Management Of Intestinal Obstruction Research Articles

Incarcerated Intestine by Testicular Mass in Huge Scrotum: A Case Report

Large testicular tumor is not a commonly seen entity in the modern era. While treatment of large testicular tumors is via inguinal radical orchiectomy, large testicular tumors carry the dilemma of delivering these large masses via the inguinal or scrotal approach. Our case was a 90 years old man with obstruction signs and huge scrotum that shows incarcerated large bowel with huge testicular mass, that in his surgery we did Radical Orchiectomy and we replace incarcerated Large Bowel in scrotum and discharge him successfully. Giant testicular cancer is considered one of the largest testicular masses in the world. Delayed seeking medical advice and appropriate management is the major cause behind this rare presentation. Increasing the awareness regarding self-examination and eliminating the stigma is the cornerstone to markedly reduce this type of unusual presentation since any testicular size change and mass can be easily noted by the patient. Surgical exploration and adjuvant chemotherapy seems as a reasonable treatment option in the setting of bilateral intra-abdominal testis tumor in an adult patient. The study underscores the effectiveness of the intervention in promoting preventive behaviours against testicular cancer among university students, laying the groundwork for future educational initiatives. Although testicular cancer (TC) is the most common malignancy in males between the ages of 18 and 50 years, little effort has been made to increase public awareness about TC and testicular self-examinations (TSEs). Intestinal obstruction without a past surgical history of abdominal surgeries or trauma is a rare and challenging clinical situation. This case report describes the presentation, diagnosis, and management of intestinal obstruction in a patient with an uncommon aetiology of small bowel obstruction. Chronic hernia incarceration can lead to weakening and ischemia of the bowel, and minimal trauma can lead to perforation of the weakened segment. In such presentations, bowel resection and repair of the defect with a biological material is safe and feasible.

Study of Etiological Spectrums, Symptoms, and Management of Intestinal Obstruction Among Population in Central India

Abstract Introduction: Intestinal obstruction has emerged as a challenging emergency putting unwanted financial as well as clinical burden globally. A study on etiology, symptoms, and management could benefit in treating larger population of the region. Aim: The study aimed to study the demography, etiology, symptoms, and management of intestinal obstruction among a population in central India. Materials and Methods: A single-center prospective observational study of intestinal obstruction was done among patients admitted to various surgical wards, during the period from January 1, 2018, to May 31, 2019. Here, we studied 50 cases of intestinal obstruction. Patients belonged to the age groups ranging from 15 to 85 years were included. Patients were selected on the basis of clinical history, physical findings, and radiological and hematological investigations. For statistical analysis, Chi-square and Fisher exact tests were performed. Results: There were a total of 12,233 admissions among which 228 cases were acute intestinal obstruction, we randomly selected 50 cases for the present study. Males were 72% (n = 36) and females were 28% (n = 14). The age groups 31–40 (20%) and 51–60 (20%) showed the highest incidence. Postoperative adhesions (40%), obstructive hernia (30%), and malignancy (14%) were the major causes of obstruction. Surgical intervention was carried out with release of adhesions in majority of cases (40%), resection anastomosis in 22%, and release of adhesions with herniorrhaphy in 18% of cases. Pain in the abdomen was a major symptom (88%) among the cases. The mortality rate was 14% of the total subjects involved in the study. Conclusion: Acute intestinal obstruction remains an important surgical emergency in the surgical field, success in the treatment depends largely upon early diagnosis and proper management and treatment of pathological effects of the obstruction. Postoperative adhesions are one of the main causes responsible for intestinal obstruction.

A study of etiology and management of intestinal obstruction

Though the diagnosis of intestinal obstruction is simple, the identification of the underlying cause may not be that simple. At times the underlying cause may become evident only during laparotomy. There is a high risk of morbidity and mortality linked with the condition, making early diagnosis and management crucial. The management may be conservative or surgical based on cause and requires adequate fluid and electrolyte resuscitation. Hence, we analyzed the various aetiological factors and management techniques of intestinal obstruction in a tertiary care center.

Unveiling new patterns: A surgical deep learning model for intestinal obstruction management.

Swift and accurate decision-making is pivotal in managing intestinal obstructions. This study aims to integrate deep learning and surgical expertise to enhance decision-making in intestinal obstruction cases. We developed a deep learning model based on the YOLOv8 framework, trained on a dataset of 700 images categorised into operated and non-operated groups, with surgical outcomes as ground truth. The model's performance was evaluated through standard metrics. At a confidence threshold of 0.5, the model demonstrated sensitivity of 83.33%, specificity of 78.26%, precision of 81.7%, recall of 75.1%, and mAP@0.5 of 0.831. The model exhibited promising outcomes in distinguishing operative and nonoperative management cases. The fusion of deep learning with surgical expertise enriches decision-making in intestinal obstruction management. The proposed model can assist surgeons in intricate scenarios such as intestinal obstruction management and promotes the synergy between technology and clinical acumen for advancing patient care.

Ileus conditions after rectal and Hartmann's resections.

Bowel obstruction is one of the most common postoperative complications in pelvic surgery. In most cases, adhesive mechanical ileus of the small bowel is the cause. In procedures such as Hartmann's resection or abdominoperineal rectal resection, it seems that the large wound area on the pelvic walls and pelvic floor and the dead space after the removed rectum with mesorectum contribute to the ileus condition. The aim of this paper was to identify the risk factors for ileus after selected pelvic procedures and to map the possible ways of prevention and treatment of these complications. We performed retrospective simple analysis of a set of 98 patients who underwent elective abdominoperineal resection of the rectum, pelvic exenteration or Hartmann's resection for rectal cancer between 2017-2022. Postoperative complications were recorded, especially bowel obstruction, and perineal wound or rectal stump healing complications. In all 9 patients, who needed reoperation, we searched for risk factors for ileus known from the literature. We also described the management of ileus. In the group of 9 patients subjected to detailed analysis, 8 risk factors were most common: male gender, obesity, history of radiotherapy, open surgery, requirement of adhesiolysis in primary surgery, large blood loss, difficult dissection, and impaired healing of the rectal stump/perineum. A total of 8 (88.9%) patients had a combination of 4 or more of the mentioned risk factors. Our results confirm the impact of risk factors known from the literature; furthermore, they indicate a connection with the formation of a dead space in the pelvis and with complications of the rectal stump or perineal wound healing. Some of the risk factors cannot be changed, and current preventive measures cannot completely prevent the formation of adhesions. It is therefore advisable to look for other materials and methods that would ideally limit the formation of adhesions and at the same time fill the dead space and thus separate it from the perineal wound.

Utility of Serum L-lactate in Identifying Ischemia in Acute Intestinal Obstruction: A Prospective Observational Study.

Introduction In cases of intestinal obstruction, increasing luminal dilatation compromises bowel wall perfusion, eventually resulting in intestinal ischemia and bowel necrosis in advanced cases. Elevated L-lactate, as a biomarker of ischemia, may indicate the presence of bowel ischemia in cases of obstruction. The objective of this study was to evaluate the value of serum L-lactate measurement in predicting the presence of intraoperatively observed intestinal ischemia in patients with acute intestinal obstruction. Methods Patients diagnosed with acute intestinal obstruction were prospectively studied over an 18-month period. Serum L-lactate values were assayed twice: at the time of presentation and following appropriate fluid resuscitation. Receiver operating characteristic (ROC) curve analysis was applied to determine the predictive value of serum L-lactate in detecting intestinal ischemia. Results One hundred forty-four cases of intestinal obstruction were included in this study, of which 91 underwent operative intervention. Intestinal ischemia was identified in 52 cases and categorized intra-operatively as reversible (n = 33) and irreversible (n = 19). ROC analysis showed a good predictive value of serum L-lactate after fluid resuscitation for irreversible intestinal ischemia (area under the curve (AUC) = 0.884, 95% confidence interval (CI), 0.812-0.956). An L-lactate cut-off of 19.1 mg/dL following fluid resuscitation was determined to have a sensitivity of 89.5%, a specificity of 72.9%, a positive predictive value of 46.6%, and a negative predictive value of 96.3% for gangrenous bowel. Conclusion Serum L-lactate is a good predictive tool for identifying intestinal ischemia during the management of intestinal obstruction. Serum L-lactate after resuscitation showed better predictive value for ischemic bowel.

Management of ileus or small bowel obstruction after minimally invasive sacrocolpopexy; a multicenter case series

Management of ileus or small bowel obstruction after minimally invasive sacrocolpopexy; a multicenter case series

A tale of two analyses: Administrative vs primary review of nutrition support team performance.

Our pharmacy department performed a medication-use evaluation using administrative data to assess prescription of parenteral nutrition (PN). They found that 31.6% (185 of 586) of nutrition support team (NST) patients received ≤5 days of PN, whereas 120 received ≤3 days. These results raised the question of NST prescribing practices given the incidence of short-duration PN. Since our NST evaluates all PN requests, the study prompted further review to identify reasons for short duration PN. Charts of patients receiving PN for ≤3 days in the initial study underwent an in-depth review focusing on indications, reasons for discontinuation, and protein-calorie malnutrition (PCM) at time of NST consultation. A total 120 of 586 patients had PN ≤3 days. PN was clearly indicated in 94 cases: 27 patients received home PN but resolved the need for admission, 11 were admitted to later discharge on PN, 18 chose alternative/palliative care soon after starting PN, and 38 were nil per os for ≥6 days because of ileus, bowel obstruction, or contraindication to enteral feeding. Of the remaining 26 patients, 15 had PCM with poor intake for ≥ 3 days, warranting PN; only nine cases had unclear indications for PN and 11 could have potentially been avoided. Administrative data implied inappropriate PN use, whereas in-depth review confirmed appropriate prescription in most patients. Reducing short-duration PN in the management of ileus or obstruction remains difficult because of variable time to symptom resolution. In-depth chart review remains the best method to assess appropriateness of PN use.

Synchronous resection of primary colorectal cancer with liver metastases: two birds with one stone?

About one in every five patients with colorectal cancer presents with liver metastases at the time of diagnosis1. Logically, the mode of presentation drives the sequence of intervention. In patients with an urgent presentation and complications from the primary tumour, the management of intestinal obstruction, perforation or bleeding dictates treatment. Even if the acute episode is managed non-surgically, for example with use of a colonic stent for obstruction, the likelihood of advanced T category or node positivity of the primary tumour suggests that systemic chemotherapy should be the preferred treatment after resolution of the urgent issue2. Contrast-enhanced MRI of the liver and contrast-enhanced CT of the thorax after treatment of the emergency situation should be considered to document the extent of disease at baseline and before commencement of systemic chemotherapy. Patients with colorectal cancer and synchronous liver metastases may also present with either an asymptomatic or minimally/moderately symptomatic primary tumour. Should staging show metastases in more than one organ (in the context of liver metastases, this typically represents additional lung metastases), both North American and European oncology guidelines2,3 advocate systemic chemotherapy as first-line treatment. Thus, it is in the subset of patients with colorectal cancer and synchronous liver-limited metastatic disease with an asymptomatic presentation that synchronous surgery (resection of primary and liver metastases at a single operative procedure) is an option. In this setting, the practical management question of how to select patients for synchronous rather than staged surgery (resection of bowel tumour followed by hepatic resection) is an active issue (Fig. 1).

Diagnosis and management of intestinal obstruction during pregnancy

Acute intestinal obstruction in pregnancy is a rare, unusual, and very challenging non obstetric surgical pathology linked with great fetal-maternal morbidity and mortality. It is estimated that a surgeon may encounter and resolve 1 to 2 cases in his career. Bowel obstruction is difficult to diagnose because signs and symptoms such as pain, vomiting, abdominal distention, and constipation are frequently attributed to normal pregnancy. On the other hand, gravidity requires immediately, in case of suspicion of grave abdominal pathology, such as bowel obstruction, that surgery should not be delayed.

Epidemiology and causes of intestinal obstruction in Ethiopia: A systematic review.

Objective:This systematic review was aimed to address the prevalence and causes of intestinal obstruction in Ethiopia.Methods:Systematic searches were conducted on PubMed, EMBASE, CINAHL, Scopus, African Journals Online, HINARI, and other supplementary sources, including Google Scholar. We conducted methodological quality assessments for the articles by employing a critical appraisal checklist of Joanna Briggs Institute.Results:The reported prevalence of intestinal obstruction in Ethiopia ranges from 18.6% to 50.7% among patients with acute abdomen. However, the prevalence varies from 4.3% to 34.6% among total surgical admissions. The leading causes of small intestinal obstruction were small bowel volvulus, intussusception, and adhesion. Sigmoid volvulus was the most commonly reported cause of large intestine obstruction, followed by colonic cancer.Conclusion:The highest reported prevalence of intestinal obstruction in Ethiopia was 50.7% among patients with acute abdomen and 34.6% among surgical admissions. Small intestine volvulus and sigmoid volvulus were the common causes of small and large bowel obstructions, respectively. Therefore, clinicians have to consider the common causes during the diagnosis and management of intestinal obstruction.

A Rare Case Report of Idiopathic Abdominal Cocoon Presenting as Acute Intestinal Obstruction-Management Challenges

The idiopathic variant of sclerosing Intraperitoneal fibrosis is a rare pathological entity causing intestinal obstruction. Even though it is described since the beginning of the last century, we are still clueless about the aetiology of this problem. The presentation is often confusing and the clinical and laboratory values will be not confirmatory to establish a diagnosis. A Contrast-enhanced CT scan is a vital investigation of choice. Here we discuss a case of intestinal obstruction with a preop diagnosis of internal herniation, which turned out to be a case of massive intraperitoneal fibrosis. The histopathology was not significant, and no secondary cause was identified. The case report throws wisdom into the existence of this entity and how with a CT scan we can suspect it before surgery. With adequate and meticulous enterolysis we can surgically rehabilitate these patients so that they can lead a normal life.

Computed tomography in intestinal obstruction: a tertiary care perspective from Northern India

Background: Intestinal obstruction is a very common surgical emergency faced today in surgical ERs (emergency rooms) all around the globe. With the advent of newer technology, management of intestinal obstruction has changed significantly. Today computed tomography (CT) employs both intravenous as well as oral contrast for determining the cause and the level of obstruction. It also gives additional information regarding any malignancy causing the obstruction, its staging and status of vessels. Thus, a surgeon can go in the procedure with a plan already in mind which can be discussed in detail with experienced surgeons beforehand.Methods: This was a prospective observational study that was done in department of surgery at GMC Jammu over a period of two years. Patients of intestinal obstruction who presented to our department were enrolled in this study. They were subjected to a contrast enhanced CT after due preparation and managed accordingly. Data was recorded in a tabulated fashion and evaluated.Results: After implementing the exclusion criteria’s, a total of 163 patients were included in this study, majority being males in the age group of 20-40 years. Major cause of intestinal obstruction was attributed to post-operative adhesions followed by band obstruction due to various cause. CT findings were seen to be quite significant in evaluation and management of intestinal obstruction. About 30 % of the patients enrolled in our study were treated conservatively while 70 % required operative intervention in form of exploratory laparotomy.Conclusions: Computed tomography is widely available now a days at a cheaper cost. It greatly increases the armamentarium of the surgeon in dealing with this condition. A lot many cases today are dealt conservatively due to high utilisation of CT scan. It also helps the surgeon to preoperatively plan a proper surgical approach

Outcomes of management of intestinal obstruction at an urban tertiary hospital in sub Saharan Africa: a cross-sectional study

BackgroundIntestinal obstruction (IO) is a common cause of acute abdomen globally, it remains challenging as it increases surgical financial expenditure while also causing major morbidity. Clinically it presents with nausea, vomiting, colicky abdominal pain and cessation of bowel movements or passage flatus and stool. Diagnosis, especially in resource limited settings, can be clinical but is usually confirmed radiologically. We studied the current diagnosis, management and outcomes of IO in Mulago Hospital.Materials and methodsThis was a prospective study done at all the surgical units of Mulago from January to May 2014 to assess general diagnosis and management of IO. Ethical approval was got in line with Helsinki declaration, we used pretested and validated questionnaires to collect data. Informed consent was got with eligible and consenting/assenting patients that fitted the inclusion criteria of age and presenting with suspected intestinal obstruction. Uni-variate and bi-variate variables analysis was done plus measures of association.ResultsWe enrolled 135 patients, excluded 25 and recruited 110 patient. We had more males than females i.e. 71.8% males and 28.2% females. Colicky abdominal pain, abdominal distension, and vomiting were commonest symptoms, then abdominal distension, increased bowel sounds and abdominal tenderness were the commonest signs. Most patients’ (51%) were diagnosed radiologically with a lesser number clinically diagnosed. “Dilated bowel loops” was the commonest radiological sign. Surgery was the main stay of management at 72.7% while 27.3% were conservatively managed. Postoperatively the bowels opened averagely on the 3rd post-operative day (POD) with return of bowel sounds occurring on 5th POD. Most discharges (73%) occurred by the 7th POD. Unfavourable outcomes were prolonged hospital stay followed by wound sepsis (surgical site infection) and then Mortality.ConclusionThis study noted that In Mulago we mostly diagnosed patients radiologically with most surgically managed and which is similar to regional practices. Postoperatively bowel opening happening on third POD with return of bowel sounds on fifth POD. Prolonged hospital stay followed by wound sepsis and then mortality were commonest unfavorable management outcomes.

The diagnosis and management of intestinal obstruction after pediatric liver transplantation.

The aim of this study was to analyze the risk factors, causes, and management of intestinal obstruction after pediatric liver transplantation. Retrospective analysis was performed on pediatric liver transplantation recipients from January 1st 2013 to December 31st 2019 at Organ Transplant Center, Tianjin First Central Hospital. The cases of intestinal obstruction were analyzed. A total of 1034 pediatric liver transplantations were performed during the study period, 66 intestinal obstructions were diagnosed in 61 recipients. Three recipients suffered intestinal obstructions twice, and one recipient suffered three times. Forty of the 66 cases were treated with non-surgical treatment, including fasting, gastrointestinal decompression, purgation, enema, and parenteral nutrition. Surgical intervention was performed in 26 cases. Diaphragmatic hernia, intestinal inflammatory stenosis, PTLD, and intestine perforation are essential causes of intestinal obstruction in pediatric liver transplant recipients. Diaphragmatic hernia was independent risk factors for intestinal obstruction. The 1-, 2- and 3-year survival rate of the recipients with or without intestinal obstruction were 98.4%, 96.5%, 96.5% and 95.3%, 94.4%, 94.0%, respectively, without significant difference. Most cases of intestinal obstruction after liver transplantation in children can be remitted by non-surgical treatment, but there are still some cases need to be treated by surgery. Both measures are related to ideal outcomes, intestinal obstruction does not increase the mortality rate in pediatric liver transplantation.

Management outcome and its associated factors among surgically treated intestinal obstruction cases in Dilla University Referral Hospital, Southern Ethiopia. A cross-sectional study

BackgroundIntestinal obstruction is the most common surgical emergency worldwide. Intestinal obstruction continues to remain a challenge to surgeons despite advances in the field of medicine, surgical technique and accounts for high mortality ranges from 3% to 30% all over the world. ObjectiveThe study aimed to assess management outcome and its associated factors among surgically treated intestinal obstruction cases, at Dilla University Referral Hospital 2020 GC. MethodHospital-based cross-sectional study was conducted on all cases surgically managed for intestinal obstruction, at Dilla University Referral Hospital from November, 1/2016 up to November, 30/2019. Data were collected using a structured questionnaire by trained data collectors. The collected data was checked for its completeness and entered into epidata version 3.1 then exported to SPSS version 26 for cleaning and analysis. The odds ratio along with 95%CI was estimated to measure the strength of the association. Statistical significance was declared at p-value < 0.05. Result258 cases were included in this study. From these, 223 (86.4%) cases have favorable surgical management outcomes of intestinal obstruction. Of 35 cases with unfavorable outcome, the most common postoperative complication occurred was surgical site Infection followed by post-operative pneumonia. A total of 4.7% of postoperative deaths were documented as unfavorable surgical management outcomes. Fever, length of illness, comorbidity, intraoperative bowel condition, bowel resection was done and length of hospital stay after operation were independent significantly associated factors with the surgical management outcome of intestinal obstruction. ConclusionThe unfavorable management outcome of patients with IO who treated surgically at the study area was high. Assessing co-morbidity, fluid resuscitation, administration of prophylactic antibiotics before operation and properly applying infection prevention protocol are some of the activities that need emphasis in intestinal obstruction management.

The Value of Haematological Parameters and Tumour Markers in the Prediction of Intestinal Obstruction in 1474 Chinese Colorectal Cancer Patients.

Intestinal obstruction, a life-threatening problem, often occurs in patients with advanced colorectal cancer (CRC). However, the cause of obstruction is still unknown. Very few prediction models for intestinal obstruction in CRC exist, and their results are unreliable. Therefore, we investigated whether preoperative serum tumour markers (STMs) combined with haematological and biochemical markers could be used as predictors. We retrospectively analysed 1474 patients with CRC who underwent radical resection after admission. Several clinical features, STMs, and serum biochemical and haematological indicators were analysed. Predictors of intestinal obstruction were analysed with univariate and multivariate logistic regression. The accuracy of the multivariate predictors of obstruction was measured by the area under the receiver operating characteristic (ROC) curve (AUC). The Kaplan-Meier method was used to create survival curves. Obstruction was found more in males (62.18%), never-smokers (73.95%), the left colon (54.20%), the tumour diameter > 4.5 cm (55.88%), high differentiation (89.50%), and negative nerve invasion (70.17%). The serum tumour markers (STMs) and peripheral blood routine indexes (PBRI) were significantly associated with obstructive status (p < 0.05). Multivariate analysis demonstrated that the neutrophil and lymphocyte counts, carcinoembryonic antigen, carbohydrate antigen 19-9, carbohydrate antigen 125, albumin, alkaline phosphatase, gamma-glutamyl transpeptidase, total protein, and neutrophil-to-lymphocyte ratio were predictors of intestinal obstruction (p < 0.05). The AUC for the curve with all the eight factors was 0.715 (95% confidence interval: 0.673-0.758). The STMs and PBRI were related to the obstruction status of the patients, and they could be used in combination with other clinical factors to significantly improve diagnosis and management of intestinal obstruction in CRC patients.

Study of clinical presentation and management of intestinal obstruction and its evaluation with respect to morbidity and mortality

Introduction: Intestinal obstruction is one of the common surgical emergencies. Often the patients presenting with intestinal obstruction may be extremely ill and require prompt evaluation and definitive treatment. Aim: The aim of this study was to evaluate the clinical pattern and surgical management outcome of Intestinal Obstruction. Material and Methods: This prospective descriptive study was conducted at Peoples College of Medical Sciences and Research Centre and Hospital during the period from December 2017 to April 2019. The patients presenting with clinical features of acute intestinal obstruction were included in the study after their informed consent. Patients below the age of 14 years were excluded. A predesigned and validated proforma was used to record data. Study group in terms of clinical profile, etiology of obstruction, surgical procedures performed, and the morbidity and mortality of patients was observed. Data was compiled using sheets function and analyzed using SPSS software version 20. Results: A total of 50 patients were included in the study.The mean age of patients was 35.85±10.99 years. The pattern of intestinal obstruction observed in patients was small bowel obstruction, followed by a large bowel obstruction, and the remaining with features of both. The common causes of intestinal obstruction were adhesion and bands, followed by tuberculosis. Adhesiolysis and release of bands were performed in 41%, resection, and anastomosis in 49%. Wound infection was the most common complication observed. A mortality rate of 4% was observed. Conclusion: Small bowel obstruction was the common type of intestinal obstruction. Prompt diagnosis and early surgical treatment after resuscitation is key to favourable treatment outcomes.

Clinical study on the surgical management of intestinal obstruction at a tertiary hospital

Clinical study on the surgical management of intestinal obstruction at a tertiary hospital

A study of surgical management and its outcome in adult patients with intestinal obstruction

Background: Intestinal obstruction (IO) is one of the most common surgical emergencies, for which the therapeutic strategy has evolved progressively. The aim of this study was to assess the etiology, clinical spectrum and the outcome after surgical management of IO in adult patients.Methods: A prospective, observational study was conducted in adult patients admitted for IO and undergoing surgical management. All patients underwent routine haematological investigations, urine examination (routine and microscopic) and ultrasonography abdomen and pelvis. Specific investigations like serum amylase levels, X-ray abdomen and pelvis (supine and erect) and computed tomography scan were done, if indicated. Treatment modality was confirmed once definitive diagnosis of IO was made. All treated patients were observed for postoperative complications. They were followed up after 7 days and one month postoperatively.Results: In this study, the mean age of patients was 45.8 years and 60% were males. The most common cause of IO was found to be postoperative adhesions followed by paralytic ileus. Out of 80 patients of IO, 50 required surgical intervention, majority of which were treated with release of adhesions (38%) and resection anastomosis (44%). Poorer outcomes were observed in cases of malignancy and mesenteric ischaemia. Mortality (14%) was mainly due to complications like septicemia and respiratory tract infection.Conclusions: The commonest cause of IO in our study was postoperative adhesions. Poor outcome of the disease was associated with late presentation to the hospital, which had high incidence of bowel damage with associated faecal contamination of the peritoneum.