Cases Of Acute Intestinal Obstruction Research Articles

A STUDY ON INTESTINAL OBSTRUCTION REGARDING ITS EPIDEMIOLOGY, ETIOLOGY AND MANAGEMENT IN A PERIPHERAL MEDICAL COLLEGE

Objectives: The intestinal obstruction is a widespread emergency problem in our surgical practice day by day. It is a significant cause of morbidity and mortality in our health system. It is caused by adhesions, hernias, malignancies, endometriosis, inflammatory bowel disease stenosis, intussusception, and others. Our research aims to identify the etiology, epidemiology, and clinical presentations of the pathology so that we can manage the disease as early as possible for better outcomes in our peripheral institution. Methods: The study was performed on 100 cases of the age group 12–76 years admitted in the surgical ward of Midnapore Medical College and Hospital, Paschim Medinipur (W.B.) from December 2016 to June 2018. Cases of acute intestinal obstruction who underwent operation were included in our research to establish the pathology of intestinal obstruction. Results: In our study, the incidence of acute intestinal obstruction is 1.6% of total surgical cases. Maximum patients (25%) were in the age group 51– 60 years. The most common cause of intestinal obstruction was obstructed/strangulated hernia (40%). The most common symptoms were pain abdomen (88%), abdominal distension (84%), and vomiting (78%). An X-ray revealed presence of air-fluid levels in 75% of patients. The overall mortality rate was 10%. Conclusion: The morbidity and mortality of intestinal obstruction are dependent on early diagnosis, prompt resuscitation, and proper management. The critical determinants of the morbidity are age of the patient, duration of the disease, existing comorbidity, and delay in treatment. X-ray in erect view is an essential mode of diagnostic method and obstructed hernia is the most common etiology of obstruction in our research study.

A prospective observational study on etiology and management influencing outcome in operatively managed cases of acute intestinal obstruction in adults

Background: Acute intestinal obstruction (IO) is an important cause for acute abdomen in surgery which presents as abdominal pain, vomiting, distension, and constipation depending on the level and extent of obstruction of gastrointestinal tract. Early diagnosis of acute IO with understanding of various etiologies, use of better diagnostic techniques, and skillful operative management and good postoperative care, carries a good outcome. Aims and Objectives: The objective of the study was to find out the prevalence of various etiologies of acute IO and to study the various post-operative morbidity and mortality. Materials and Methods: This was a hospital-based observational study in the Department of General Surgery of Calcutta National Medical College and Hospital among patients with a diagnosis of acute IO during the study period of December 2016-April 2018. Results: Acute IO commonly affects male with a male: female ratio 7:3 and the most common occurrence in the age group of 40–59 years (30%). The most common etiology was obstructed/strangulated hernia (36%), followed by large bowel neoplasm (18%), adhesion (16%), intestinal tuberculosis (12%), and volvulus (10%). The most common surgical procedure performed was the resection of gangrenous bowel and creation of stoma (30%), followed by prosthetic repair of hernia (28%). The mortality rate of the present study was 12%. The morbidity rate was 46%attributing mainly to respiratory complications (30.4%) and surgical site infections (26.08%). Conclusion: This study demonstrates that the pattern of IO differs from the Western world with obstructed hernias being the most important cause and also emphasizes the fact that intestinal tuberculosis assumes a prominent role.

Socio-demographic and Clinical Characteristics of Patients with Acute Intestinal Obstruction at Tertiary Care Institute of North India

Background: Acute intestinal obstruction continues to be one of the commonest surgical emergencies. Present study was done to evaluate the Socio-demographic and Clinical Characteristics of patients with acute intestinal obstruction at IGMC Shimla. Material and Methodology: This cross sectional study was done among total of 50 patients admitted with features of acute intestinal obstruction in the general surgery department of Indira Gandhi Medical College Shimla, randomly selected during the period from 15 June 2019 to 15 June 2020. Data regarding Socio-demographic and Clinical Characteristics was extracted and analysed using Epi Info Software v7. Results: Intestinal obstruction occurs in all age groups, the age spectrum in our clinical study was 14 years to 85 years. The study showed the peak incidence in the age group 51-60 (11) and 61-70(10) years .Mean age in our current study was 53 years and male to female ratio was 3:1. Most common symptoms in present study were Abdominal pain (100%) followed by Vomiting (80%). Most common signs in present study were Distension (72%) and abdominal tenderness (64%). Conclusion: Our study concluded that most of the cases of acute intestinal obstruction were male, aged above 50 years. Abdominal pain was the most common symptom while abdominal distension was the most common sign among patients.

Management and Outcomes among Acute Intestinal Obstruction Patients Admitted At Tertiary Care Institute of North India

Background: Acute intestinal obstruction continues to be one of the commonest surgical emergencies. Present study was done to evaluate the Management and outcomes among acute intestinal obstruction patients admitted at IGMC Shimla. Material and Methodology: This cross sectional study was done among total of 50 patients admitted with features of acute intestinal obstruction in the general surgery department of Indira Gandhi Medical College Shimla, randomly selected during the period from 15 June 2019 to 15 June 2020. Data regarding Socio-demographic Characteristics, Management and outcomes was extracted and analysed using Epi Info Software v7. Results: The study showed the peak incidence of Intestinal obstruction in the age group 51-60 (11) and 61-70(10) years .Mean age in our current study was 53 years and male to female ratio was 3:1. In our study patients of intestinal obstruction were managed more commonly surgically 30 (60%) than conservative 20 (40%). Among the 30 patients managed surgically, Adhesiolysis was done in 8 patients, Resection and anastomosis in 7 patients, Resection anastomosis and stoma creation in 5 patients, Hemicolectomy in 6 patients, Appendicectomy in 2 patients, Transverse loop Colostomy in 1 patient and De-rotation with sigmoidopexy in 1 patient. In the present study of 50 patients, 2 patients died. All death were due to Septicaemia and ARDS. Conclusion: Our study concluded that most of cases of Acute Intestinal Obstruction were managed surgically. Adhesiolysis, Resection and anastomosis, Resection anastomosis and stoma creation and Hemicolectomy were the common mode of surgical management. All death occurred due to Septicaemia and ARDS.

P186 Inflammatory Bowel Disease Care in the Covid-19 pandemic era: Experience from a Tunisian gastroenterology department

BackgroundThe coronavarius disease (COVID-19) pandemic has brought forth a multitude of challenges for both patients having inflammatory bowel disease (IBD) and clinicians involved in their care. The national-wide lockdown in Tunisia, from Mars to Mai 2020 had substantially decreased healthcare accessibility and drugs availability. In addition, the uncertainty caused by the COVID-19 pandemic was likely to lead to anxiety and negative emotional and behavioral reactions which are thought to be predictors of active IBD and relapses. We aimed to assess the hospital admission and complication rates in patients with IBD during the first wave of COIVD-19 infection in Tunisia and to compare them to those observed during the same period one year earlier.MethodsWe retrospectively analyzed the clinical features of patients with IBD admitted to our department during the period of time following the national lock-down in Tunisia ( from Mai, the 4th to August, the 31th). We compared the total global admission rate, IBD related complications, surgery rates and postoperative complications between the study period (P1) and the corresponding period of the previous year (P2 : from Mai, the 4th to August, the 31th, 2019). The Chi square test and Fisher exact test were used for analysis of categorical data. ResultsEighty patients with IBD were included in this study (44 patients in P1 and 36 patients in P2), 73.7% of which (n=59) had Crohn disease. The sex ratio was 1.16 and the mean age was33.8 years ± 11.9. The mean follow-up period was 5 years. In 17.5% of cases (n=14), the IBD was diagnosed during the admission. None of the P1 patients had tested positive for SARS-CoV-2. The incidence of hospitalizations during P1 was 2.6 per week. It was greater than that of P2 but without the difference being statistically significant (2.1 admissions per week; incidence rate ratio: 0.34; 95% CI: 0.67-1.2; p = 0, 54). A total of 31 complications were noted (19 in P1 vs 12 in P2; p=0,489). The complications were as follows: 19 cases of acute severe colitis (12 in P1 vs 7 in P2 ; p= 0,234), 8 cases of intra-abdominal abscesses (6 in P1 vs 2 in P2 ; p=0,234), 4 cases of acute intestinal obstruction (1 in P1 vs 3 in P2 ; p=0,322). Among patients who had presented an acute severe colitis, 6 had undergone subtotal colectomy (6 in P1 vs 0 in P2, p=0,006).ConclusionOur study showed that during the pandemic period, there was an increase in the incidence of hospitalizations of patients with IBD as well as a significant increase in the need for surgery in severe acute colitis. These results should be taken into account so that IBD management strategies can be adjusted accordingly, if the COVID-19 pandemic persists or recurs, or in case of future outbreaks.

Clinical Study of Acute Intestinal Obstruction

Background: Acute intestinal obstruction is one of the most common surgical emergencies. There are many causes of acute intestinal obstruction like bands and adhesions, neoplasms, strictures etc. Aims and Objectives: In this study we have tried to find out common clinical presentation, aetiology and treatment of acute intestinal obstruction. Materials and Methods: This is a prospective study conducted at department of General Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra in which we have studied 45 cases of acute intestinal obstruction to find out the clinical presentation, aetiology and treatment of acute intestinal obstruction. Conclusions: Acute intestinal obstruction is more common in females than in males. Small intestinal obstruction is more common than large intestinal obstruction. The commonest cause of intestinal obstruction is adhesions. The next most common cause is Tubercular stricture. Malignancy is most common cause of large intestinal obstruction. Most of the patients having large bowel obstruction required laparotomy.

A Study on Raised Serum LDH Level in Acute Intestinal Obstruction – A Marker of Bowel Gangrene

Background: Bowel gangrene is a major abdominal catastrophe associated with high mortality rate. Intestinal obstruction accounts for 20% of all surgical emergencies around the world. The present study aims to estimate the LDH levels in patients with acute intestinal obstruction and correlate with bowel viability. Subjects and Methods: In this study, the estimation of serum LDH was conducted in 45 cases of acute intestinal obstruction who were admitted in surgical wards. After fulfilling the inclusion and exclusion criteria the study subjects were recruited. All the cases were thoroughly examined. Time of presentation and onset of symptoms were noted. Under aseptic conditions, 3 ml venous blood samples were collected from the study subjects, centrifuged at 3000 rpm and separated serum sample was used for the estimation of lactate dehydrogenase (LDH) and the estimated value of serum LDH is compared with the viability of the bowel intra operatively. Results: The total number of patients presented with obstruction is 45 out of which 25 were found to have elevated LDH which is about 55.56%. Out of 25 patients presented with elevated LDH, 20 patients found to have gangrenous bowel. 60% presented with abdominal pain and 40% had irreducible swelling. Most commonly associated symptoms are vomiting (84%) followed by abdominal distension (40%), obstipation (36%), pyrexia (24%), blood in stools (8%) and diarrhoea (4%). Per rectal examination showed 76% had normal faecal staining, 12% blood stained faeces and 8% empty. Complications observed were anastomotic leak 8%, wound infection 16%, wound gaping 8%, burst abdomen 8%. Conclusion: The present study results indicate that ischemic changes in any part of the bowel can cause elevation in the serum levels of LDH and a higher value of >1000 IU/L strongly indicates an underlying gangrenous change. It is a less invasive, cost effective and easily available diagnostic tool to diagnose bowel ischemia/gangrene. Hence it is more useful in centres where the diagnostic facilities are limited.

Surgical and medical management of 05 cases of acute intestinal obstruction on pregnancy in university hospital center of Treichville, Côte d’Ivoire

From January 2003 to December 2017, the authors report five cases of acute intestinal obstruction during pregnancy. Two of them were received in digestive and proctological surgery emergencies. The other three patients were received urgently from the obstetrics and gynecology department. This association is a rare event. Clinical polymorphism delays the therapeutic management. In 1/5 cases only the diagnosis of occlusion on pregnancy was made. In 2/5 of the cases the diagnosis of occlusion was made and that of the pregnancy which at the 1st trimester was unknown. In last 2/5 of cases the pregnancies were at the 3rd trimester, the diagnosis of occlusion during pregnancy was made intraoperatively; Caesarean section being indicated for the fetal in distress on probable urinary tract infection. Authors did not have any maternal-fetal deaths. Through five cases of this association and a review of the literature, authors highlight the diagnostic and therapeutic difficulties and the therapeutic attitudes likely to improve the feto-maternal prognosis. This fetal prognosis depends essentially on the age of the pregnancy and the speed of the management.

LAPAROSCOPY IN TREATMENT OF ADHESIVE INTESTINAL OBSTRUCTION

Acute adhesive in testinal obstruction iseliminated with the help of laparoscopic adhesionin 76 patients. Laparoscopic technologi esarehig hly effective in the diagnosis and treatment of acute adhesive obstruction. Thead vantages of laparoscopic adhesion are minimalir regularities, the absence of typical laparotomy complications and rapid rehabilitation of patients, reducest helikel ihood of a recurrence of the adhesion process. Were commend starting treatment for all cases of acute intestinal obstruction in the first stage of the development of the pathological process from diagnostic laparoscopy with the subsequent resolution of possible laparoscopic adhesion.

Intestinal obstruction in von Recklinghausen's disease.

Gastrointestinal manifestations occur in up to 25% of patients with neurofibromatosis type 1. This review reports all published cases of acute intestinal obstruction due to neurofibromatosis type 1 and identifies mechanisms of obstruction, the nature of the tumour and the outcome. A systematic review of the literature on acute intestinal obstruction due to neurofibromatosis type 1 was performed by searching the major electronic databases. All relevant references were reviewed for possible inclusion. All the references of the relevant articles were screened for any further articles that were missed in the initial search. We identified 25 articles from 1972 to 2013 reporting 25 patients with von Recklinghausen's disease who underwent laparotomy for acute intestinal obstruction. Three further patients were operated on in our institution. The mean age of the patients was 44.2 years and the male/female ratio 15/13. The mechanisms of obstruction were intrinsic obstruction (16), extrinsic obstruction (8) and intussusception (4). Histology was reported to show neurofibroma (19), gastrointestinal stromal tumour (5) and adenocarcinoma (4). Among patients whose outcome was mentioned (17), 10 were asymptomatic after a mean follow-up of 1.5 years. Acute bowel obstruction is a rare manifestation of neurofibromatosis type 1. Surgery is often necessary to treat the complication and to determine the exact nature of the tumour and the prognosis.

Les invaginations intestinales de l’adulte. À propos de 21 cas au centre hospitalier universitaire Yalgado Ouédraogo de Ouagadougou

IntroductionThe intussusception is a common abdominal emergency in children but rare in adults. The aim of our study was our experience in the management of this disease.Patients and methodsA retrospective study of 21 cases of intussusception in adults undergoing surgery in emergency visceral Centre Hospitalier Universitaire Yalgado Ouedraogo (CHUYO) from 1 January 2004 to September 30, 2009.ResultsWe observed 21 cases of intussusception. They accounted for 5.4% of occlusions. There were 9 men and 12 women with a mean age of 42 years. The average period of consultation was 9.42 days. The clinical picture was that of acute generalized peritonitis in 5 cases of acute intestinal obstruction in 7 cases and in 9 patients, it was a painful abdominal mass. Radiograph of the abdomen without preparation had objectified air fluid levels in 13 cases. Abdominal ultrasound was performed in 12 patients allowed the diagnosis in 9 cases. Surgical exploration found 11 had ileo-ileal intussusception, ileocaecal 1, 4-caeco ileo-colic, a colo-colic and colic-caeco 4. These invaginations were tumor-induced inflammation in 5 cases and in 4 cases. They were primitive in 12 cases. The invaginated bowel was viable in 13 cases, necrosis in 8 cases including one case of perforation. Bowel resection was done in 19 cases. The postoperative course was uneventful in 20 cases. The death occurred in one patient.ConclusionThe intussusceptions in adults are rare. History of abdominal pain and / or sub-recurring occlusions must be sought to make an early diagnosis aided by imaging. The frequency of organic causes in adults requires a surgical treatment in all cases.

Internal hernias: anatomical basis and clinical relevance

The aim of this study was to present and discuss the anatomical basis of internal hernias thanks to our clinical experience of 14 cases. Internal hernias are uncommon cases of acute intestinal obstruction when a viscera protrudes through an intraperitoneal orifice, remaining inside the peritoneal cavity. It excludes iatrogenic post surgical hernias. From an anatomical point of view, three kinds of orifices may be interested. The orifice may be normal: epiploic or omental (Winslow's) foramen, or abnormal through a pathologic transomental hole realizing an internal prolapsus or procidentia, without sac. Or this orifice may be a paranormal peritoneal fossa (para duodenal or retrocaecal) acting as a trap for the bowel: these hernias possess a sac and are considered as true hernias. The clinical diagnosis is always difficult. CT scan can be useful confirming the obstruction and leads to an urgent operation. This retrospective study evaluates diagnosis, management and follow-up according to the type of anatomical orifice and delay of surgery.

Two cases of acute intestinal obstruction due to impaction of gall-stones

Two cases of acute intestinal obstruction due to impaction of gall-stones

Adult Surgical Emergencies in a Developing Country: The Experience of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

The goal of this study was to examine the adult surgical emergencies seen at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, with a view to proffering preventive solutions where appropriate and improving outcome. From the register of patients seen at the Casualty department and from the operations register in the main operation room of NAUTH, names and hospital numbers of adult patients treated as emergencies over a 5-year period, from 7 September 1998 to 6 September 2003, were obtained. The hospital folders were then retrieved from the Records Department. From each folder, the following details about each patient were extracted: age, sex, diagnosis at presentation, causative factors, treatment given, and outcome. A total of 902 adult patients were treated during the period. The commonest emergency operation was appendectomy for acute appendicitis in 139 patients (97 women and 42 men), followed closely by road traffic accidents (RTAs) involving 137 patients (103 men and 34 women). Gunshot injuries, which resulted mainly from armed robbery attacks, accounted for 127 cases. More men (113) sustained gunshot injuries than women (14). Of the 92 cases of acute intestinal obstruction seen, 62 occurred in women and 30 in men. Some 126 men presented with acute urinary retention, and two others presented with priapism. Governments at various levels should provide modern diagnostic tools for the accurate preoperative diagnosis of surgical emergencies in hospitals. Governments should also inculcate strict discipline into drivers using the highways, particularly in relation to abuse of alcohol and drugs. Good roads and adequate security should be provided for the people. The need for Pre-Hospital Care for the efficient evacuation of accident victims is emphasized. These measures will help to improve the management and outcome of surgical emergencies, and decrease the number of surgical emergencies resulting from RTAs and gunshot wounds.

Spectrum of causes of intestinal obstruction in adult Nigerian patients.

To present changes in the cause of intestinal obstruction in an African setting. Consecutive cases of acute intestinal obstruction from 1985 to 1994. Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Adult patients with clinical and radiological evidence of intestinal obstruction. There were 99 patients (60 males) aged 15 - 101 years (mean age 45 years). The majority of patients were young and middle-aged adults. Main causes of obstruction included adhesion (N = 44), volvulus (N =15), external hernias (N = 11), colorectal carcinoma (N = 10) and intussusception (N = 8). Approximately two-thirds of patients (28/44) with adhesion had had previous abdominal operations. The overall mortality was 14%, mainly owing to strangulation obstruction and colonic malignancy. The increasing role of adhesions as a cause of acute intestinal obstruction demands greater need for routine preventive measures against adhesion formation.

Paediatric acute intestinal obstruction in Central India.

67 cases of acute intestinal obstruction in children were analysed. Intussusception (31.3%), external hernia (23.8%) and imperforated anus (16.4%) were the main causes of obstruction in more than 70 per cent of the cases. There are significant differences in the pattern of paediatric intestinal obstruction in developing countries, as compared with that in other parts of the world. The overall morbidity and mortality in this series was 26.8% and 23.8% per cent, and the neonatal mortality was 43.5%.

Intestinal obstruction due to volvulus of the colon.

A survey of 276 cases of acute intestinal obstruction showed that volvulus was responsible for 8.6 per cent. Forty-six cases of volvulus of the colon are reviewed.The authors feel that right hemicolectomy with ileotransverse colostomy is the procedure of choice in volvulus of the right colon; anterior resection with end to end anastomosis, whenever possible, is preferred in lesions involving the sigmoid colon.

Strangulated internal hernia associated with trauma.

Two patients with strangulated intestinal obstruction due to internal hernia associated with trauma admitted to the Third Surgical Service at St. Luke's Hospital aroused our interest in this condition, especially since the first of these patients is our father. Intestinal obstruction caused by internal hernia is relatively uncommon, the incidence ranging from less than 0.01% to 5% of all cases of acute intestinal obstruction in various series. Even more unusual are those cases with hernia through defects in the mesentery or omentum, such as occurred in the cases here reported. Excluding those defects produced surgically, these amount to about 10% of the reported cases of internal hernia. Careful review of the literature revealed only 32 previous cases of hernia through a defect in the greater omentum (Table 1). The fine review by Martzloff 16 covered the period from 1840 to 1929, and three other authors reviewed the literature, but only

Experimental closed loop obstruction of the entire colon.

The concept of the loop in acute intestinal obstruction is an important one. Clinically, this condition has been related to early fatal termination; experimentally, studies on closed loops have been made under varied conditions to better understand the precise mechanism of death in acute intestinal obstruction. These experiments and their relation clinically to complete obstruction have been concerned almost entirely with the small intestine.* Some of these observations have been applied to the colon by inference. However, there are no data available pertaining to the entire isolated colon closed at each end. Bacteremia was only rarely found in fatal cases of acute intestinal obstruction by McKenna.3Hartwell and others,4after experimental studies on dogs, believed that death in intestinal obstruction was due to dehydration and to a toxin in the circulating blood. Murphy and Brooks5recovered toxic material from the thoracic ducts of animals which previously

Intestinal obstruction due to food.

Intestinal obstruction due to impacted foodstuffs is a rare but interesting and well-recognized surgical emergency. The incidence of this type of obstruction may be assessed from the analysis by Storck, Rothschild, and Ochsner (1940) of a series of 875 cases of acute intestinal obstruction, excluding those due to herniae, neoplasms, or peritonitis, and treated at the Charity Hospital, New Orleans. Of these, 51 were due to foreign bodies, and of this number five were caused by the impaction of food boluses. Handfield-Jones and Porritt (1948) give the incidence of intraluminal foreign body obstruction as 0.3% of all cases of acute intestinal obstruction. Latchmore (1940) had the exceptional experi ence of operating in one year on no fewer than four cases of obstruction due to food. There have been only four such cases at the Radcliffe Infirmary in the last 20 years. One of these was due to orange pith, and has been reported elsewhere by Fleming and Ward-McQuaid (1950). Elliot (1932) listed 40 cases of food impaction, and Fantus and Kopstein (1940) brought this number up to 75. Since their paper, single instances of small series have been reported. Four further cases are now recorded?two due to orange pith, one to almonds, and one to watercress? so that, including the other case due to orange pith men tioned above, 178 cases have now been traced. Delrio, Paz, and Carpanelli (1944) discussed 31 cases, including 7 of their own ; but 13 of these have not been included, as the case histories are not reviewed in full and the relevant original South American publications are not available. It is clear that great numbers of cases occur and are not reported, and perhaps the bizarre examples are more likely to be recorded than those that are less unusual.