO except for Crohn’s (predominantly male). Ethnicity of the patient population was white (12.1%), African American (7.9%), Hispanic (48.4%) and Asian/others (31.6%). Conclusion: Adhesions were the most common cause of SBO according to our study (56%), a finding consistent with other studies in the developed countries (70% as per current literature). Hernia was the second most common cause of SBO in our study, unlike other studies in western countries where malignant mass or Crohn’s disease have been found to be the second most common cause. This could be attributed to the cultural diversity in our population group. The prominence of hernias as an etiology of SBO in developing countries has been attributed to the infrequency of elective hernia repair in those areas.