Pattern of intestinal obstruction in Basrah : a prospective study

الملخص EN

Intestinal obstruction remains one of the commonest surgical emergencies, with hernias being electively repaired; adhesive obstruction has emerged as the leading cause of intestinal obstruction in the west, while the obstructed hernia remaining the main cause in developing countries.

This is a prospective study involving 464 patients admitted with intestinal obstruction to the surgical unit in AL-Mawane general hospital, Al-Sadir teaching hospital, Al-Basrah maternity and child hospital and Al-Basrah general hospital during the period between (January 2004- December 2007).

All patients were admitted and thorough careful history, particularly history of previous surgery and examination were done involved the hernial orifice.

Type of treatment, time surgical intervention, operative finding and period of hospital stay were noted.

Most of our patients were attended for postoperative followed up for complications and recording the mortality in the hospital.

The study included 464 patients, their age ranged from 2 days to 75 years.

(Mean 33.8years), and they are more frequent in female 258 patients (55.7%) than male206 patients (44.3%).

Acute onset of presentation was found in 296 patients (63.7%).

Constipation in 419 patients (90%) and abdominal pain in 380 patients (82%) were the main presenting symptoms.

Previous admissions for same complain were reported by 64 patients (13.7%).

History of previous surgery were reported by 71 patients (15.4%), and time interval from previous surgery, varies from one month to (5) years.

Simple obstruction was the most common form of intestinal obstruction (67.7%).

Of all patients included in the study, 288 patients (62%) present with small bowel obstruction and 176 patients (38%) with large bowel obstruction.

The commonest cause of intestinal obstruction was strangulated external hernia in 99 patients (21.3%), intestinal adhesions in 73 patients (15.7%).

The hernia (29.2%) together with adhesions from previous surgery (25.4%) constitute the bulk of causes of small bowel obstruction , while volvulus of sigmoid colon (23.6%)and tumours (22.7%) form the main cause of large bowel obstruction.

Intussusception was the most prevalent variety of intestinal obstruction in child age group (27.2%), followed by hirschsprungs disease (22.2%).

Of strangulated hernia, inguinal hernia was the most frequent type of hernia seen (71.7%).

Surgical intervention was necessary in 409 patients (88.2 %).The period of conservative treatment ranges from 3-14 days, with average (6.3) days.

Post operative complication occurred in 167 patients (40.8%).

The mortality was 6.8 % and it was related to extreme of life, delay in presentation and mismanagements.

The study concluded that simple intestinal obstruction is the commonest type of obstruction, higher rate of strangulated hernia than the rate of obstruction due to adhesions, which is opposite to a typical pattern of developed countries.

Intussusception is the most frequents cause of intestinal obstruction in children, early presentation and diagnosis is the key to reducing morbidity and mortality.