¹Assistant Professor, ^2,3,4Resident, ⁵Professor & HOD, Department of Surgery, Dr D Y Patil University, Pimpari, Pune-411018, INDIA.

Email: nandanvemuri@gmail.com

Table 1: Age and Gender incidence

In present study most common sign and symptoms were abdominal tenderness (89.13 %), abdominal pain (85.87 %), vomiting (83.7 %), abdominal distension (75 %) and constipation (60.87 %).

Table 2: Sign and symptoms

In present study most common etiology noted was adhesive obstruction (41.3 %), obstructed inguinal hernia (27.17 %), incisional hernia (9.78 %) and sigmoid volvulus (6.52 %). Other less common causes were ileocecal tuberculosis (3.26 %), ascending and descending colon growth (3.26 %), rectum/anal canal growth (3.26 %), sigmoid colon growth (2.17 %), internal hernia (2.17 %) and intussusception (1.09 %).

Table 3: Etiology of intestinal obstruction

Adhesiolysis + Resection Anastomosis (44.57 %) was most common surgical procedure followed by herniorrhaphy (36.96 %) and resection anastomosis (15.22 %).

Table 4: Types of surgery operations

Sepsis (15.22 %), urinary tract infection (13.04 %), wound infection (11.96 %), basal atelectasis (6.52 %) and burst abdomen (6.52 %) were common complications noted in post-operative period. In present study 9.72% mortality was noted.

Table 5: Post-operative complications.

DISCUSSION

Clinical presentation of pain, vomiting, distension and constipation, laboratory and radiographic factors should all be considered when making a decision about treatment of bowel obstruction. Late presentation, inadequate preoperative resuscitation and delayed operation have been found to have a significant effect on prognosis.⁵ In present study, most common age group was Most common age group was between 41- 50 years (26.09%) followed by 51-60 years (20.65%) and male predominance (72.83%) was noted. It is consistent with the study conducted by Souvik et al.⁶ and Deshmukh et al.⁷. The aetiological pattern of dynamic bowel obstruction has been reported to vary from one geographical area to another and different parts of the same country. In present study most common etiology noted was adhesive obstruction (41.3 %), obstructed inguinal hernia (27.17 %), incisional hernia (9.78 %) and sigmoid volvulus (6.52 %). Findings of etiology of present study was comparable with other study groups like Thampi et al.⁸ and Gayathri V et al. ⁹ A study conducted by Adhikari S et al.,¹⁰ in eastern India showed that hernias were the most common cause of intestinal obstruction. In study by Priscilla SB et al.,¹¹ large intestine obstruction was found in 17% cases and small intestine obstruction was found in 83 % cases. Obstructed inguinal hernia was the most common cause of acute intestinal obstruction. Arun Katari¹² studied 50 patients, 44% of patients had rebound tenderness and 36% had exaggerated bowel sounds. Postoperative adhesions (36%) was most common cause of intestinal obstruction followed by obstructed hernia (30%) and sigmoid volvulus (14%). Among cases of obstructed hernia (n=14), inguinal hernia (n=8), femoral hernia (n=1), umbilical hernia (n=1) and incisional hernia (n=4) were causes. Junaid Alam et al., studied acute intestinal obstruction in 263 patients, noted males preponderance (66.15%) and commonest age group affected was 41-50 years. Abdominal pain was the most common presenting symptom followed by abdominal distension. Most common radiological finding was multiple air fluid levels seen on Xray abdomen. Main cause of obstruction was ileocecal tuberculosis followed by Adhesions and Bands. Small bowel obstruction was present in 81.36% cases and large bowel obstruction in 18.63% cases. The most common surgical procedure was segmental bowel resection with end to end anastomosis. Most of the cases recovered without any complications (78.32%).Wound dehiscence, burst abdomen was the major cause of morbidity. 5.32% mortality rate was reported. commonly seen in patients with strangulated hernia and increased age. Similar findings were noted in present study. In study by Janga J et al.,¹⁴ incidence of acute intestinal obstruction was 3%, with a M: F ratio of 1.38:1. The commonest age group affected was 31-40 years. Major cause of obstruction was obstructed hernia (36%) followed by adhesions and bands (26%), sigmoid volvulus (12%), TB abdomen (8%) and malignant obstruction (6%). Surgery was the mainstay of treatment, with herniorrhaphy, adhesiolysis and resection - anastomosis being the most commonly performed procedures. Post-operative complications noted were – wound infection (12%), respiratory infection (6%) and prolonged ileus (6%). In the present study of 50 cases, 5 patients (10%) died due to septicemia and MODS. Similar findings were noted in present study. In study by Gadhavi JM.,¹⁵ management of small bowl obstruction was adhesiolysis (n=14), resection and anastomosis (n=8), hernia repair (n=8) followed by resection, volvulus derotation (n=2) and Mekels diverticulectomy (n=2). For the management of large bowl obstruction colostomy (n=8), resection and anastomosis (n=4), intussusception milking (n=2), volvulus derotation (n=2) and right hemicolectomy (n=4). Emergency surgical intervention is considered to be the standard treatment of choice for patients with dynamic (mechanical) bowel obstruction. Majority of patients in this study underwent emergency surgical treatment. One of the many factors affecting the surgical outcome in patients with dynamic bowel obstruction is time interval between duration of onset of bowel obstruction and surgical intervention.¹⁰ Early diagnosis of obstruction, skillful operative management, proper technique during surgery, and intensive postoperative treatment carries a grateful result.

CONCLUSION

Success in the treatment of acute bowel obstruction depends mainly on the early diagnosis and efficient management and treating the pathological effects of the obstruction as much as the treatment of the cause itself. Males are commonly affected mostly during their fifth decade. Intra-abdominal adhesions remains to be the most common cause followed by obstructed/strangulated inguinal hernia.

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