¹Associate Professor, Department of General Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research Melmaruvathur, Tamil Nadu, INDIA.

²Associate Professor, Department of General Surgery, Karpaga Vinayaga Institute of Medical Sciences & Research centre, Chengalpet District, Tamil Nadu, INDIA.

Email: karuppasamy01@yahoo.co.in

RESULTS

During study period, 132 patients underwent surgical management for acute intestinal obstruction. In present study, most common age group was between 51- 60 years (28.03 %) followed by 41-50 years (23.48%) and 31-40 years (17.42 %) age group. Male patients (57.58 %) were more than females (42.43 %).

Table 1: Age and Gender distribution

In present study, most common sign and symptoms were abdominal pain (93.18 %), abdominal distension (83.33 %) and obstipation (81.82 %), tenderness (77.27 %) and vomiting (68.94 %),

Table 2: Sign and symptoms

On erect abdomen X ray, common findings were multiple air fluid levels (83.33 %), dilated bowel loops (74.24 %) and coffee-bean sign (3.79 %).

Table 3: Radiological sign

Common etiologies for surgical management for acute intestinal obstruction in present study were intra-abdominal adhesions (52.27 %), incisional hernia (12.12 %), abdominal tuberculosis (11.36 %) and sigmoid volvulus (5.30 %).

Table 4: Etiology

Adhesiolysis + Resection Anastomosis (52.27 %) was most common surgical procedure followed by herniorrhaphy (16.67 %) and resection anastomosis (9.85 %).

Table 5: Surgical management

In patients underwent surgical management for acute intestinal obstruction in present study, common complications noted in post-operative period were wound infection (10.61 %), Sepsis (8.33 %), urinary tract infection (6.06 %), burst abdomen (5.3 %) and basal atelectasis (3.03 %). In present study 8.33 % mortality was noted. Age > 60 years, malignancy, major surgeries were common among patients could not survived.

Table 6: Post-operative complications

DISCUSSION

The common symptoms of acute intestinal obstruction are nausea, vomiting, abdominal pain with distension and obstipation. Acute intestinal obstruction is usually diagnosed clinically aided by radiological investigations, and in some cases diagnostic laparoscopy. Adhesions and bands form the most common causes for small intestinal obstruction: up to three fourths of all cases. Peritoneal adhesions are common after laparotomy and are exacerbated by intra-abdominal infection, the tissue ischemia associated with wound closure, external beam radiation, and the inevitable presence of foreign material such as sutures.⁶ Although small bowel obstruction can occur any time after laparotomy, the risk is found to be greatest in the first few postoperative years. In study by Deolekar SR et al.,⁷ 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 ischemia. Mortality (14%) was mainly due to complications like septicemia and respiratory tract infection. In study by Junaid Alam et al.,⁸ 263 patients were diagnosed to have acute intestinal obstruction, with males preponderance (66.15%), commonest among 41-50 years, abdominal pain was the most common presenting symptom and abdominal distension was the most common physical finding on clinical examination. The most common radiological finding was multiple air fluid levels seen on X patients, the main cause of obstruction was Ileocecal tuberculosis followed by Adhesions and Bands. Small bowel obstruction was present in 81.36% cases. The most common surgical procedure was segmental bowel resection with end-to-end anastomosis. Wound dehiscence, burst abdomen was the major cause of morbidity. 5.32% mortality rate was reported during post operative period, common in patients with strangulated hernia and increased age. Chakma N et al.,⁹ studied 87 cases of acute intestinal obstruction, common age group affected was 41-50 years, common sex was male, the commonest cause of acute intestinal obstruction in this study was adhesion and band (41.4%) followed by malignancy (26.4%). The other causes of intestinal obstruction are obstructed hernia (9.2%), volvulus (6.9%), stricture (5.7%), ileocecal tuberculosis (3.4%), superior mesenteric artery thrombosis (3.4%). The most common operation performed was adhesiolysis (39%) followed by resection and anastomosis (17.2%) and the most common post-operative complication observed was wound infection (29.9%). The mortality rate was 9.2%. In study by Gadhavi JM,¹⁰ among 60 patients, for management of small bowl obstruction, major surgeries were adhesiolysis (14 patients), resection and anastomosis (8 patients), band release procedure (4 patients), hernia repair (8 patients), resection, hernia repair, volvulus derotation and Mekell’s diverticulectomy was done in 2 patients respectively. For the management of large bowl obstruction colostomy (8 cases), resection and anastomosis (4 cases), intussusception milking (2 cases), volvulus derotation (2 cases) and right hemicolectomy (4 cases for CA ascending colon) were done. Early diagnosis of obstruction, pre-operative preparation, skillful operative management, proper technique during surgery and intensive postoperative treatment carries a grateful result. Although the mortality due to acute intestinal obstruction is decreasing with better understanding of pathophysiology, improvement in diagnostic techniques, fluid and electrolyte correction, much potent anti-microbials and surgical management, but still mortality ranges from 3% for simple obstruction to as much as 30% when there is vascular compromise or perforation of the obstructed bowel.¹¹ The optimal outcome for patients presenting with intestinal obstruction is influenced by several factors, such as whether the obstruction is partial or complete, the presence of ischemic or gangrenous bowel, perforation, duration of symptoms, development in the early postoperative period, the admitting service, and etiology.^12,13 The evaluation of patients with suspected bowel obstruction endeavors not only to confirm the diagnosis but also to determine the need for and timing of surgery.

CONCLUSION

Male, age more than 50 years, abdominal pain, abdominal distension and obstipation were common factors in patients underwent surgical management for acute intestinal obstruction. Common etiologies were intra-abdominal adhesions, incisional hernia, required adhesiolysis + Resection Anastomosis, herniorrhaphy. Age > 60 years, malignancy, major surgeries were common factors among patients could not survived.

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