Managing ‘Adhesive Small Bowel Obstruction’ in Tanzania: A Single Center Retrospective Review of Treatment Approach and its Outcomes

Abstract

Background The management of adhesive small bowel obstruction has evolved significantly in high income countries with improvements in diagnosis and treatment, from conservative to minimally invasive approaches. In Tanzania, like in many low and middle income economies, these developments have not been herald. Addressing adhesive small bowel obstruction in this setting is therefore vital to improve outcomes. This study aimed to explore current treatment modalities and their outcome among patients with ‘adhesive small bowel obstruction’ at Muhimbili national hospital. Methodology A descriptive retrospective, cross-sectional study was conducted at Muhimbili National Hospital covering the period 2014 to 2016. Patients with a documented diagnosis of adhesive Small Bowel Obstruction were sought from medical records. Using a predefined data capture sheets, age, sex, type of management, complications, mortality and time to feeding (among patients who were managed conservatively) were captured. The study had 80% power to detect a mortality rate of 8.7% at 95% confidence interval. Descriptive statistics were populated and summarized as proportions while mortality between the operated versus the conservative group compared using chi square test with significant value set at p value of <5%. Results A total of 127 patients with diagnosis of adhesive small bowel obstruction were identified. The mean age was 40.5±17.6 and a slight male predominance at a ratio of 1.6:1. Operative approach was predominant over conservative at ratio of 1.7:1. One third of the surgical group had bowel resection and anastomosis performed. In 18.8% of the operated cases, a complication was reported with Enterocutaneous fistula and surgical site infection being the most common. Overall mortality was 8.7% being higher in the operated group at 10%. Conclusion Open surgical approach is the predominant management approach in patients with Adhesive Small Bowel Obstruction. One in three of surgically managed required bowel resection signifying late presentation. Managing adhesive small bowel obstruction carries high morbidity and mortality. There is no standardized protocol for the management of these patients at the tertiary level. Recommendation Locally adoptable protocol for diagnosis and treatment of adhesive small bowel obstruction is needed. This should maximize on resources that are available even at district level facilities with much consideration of the role of surgery.