Acute mechanical intestinal obstruetion : the problem of diagnosis of strangulation without CT scans

Abstract EN

To assess the possibility of pre-operative differentiation of strangulated and non-strangulated intestinal obstruc¬tion based on clinical; radiological and laboratory features without CT scan, 66 patients with acute bowel obstruc¬tion were studied prospectively.

Forty-nine (74 %) were male, 17 (26 %) female with a wide age distribution.

In 56 (85 %) the small bowel was obstructed, in ten (15 %) the large bowel.

Adhesions were the most common cause of obstruction (36 %), followed by hernias (20 %), volvulus (12 %), intussusception (11 %), malignancies (11 %) and other causes (10 %).

At surgery strangulation, defined as compromise of the blood supply and necessitating resec¬tion of gangrenous bowel, was found in 18 (27 %) of the patients.

Ten patients (15 %) developed complications after surgery and ten patients died, mostly from age and cardiovascular conditions.

Persistent abdominal pain, rebound tenderness, elevated temperature, leukocytosis, and air-fluid levels were considered as possible predictive factors for the pre-operative diagnosis of strangulation but it was concluded that such factors were not sufficiently reli¬able and early surgery was imperative to detect reversible ischemic bowel in strangulated obstruction.