A Clinical Analysis of Acute Small Bowel Obstruction – A Review of Sixty-four Patients in a Tertiary Hospital

Abstract

Background: Acute small bowel obstruction (SBO) is an ever increasing clinical problem. Successful management depends on comprehensive knowledge of the aetiology and patho-physiology of SBO, familiarity with imaging methods, good clinical judgment, and sound technical skills.
Aim of the Study: To study the incidence, clinical features, and operative findings of small bowel obstruction in a Tertiary Hospital of Kerala.
Materials and Methods: A prospective cross-sectional analytical study was conducted in the Department of General Surgery, Medical College, Kerala, including 64 patients. Inclusion criteria: (1) Patients aged between 18 and 87 years were included in the study. (2) Patients with complaints of vomiting, pain in the abdomen, fever, and abdominal distension were included. (3) Patients who had hernia with recent onset of irreducibility, pain, vomiting, and constipation were included in the study. Exclusion criteria: (1) Patients who were aged below 18 and above 80 years were excluded from the study. (2) Patients with signs and symptoms of subacute intestinal obstruction (IO) and paralytic ileus were excluded from the study. The following data were collected: A detailed record of the patient’s history, physical examination, and necessary investigations such as baseline, X-ray abdomen erect and supine in all cases, and ultrasound abdomen was recorded based on the requirement for each case. The pro forma was used to record the age, sex, and symptom duration, past surgical and medical history of all patients. All patients were subjected to surgery as their clinical presentation was of acute nature. The patients were stabilized from shock, fluid-electrolyte imbalances, and nasogastric aspiration before taking them to the operation theater. All the patients were followed postoperatively for 2–4 months from the time of discharge. The events of post-operative period and complications were noted and tabulated. All the data were analyzed using standard statistical methods.
Observations and Results: A total of 64 patients presenting with acute IO were included in the study. Among the 64 patients, there were 49 male (76.56%) and 15 female (23.43%) with a male to female ratio of 3.26:1. The mean age of the patients was 49.36 ± 3.14 years. The youngest patient was aged 19 years and the eldest one was 76 years. It was observed that pain in the abdomen accounted for the most common symptom with 60/64 patients presenting with the symptom, followed by abdominal distension 49/64 (76.56%), vomiting in 43/64 (66.15%), and absent bowel sounds in 28/64 (43.75%) of the patients. Among the causes for small bowel obstruction (50/64), intussusceptions were noted in 13/64 (20.31%), volvulus in 10/64 (15.62%), adhesions in 8/64 (12.50%), hernia in 7/64 (10.93%), appendicitis in 6/64 (9.37%), and intestinal tuberculosis in 6/64 (9.37%) of the patients. Among the large bowel obstructions, volvulus was noted in 7/64 (10.93%), intussusceptions in 4/64 (06.25%), and large bowel tumor in 3/64 (4.68%) of the patients. Paralytic ileus was noted in 10/64 (15.62%) of the patients.
Conclusions: Acute IO is a common surgical emergency requiring timely intervention to reduce morbidity and mortality. Acute IO is more common in small bowel when compared to large bowel. Males are more commonly affected than females. The clinical presentation varies on the level of obstruction and hence the incidence of symptoms varies from study to study. Intussusceptions, volvulus, herniae, and adhesions account for more than 50% of the causes of IO. Laparotomy was the most common means of IO management, while bowel resection and anastomosis were the most common intraoperative procedure. Early recognition and timely intervention are important to prevent the bowel going for gangrenous changes. Mortality increases with the delay in the institution of surgical or medical treatment.