SP8.3 Aetiology and Management Outcomes of Adult Mechanical Bowel Obstruction in Nigeria: A Systematic Review and Meta-analysis

Abstract

Abstract Aim Adult mechanical bowel obstruction (AMBO) has been previously reported to be majorly caused by hernias in developing countries. In Nigeria, however, there has been a recent change in pattern with adhesions now being the leading cause. The changing pattern of the causes, clinical features, mode of management and factors influencing the outcome of adult patients managed for bowel obstruction in Nigeria necessitated this review. Method Relevant keywords relating to AMBO were used to conduct a search on PubMed, Google Scholar and AJOL. 452 articles were subjected to title, abstract and full text screening, according to the inclusion and exclusion criteria. 10 articles met the inclusion criteria and were included in the final qualitative synthesis. Results The total sample size across the 10 studies was 1033. Adhesions, hernias and intra-abdominal tumours, responsible for 46.25%, 26.31% and 12.23% of cases, respectively, were the major causes of AMBO. 65.6% of cases were managed operatively and 34.4% were managed conservatively. The meta-analysis revealed high morbidity and mortality rates of 31% (95% CI: 17, 44) and 11% (95% CI: 6, 15), respectively, among adult patients managed for mechanical bowel obstruction in Nigeria. Conclusions Adhesion, which results majorly from appendicectomy is the most common cause of AMBO in Nigeria. This is unlike former reports where hernia was the most common cause. Morbidity results majorly from wound infection, recurrent adhesions and post-operative enterocutaneous fistula. The mortality rate is similar to reports from various West African studies and it is significantly influenced by surgical intervention time.