Cause Of Mechanical Intestinal Obstruction Research Articles

Abdominal cocoon syndrome (ACS): a case report of a Chinese male diagnosed idiopathic ACS with inborn short intestine

Introduction and importance: Abdominal cocoon syndrome (ACS), as a rare cause of mechanical intestinal obstruction, can be divided into primary/idiopathic vs. secondary type. The primary ACS is often asymptomatic and only diagnosed in exploratory laparotomy. The major treatment of surgery can be challenging. Since the gut wall and peritoneum are densely adhered, gut perforation might occur during adhesiolysis. Thus, it is important to have an experienced surgeon to perform the surgery. Case presentation: The authors present a primary ACS case of a 50-year-old man. The patient demonstrated an unbearable upper abdominal pain upon admission. A computed tomography (CT) scan showed a severe bowel obstruction. An exploratory laparotomy was indicated, leading to the diagnosis of ACS, which was considered idiopathic after ruling out secondary factors. An adhesiolysis was performed successfully. Note that the entire intestine measured was only 2.1 m during the surgery. There was no post-surgical complication. The patient was recovered uneventfully. Clinical discussion: The aetiology of primary ACS is unknown. The incidence is comparatively low and considered equal between men and women. As a rare cause of gut obstruction, the suspicion of the diagnosis should be strengthened. Surgery including adhesiolysis and bowel resection remains the major treatment. If adhesiolysis fails, bowel resection will be inevitable. The knowledge and experience of surgeon will be tested. Conclusion: The aetiology of primary ACS should be further explored. And the differential diagnosis of bowel obstruction should cover ACS in order for the surgeon to be prepared before surgery.

SMALL BOWEL INTUSSUSCEPTION CAUSED BY METASTASIS FROM A LOWER LIMB LIPOSARCOMA

Abstract Introduction Liposarcoma represents one of the most frequent types of soft tissue sarcomas, constituting a heterogeneous group of lesions. There are four different subtypes: well-differentiated; dedifferentiated; myxoid and pleomorphic. Its main locations are the retroperitoneum, extremities, trunk and the cervical area. Clinical case A 90-year-old male with a pleomorphic liposarcoma in the left thigh in 2012, local recurrence from a dedifferentiated liposarcoma in 2018 and 2021, presented to our emergency department with abdominal pain and vomiting. CT scan revealed an image of intestinal intussusception in the distal jejunum due to a 5 cm intraluminal polyp. Emergency laparotomy revealed a change in the distal jejunum caliber caused by the intussusception finding a 5 cm polypoid mass. We made an intestinal resection with a L-L anastomosis. Histopathological examination showed evidence of metastasis from dedifferentiated liposarcoma. Discussion A sarcoma is a malignant tumor, an infrequent type of cancer from connective tissue. The liposarcoma is the most frequent subtype and the dedifferentiated type can occur as dedifferentiation from other subtypes. The most common sites of metastasis include the lung, liver, and bone. Metastasis to the small bowel is rare with few reported cases. Intestinal intussusception is an infrequent cause of mechanical intestinal obstruction in adults. Etiology is diverse and it is often caused by benign lesions in the small bowel and malignant lesions in the colon. The diagnostic technique of choice is the CT scan with contrast and treatment usually requires surgery. Intestinal reduction is controversial because of the risk of perforation or tumor spread.

Appendiceal band syndrome as a cause of mechanical intestinal obstruction: A case report

Acute appendicitis is a common surgical emergency we encounter on surgical floor. Adynamic obstruction due to appendicitis and its related complications are seen very often; however, the mechanical obstruction is a rare happening associated with acute appendicitis. We reported a case of 7 years old boy, who presented with generalized abdominal pain more marked in right iliac fossa and abdominal distension as well. On clinical examination tenderness in RIF and guarding in lower abdomen was present. Complete blood picture was showing the leucocytosis and neutrophilia and rest of the laboratory findings were reference ranges. After making the patient clinically stable the retrograde appendectomy was performed. At operation, the vermiform appendix was found encircling a loop of terminal ileum like a band. The tip of appendix was gangrenous. The postoperative recovery was uneventful. This case was a rare happening of appendiceal band syndrome which is a rare diagnosis because its been not considered to have mechanical intestinal obstruction following a appendicular pathology. And having appendiceal band syndrome or tie it self is rare happening, however; having association with mechanical intestinal obstruction make this case even more interesting that need emergency appendectomy to relieve the symptoms and prevent complications. Appendiceal band syndrome is a rare happening that may cause acute intestinal obstruction and gut may become gangrenous due to break in blood supply and should be diagnosed at earliest and treated with open appendectomy.

Delayed presentation to regional hospital of gallstone ileus

Gallstone ileus is a rare cause of mechanical intestinal obstruction accounting for less than 1% of obstructions and results from the migration and impaction of a gallstone within the gastrointestinal tract. It is a rare complication of cholelithiasis seen in as little as 0.3% of patients. Morbidity associated with gallstone ileus has been reported as up to 27% and mortality rate has been reported at rates ranging from 7% to 30%, this is attributed to advanced age, and delay to presentation at treatment. An 86-year old male who presented to a rural hospital with signs and symptoms consistent with small bowel obstruction and imaging demonstrating features consistent with gallstone ileus. Diagnosis was made on computed tomography (CT) of a small bowel obstruction secondary to a large impacted gallstone. Our case highlights the ongoing utility and diagnostic value of abdominal X-ray, particularly in rural facilities with limited resources. The case also highlighted the approach of laparoscopic assisted removal of gallstone alone in medically comorbid patients, in rural facilities and particularly in the elderly population who may not be fit for longer initial surgical procedures or subsequent procedures to close choledochoduodenal fistula.

“An observational study of intestinal obstruction in adults”

Background: Mechanical intestinal obstruction is a common surgical emergency. The causes of intestinal obstruction include hernias, postoperative adhesions, malignancy, strictures etc. The etiology of this condition varies in different parts of the world and within same country. Methods: This prospective descriptive study was conducted in department of surgery at a tertiary care teaching hospital. All the adult patients, irrespective of sex with diagnosis of dynamic intestinal obstruction undergoing exploratory laparotomy were included in the study. Laparotomy findings were recorded and in the postoperative period patients were followed up for detection of complications and treatment. Results:45 patients were treated for mechanical intestinal obstruction. Mean age was 49.5 years and male to female ratio was 1.81:1. Most common cause of small bowel obstruction is Small bowel adhesions i.e. 13 patients (39.39%) ; while the most common cause of large bowel obstruction is malignancy arising from different parts of large bowel i.e. 66.67% of patients (8 patients) Wound infection was the commonest postoperative complication. There were 12 deaths in this study giving mortality rate of 26.6%. Conclusions: Bowel Adhesion is the leading causes of mechanical intestinal obstruction in our region.

Impending perforation near ileocecal junction due to phytobezoar impaction and intraluminal polyp: a\xa0case report

IntroductionBezoars and polyps are an uncommon cause of mechanical intestinal obstruction. There are four different kinds of bezoars: phytobezoars, made of vegetables and fibers; trichobezoars, resulting from the ingestion of hair and frequently an expression of psychiatric disorders; lactobezoars, which are formed of milk curd; and pharmacobezoars, caused by drugs and medications. Signs and symptoms classically vary from abdominal pain to constipation, nausea, vomiting, and abdominal distension. We present a rare case of impending perforation along with an intraluminal polyp near ileocecal junction due to phytobezoar impaction.Case presentationOur patient was a 59-year-old Sindhi female with a known history of interstitial lung disease and hypertension who presented to the emergency department with complaints of abdominal pain and constipation for 1 week, vomiting for 5 days, and abdominal distension for 2 days. After a preoperative examination and her failure to respond to conservative therapy, she was taken to the operating room for exploratory laparotomy. A hard intraluminal mass was suspected to be obstructing the small bowel at the site of impending perforation. This mass was a phytobezoar along with an intraluminal polyp. Resection of the affected segment was performed, followed by ileoileal anastomosis, and a drain was left. The patient was discharged 1 week later and was found to be well with no complaints at 3 weeks follow-up.ConclusionsEarly diagnosis of bezoars is important for early intervention and prevention of complications. Our case is unique as phytobezoar with intraluminal polyp is a rare clinical finding. Moreover, the signs and symptoms with which the patient presented are nonspecific and can be seen with multiple surgical emergencies.

Gallstone ileus: an unusual cause of mechanical intestinal obstruction in an elderly woman.

Gallstone ileus is a rare cause of intestinal obstruction. It is due to biliary-enteric fistula complicating cholelithiasis. It occurs mostly in elderly women with a heavy history of associated comorbidities. The clinical presentation is characterized by insidious and intermittent obstructive symptoms, which often might delay diagnosis. The mainstay treatment is surgical, which consisted of an urgent enterolithotomy allowing prompt relief of obstruction. The management of bilio-enteric fistula is not mandatory in the same procedure and is discussed based upon patient characteristics. Herein, we report a female case of 80-year-old, with a history of diabetes mellitus and morbid obesity. The patient presented with an abdominal acute pain associated with vomiting, evolving along five days. The physical examination showed a heart rate of 110 beats per minute, blood pressure of 110/70 mmHg and body temperature of 37.6°C. The abdominal examination revealed a slightly tympanic abdomen with diffuse tenderness. The initial biological blood assessment showed a slight increase of C-reactive protein at 21 mg/L, and leukocytosis of 14x109 elements/L. The blood investigation was normal. The CT scan of the abdomen showed dilated small bowel loops upstream of a large gallstone with a calcified rim. These findings are consistent with gallstone ileus (A). After adequate resuscitation with intravenous fluids, the patient underwent an urgent midline mini-laparotomy. The surgical exploration revealed the presence of a gallstone in the ileus resulting in an intestinal obstruction (B). The gallstone was removed through longitudinal enterotomy and the defect was closed transversally (C). Given the high anesthetic risk for the patient and the need for a shortened laparotomy, it has been decided not to treat the cholecystitis and the enterobiliary fistula. The patient had an uneventful recovery and has no symptoms within 6 months follow-up.

Gallstone ileus: the importance of individualized management

Gallstone ileus represents a complication of cholelithiasis, which in the literature has been reported as a rare cause of mechanical intestinal obstruction, however, the reported incidence is not so low, especially after 65 years of age. The formation of a bilioenteric fistula allows the passage of a large gallstone into the intestine, usually impacting the distal intestine. It is associated with a mortality that ranges between 12 and 27%. Treatment is surgical, although there is no consensus on which of the surgical techniques is the one of choice. We report the case of an 87-year-old male patient who was admitted to the emergency department with intestinal obstruction. He was diagnosed with gallstone ileus and was treated surgically with exploratory laparotomy, enterotomy with stone extraction, and primary closure. The evolution was favorable and without complications.

Cecal Volvulus: Rare Presentation of Intestinal Obstruction-Case Report

Introduction: Cecal volvulus is a rare cause of intestinal obstruction that occurs 1% - 1.5% of all intestinal obstructions. Causes of volvulus are usually unknown but it can be due to a defective peritoneal fixation of the ascending colon and cecum in 10% and secondary causes (surgical adhesions, colonic carcinoma or diverticulitis). Case Presentation: A 56-year-old woman presented with colicky abdominal pain, bilious vomiting and abdominal distention for two days, who has no history of previous surgery and no other gastrointestinal symptoms or chronic illness. On examinations, she looks ill, dehydrated, abdomen massively distended with exaggerated bowel sound but no signs of peritonitis. CT abdomen with contrast finding: type 11 cecal volvulus seen in midline to the left above the umbilicus reaching 8 cm with ileocecal junction as well as the elongated appendix is reaching the right iliac fossa. Emergency exploratory laparotomy was done and the finding was, obstructing rectosigmoid tumor with cecal volvulus. Discussion: Cecal volvulus is one of the rare causes of mechanical intestinal obstruction which required urgent surgical intervention, and it occurs due to an axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle. Conclusion: Radiological imaging helps in the diagnosis of cecal volvulus especially CT scan with contrast as gold standard for both diagnosis and assessment for complications. However, this should not delay the time of intervention especially if patient presented at late stage with evidence of peritonitis or bowel ischemia and surgical right hemicolectomy is the most effective treatment option. The colonic pathology always should be assessed, as it could be the primary cause of cecal volvulus.

S2770 When Two Rarities Occur, the Bowel Cringes

INTRODUCTION: Intussusception is a rare cause of mechanical intestinal obstruction in adults and is more frequently observed in pediatric patients. It tends to occur in association with a pathologic lead point, in most cases, a malignancy. Malignancies that commonly cause intussusception include lymphoma, colonic adenocarcinoma, and metastatic melanoma. Primary intestinal melanoma, however, is extremely rare and here we describe a case that presented as intussusception. CASE DESCRIPTION/METHODS: A 64-year-old female with asthma, COPD, OSA, HTN, HLD, GERD presented with a one week history of abdominal pain and nausea that progressed to coffee-ground emesis and melena a few days prior to admission. She endorsed a 22 pound unintentional weight loss and initial exam showed a soft but diffusely tender abdomen with labs only significant for a normocytic anemia that was near baseline. Computed tomography (CT) of the abdomen revealed intussusception and wall thickening involving the proximal small bowel (Figure 1). A small bowel enteroscopy demonstrated a 3-4 cm ulcerated, non-circumferential, non-obstructing mass in the proximal jejunum (Figure 2). A few non-bleeding superficial jejunal ulcers in the surrounding area which were presumed ischemic from the intussusception were also noted. Biopsies were sent for pathology and revealed sheets of infiltrating malignant cells with moderate amphiphilic cytoplasm and enlarged nuclei, some with pseudo inclusions. Immunohistochemical staining was done and the tumor cells stained positive for S100 and MelanA/MART1 and negative for CK7, CK20, CDX12, and CD45 which was concerning for metastatic melanoma (Figure 3). Patient underwent exploratory laparotomy with excision of the jejunal mass with surgical pathology confirming a malignant melanoma. Extensive imaging and examination of all cutaneous surfaces did not reveal a primary source. The patient was deemed to have a primary small bowel melanoma. DISCUSSION: Primary small bowel melanoma is extremely rare and should always be on the differential for neoplasms that can cause intussusception. Most intestinal melanomas represent metastatic disease and definite diagnosis can only be made after thoroughly excluding a primary lesion. It is important to recognize primary mucosal melanomas, as they are more aggressive and carry a worse prognosis, partly due to late diagnosis. Early recognition and diagnosis may allow for curative resection of the tumor, which remains the treatment of choice.Figure 1.: Proximal jejunal intussusception.Figure 2.: Push enteroscopy showing proximal jejunal mass.Figure 3.: Top left, immunohistochemical stain positive for s100. Top right, immunohistochemical stain positive for MelanA. Bottom left, H&E stain showing malignant cells with lymphovascular invasion. Bottom right, H&E stain, high power showing amphophilic cytoplasm, pleomorphic nuclei, and numerous mitotic figures.

Rolling in the Deep: Imaging Findings and Diagnostic Pearls in Gallstone Ileus.

Gallstone ileus is a dramatic complication of gallstone disease, uncommon but not exceptional in a busy emergency department. It represents a cause of mechanical intestinal obstruction, which predominantly occurs in elderly and frail patients; this contributes to the high morbidity and mortality rates associated with this condition. The modern radiologist is frequently asked to determine the cause of bowel obstruction and should be aware of the most pictorial features of this unusual disease. Broadly speaking, abdominal radiography and ultrasonography alone are limited in detecting the cause of bowel obstruction, but the sensitivity for the preoperative diagnosis of gallstone ileus may be improved by combining the findings obtained by both techniques. Computed tomography is the modality of choice for the diagnosis of this disease: it may accurately describe the number, size, and location of migrated gallstones and the exact site of bowel obstruction, providing a detailed preoperative planning. Magnetic resonance imaging may be used in selected cases for an exquisite anatomic definition of the fistulous communication.

Characteristics of Intestinal Volvulus and Risk of Mortality in Malawi.

Intestinal volvulus is a common cause of mechanical intestinal obstruction (MIO) in Africa. Sigmoid volvulus has been well characterized in both high-income and low-income countries, but there is also a predilection for small bowel volvulus in sub-Saharan Africa. An analysis was performed of the Kamuzu Central Hospital Acute Care Surgery Registry from 2013 to 2019 on patients presenting with intestinal volvulus. Bivariate analysis was performed for covariates based on the intestinal volvulus type. Multivariate Poisson regression models estimated the relative risk of volvulus and mortality. A total of 4352 patients were captured in the registry. Overall, 1037 patients (23.8%) were diagnosed with MIO. Intestinal volvulus accounted for 499 (48.1%) of patients with MIO. Sigmoid volvulus, midgut volvulus, ileosigmoid knotting, and cecal volvulus accounted for 57.7% (n = 288), 19.8% (n = 99), 20.8% (n = 104), and 1.6% (n = 8), respectively. Mean age was 46.8years (SD 17.2) with a male preponderance (n = 429, 86.0%) and 14.8% (n = 74) mortality. Overall, the most common operations performed were large bowel (n = 326, 74.4%) and small bowel (n = 76, 16.7%) resections with 18.0% (n = 90) ostomy formation. Upon regression modeling, the relative risk for volvulus was 2.7 times higher in men than women after controlling for season and age. There was no statistically significant difference in the relative risk of mortality based on the type of volvulus. Volvulus is a significant cause of primary bowel obstruction in sub-Saharan Africa. Type of intestinal volvulus is not associated increased risk of mortality. Reasons for increases in the incidence of small bowel volvulus are still largely undetermined.

Mechanical small bowel obstruction due to appendiceal tourniquet: a case report and review of literature

BackgroundAcute appendicitis is known to cause intestinal obstruction. The presentation is commonly due to functional obstruction, but on very rare occasions it presents as mechanical obstruction, especially closed loop.Case presentationWe report a case of a 59-year-old Egyptian man who presented with symptoms suggestive of intestinal obstruction. On examination, he was afebrile with distended tender abdomen with no obvious hernias. There was no history of previous abdominal surgery. Laboratory investigations were within normal range except for elevated serum creatinine levels. Plain erect X-ray and computed tomography scan of his abdomen indicated mechanical small bowel obstruction.Preoperative preparations with administration of intravenously administered fluids and antibiotics were done for exploratory laparotomy. The operation was approached through a midline incision, revealing dilated small bowel loops with a terminal ileal loop occluded by a ring of his appendix. The appendicular tip was adherent to small bowel mesentery by adhesive band (appendiceal tourniquet). Release of the band with simple appendectomy was done; a segment of ileal bowel loop was congested but regained its viability after 5 minutes’ application of gauze soaked in warm saline. His abdomen was closed in layers and one drainage tube left in situ. Paralytic ileus was the only postoperative complication which was relieved after 2 days. He was started on orally administered fluids on the third postoperative day, and discharged on the fifth postoperative day.ConclusionAcute appendicitis should be suspected as a cause of mechanical intestinal obstruction in an elderly patient with no obvious diagnostic cause, and can be managed with simple appendectomy when an early intervention is made.

Intestinal Obstruction due to Bezoar in Elderly Patients: Risk Factors and Treatment Results.

Purpose Bezoars are foreign particles from the accumulation of indigestible materials in the gastrointestinal system and a rare cause of mechanical intestinal obstruction. We aimed at investigating differences in risk factors for the development of intestinal obstruction associated with bezoar in elderly patients. Methods Hospital records of patients who underwent surgery associated with phytobezoar between January 2004 and May 2016 were retrospectively evaluated. Patients were divided into two groups [<65 years (Group 1) and ≥65 years (Group 2)]. Data were examined regarding presence of comorbidity, history of abdominal surgery, operation time, bezoar site, surgical technique, length of hospitalization, morbidity, and mortality. Results Of 121 patients enrolled, 48 (39.7%) were male and 73 (60.3%) were female (range: 24-86 years). Group 1 consisted of 69 patients aged < 65, while Group 2 consisted of 52 patients aged ≥ 65. Comorbidity was reported in 52 (42.9%) patients (mostly diabetes mellitus, 20.7%), while 60 patients (49.6%) had history of abdominal surgery (mostly peptic ulcer, 27.3%). No statistical differences were found between the two groups in terms of sex, bezoar site, surgical technique preferred, history of abdominal surgical intervention, pre- and postoperative CT examination, morbidity rates, and length of hospitalization. But, ratio of peptic ulcer operations history, presence of total comorbidity, and time of surgery decision was higher in Group 2 patients. Conclusion In bezoar-related intestinal obstruction, duration and outcome of treatment are not affected by age distribution. Possibility of bezoar should primarily be considered in elderly patients with history of peptic ulcer operation.

TYPES, SITES AND CAUSES OF MECHANICAL INTESTINAL OBSTRUCTION

Background: The pattern of types, sites and causes of intestinal obstruction is changing continuously from time to time and region to region. The objectives of this study were to determine the types, sites and causes of mechanical intestinal obstruction in our population. Materials &amp; Methods: This cross-sectional study was conducted at DHQ Hospital, Karak, Khyber Pakhtunkhwa, Pakistan from January 2011 to July 2014. A sample of 95 patients with age more than 14 years with mechanical intestinal obstruction was selected from an estimated at risk population of 1,000 individuals from district Karak. Sex, age, types, sites and causes of mechanical intestinal obstruction were variables. Except age all other variables were nominal and described by count and percentage with estimated parameters. Results: Out of 95 patients, 57 (60%) were men and 38 (40%) women with ratio of 1.5:1. Mean age was 41.15±12.63 (18-70) with a range of 52 years. Type of presentation was acute in 35 (36.84%), chronic in 25 (26.31%) and acute on chronic in 35 (36.84%) cases. Level of intestinal obstruction was small gut in 70 (73.68%), large gut in 23 (24.21%) and both in two (02.11%) cases. Cause of obstruction was adhesions in 27 (28.42%), abdominal hernias in 25 (26.32%) and malignancies in 15 (15.78%) cases. Conclusion: In our population of mechanical intestinal obstruction patients, type of presentation was equal by acute and chronic, site of intestinal obstruction was small gut in maximum cases and cause of obstruction was adhesions on top followed by abdominal hernias and malignancies.

A rare cause of mechanical intestinal obstruction; ileoceacal intussusception: a case report

A rare cause of mechanical intestinal obstruction; ileoceacal intussusception: a case report

Incidental intestinal malrotation in an adult: Midgut volvulus.

Intestinal malrotation is a developmental anomaly characterized by a midgut fixation disorder and failure to complete its normal fetal rotation around the superior mesenteric artery inside the peritoneal cavity. Malrotation is a rare cause of mechanical intestinal obstruction in adults. It may manifest as an emergency condition or with chronic abdominal symptoms. Although its diagnosis remains difficult, early diagnosis and treatment usually yield favorable outcomes. Intestinal malrotation rarely has an asymptomatic course, in which the diagnosis is usually made incidentally. Multislice computed tomography is quite helpful for making a correct diagnosis. In this study, we reported a 56-year-old patient incidentally who was detected to have intestinal malrotation and was managed symptomatically after presenting at our clinic with signs and symptoms of intestinal obstruction; we also provided a discussion of the relevant literature.

A rare cause of mechanical intestinal obstruction in geriatric population: Gallstone ileus three cases

A rare cause of mechanical intestinal obstruction in geriatric population: Gallstone ileus three cases

Predictive factors of management outcome in adult patients with mechanical intestinal obstruction.

Mechanical intestinal obstruction (MIO) is a common and potentially fatal surgical emergency, which constitutes about 20% of all admissions to the surgical emergency departments. To determine the predictive factors of morbidity and mortality in patients undergoing treatment for MIO at our tertiary hospital. This was a prospective study of consecutive patients, 18 years and above, that presented with features of MIO during a 1-year period (May 2014 to April 2015). Each patient had resuscitation, comprehensive clinical evaluation, appropriate investigations and definitive treatment. The data were analysed using SPSS version 22. One hundred and five patients were studied. The age range was 18-86 years with a mean (standard deviation) of 45.6 (14.8) years. There were 54 males with a male to female ratio of 1.1-1. The common causes of MIO were post-operative adhesion (48.6%), tumour (25.7%), external hernia (15.2%) and volvulus (5.7%). Eighty-four patients (80%) had operative intervention while 21 patients (20%) had conservative management. Univariate analysis showed that dehydration, tachycardia (>90 bpm), pyrexia, abnormal levels of potassium, urea and creatinine, leucocytosis, American Society of Anesthesiologists (ASA) status >IIIE, bowel resection, intraoperative blood loss >500 ml and duration of surgery >2 h were significant predictors of mortality (P < 0.05). Multivariate analysis showed that elevated serum urea at hospital presentation and ASA status greater than IIIE were the independent predictors of mortality, but none of the factors could independently predict morbidity. The most common post-operative complication and cause of death were wound infection (29.6%) and sepsis (66.7%). The mortality rate was 14.3%. The most common cause of MIO was post-operative adhesion. Elevated serum urea and ASA status greater than IIIE were the independent predictors of mortality.

Factores predictivos de mortalidad en la oclusión intestinal por bridas

IntroductionAdhesions are the leading cause of mechanical intestinal obstruction, a disease that has considerable mortality levels. ObjectiveTo identify the predictive factors of mortality in intestinal obstruction caused by adhesions. Material and methodsAn analytical cohort study was conducted on a sample of 118 patents in the Department of Surgery of the Provincial Hospital of Santiago de Cuba “Saturnino Lora Torres” during the period from January 2012 to December 2015. The proportions test was used for the comparison, using a significance level of P<.05, and multivariable logistic regression test to identify predictors of mortality. ResultsThere was a predominance of male and elderly patients 61 years. The operative time was less than 2hours in 86.4% and lysis of adhesions was the principal procedure. Only 3 patients needed re-intervention. The logistic regression model showed that patients over 61 years-old, a start time of more than 48hours of symptoms, ASA IV and V physical condition, the presence of vascular compromise, intestinal perforation, and septic shock, are the predictors of mortality in patients with mechanical intestinal obstruction caused by adhesions. ConclusionsIt was possible to build a predictive model of mortality for intestinal occlusion due to adhesions.