Proportion Of Obstruction Research Articles

Proportion of Intestinal Obstruction and Associated Factors Among Patients with non Traumatic Acute Abdomen Admitted to Surgical Ward in Debre Birhan Referral Hospital, North East Ethiopia

Intestinal obstruction (IO) continues to be a major problem for human being since it was first recognized and treated in 350 Before Christ. Different treatment options were developed since then with only minimal reduction in morbidty and mortality. It occurs when the normal flow of intestinal content is interrupted. Intestinal obstruction is the most common causes of emergency surgical admission through out world. It is also one of the major causes of morbidity and mortalities associated with acute abdomen. The proportion and etiologies of intestinal obstruction differ not only from country to country but also with in the different regions of the same country. Knowing proportion of obstruction is very important to manage patients accordingly. Only very few data concerning proportion of intestinal obstruction is found in Ethiopia and none in Debre Birhan. The aim of the study is to assess the proportion of intestinal obstruction and associated factors among patients with non traumatic acute abdomen admitted to surgical ward in Debre Birhan Referral Hospital from December 8,2015 to January 9,2016. Facility based cross-sectional study was conducted by using 357 patient’s record with acute abdomen from December 8,2015 to January 9,2016. Collected data was entered in to SPSS version 20. Adjusted Odds ratio with 95% confidence interval and p-value were used to measure associations. From 357 study subjects 181 (50.7%) and 141 (39.5%) were Intestinal obistruction and acute appendicitis cases respectively with response rate of 99.4%. large bowel obstruction (LBO) accounts for about 109 (60.2%) of cases while 72 (39.8%) of cases were small bowel obstruction (SBO). Male gender, residence and constipation are significantly associated with intestinal obstruction (P<0.05). From all study subjects those who had previous history of constipation were 61 (33.7%), previous history of abdominopelvic operation 25 (7%), previous history of intestinal obstruction 35 (9.8%), hernia 12 (3.4%) and previous history of rectal bleeding 5 (1.4%). Intestinal obstruction is the most common cause for non traumatic acute abdominal admission accounting 50.7%. In the study area Male gender, constipation and urban residence are significantly associated with intestinal obstruction. Postoperative adhesion and garoin hernias were found to be the commonest causes for intestinal obstruction next to Volvulus, but tumor was the rare cause of small bowel obstruction in the study area. Elective repair of hernia should be strengthened before it causes obstruction. Public awareness should be increased on the risk factors of intestinal obstruction through health education to reduce the observed magnitude. Moreover, health facilities and health professionals capable of handling patients with intestinal obstruction should be available with in the reach of the community.

Time-dependent changes in the obstruction pattern during drug-induced sleep endoscopy

PurposeDrug-induced sleep endoscopy (DISE) is used to identify the site of obstruction causing obstructive sleep apnea (OSA). However, previous studies have reported a wide range of DISE findings, and new patterns of airway obstruction have also been observed during postoperative DISE. Therefore, we aimed to determine the features of changes in obstructive patterns during DISE. Materials and MethodsForty-two patients diagnosed with OSA underwent DISE for 25min. Sites of obstruction were determined at the levels of the velum, lateral wall of the oropharynx, tongue base, and epiglottis. The velum obstruction configuration was classified as anteroposterior, lateral, or concentric. ResultsThe obstructive pattern changed in 14 patients (33%). We observed a change in the site of obstruction in 9 patients (21.4%) and in the configuration of velum obstruction in 5 patients (11.9%). The changes occurred between 3 and 22min after commencing DISE (mean, 10.6±6.2min). The proportion of obstructions in the velum, lateral wall of the oropharynx, and tongue base increased with longer DISE durations. The proportion of multiple-level obstructions increased significantly after 15min (P<0.05). In the velum, anteroposterior obstructions in 2 patients and lateral obstructions in 3 patients changed into concentric obstructions. More configurations were observed with longer procedure durations. ConclusionsHence, we assume that it is possible to miss the site of obstruction during DISE if the procedure is too short, which may partly explain the discrepancies between studies.

Manoeuvres used to clear the airway during fibreoptic intubation

Fibreoptic orotracheal endoscopy under general anaesthesia may be more difficult to perform if the upper airway cannot be fully cleared. We have studied the effectiveness of jaw thrust, lingual traction and the application of both manoeuvres simultaneously, in opening up the orolaryngeal airspace in 30 ASA group 1 or 2 patients aged between 16 and 70 yr undergoing elective general surgery requiring orotracheal intubation. Airway clearance was assessed fibreoptically at soft palate level by observing whether or not the uvula or soft palate was apposed to the base of the tongue, and at epiglottic level by observing whether or not the epiglottis was apposed to the posterior pharyngeal wall. Lingual traction with Duval's forceps cleared the tongue away from the uvula and soft palate significantly more times than did jaw thrust (P<0.05). Jaw thrust cleared the epiglottis away from the posterior pharyngeal wall more frequently than did lingual traction (P=0.052). Applying both jaw thrust and lingual traction simultaneously cleared the airway at both soft palate and epiglottic level in every patient. When used alone, jaw thrust and lingual traction fail to produce full airway clearance in a significant number of patients. Combined jaw thrust and lingual traction clears the airway more effectively but requires two assistants.