Clinico-Pathological Profile and Management of Acute Mechanical Small Bowel Obstruction: A Prospective Study

Abstract

Tahir Saleem Khan, Mohd Lateef Wani, Shadab Nabi Wani, Bashir Ahmad Kenu, Arshad Shafi Misgar, Anjum Fazili, Nusrat Shaheen, Hilal Ahamad Khan, Akram Hussain Bijli

Aim: To identify and analyze the clinical presentation, etiopathology, management and outcome of patients with acute mechanical small bowel obstruction. Materials and methods: This is a prospective study of patients admitted with acute mechanical small bowel obstruction between 2001 and 2006. Results: Of the 300 patients included in the study, 296 (98.66%) patients presented with abdominal pain, while distention of the abdomen was the most common physical finding on clinical examination, which was present in 236 (78.66%) patients. Ascaris lumbricoides (44.60%) and adhesions (34.0%) were the most frequent causes of obstruction. 86 patients (28.66%) were managed conservatively and 214 (71.33%) patients were operated on. Simple obstruction was present in 190 (63.33%) patients, while strangulation was present in 110 (36%) patients. Intussusception was the most common etiology associated with non-viable strangulation, which was present in 12/14 patients (85.71%). Enterotomy and adhesiolysis were the most commonly performed operative procedures (28.97% & 14.95% respectively). Superficial surgical site infection was the most frequently noted complication – 84/300 (28.0%). Septicemia was the commonest cause of mortality in our series – 4/300 (1.33%). Conclusion: Abdominal pain and distention of the abdomen are the most common symptoms and physical findings in patients presenting with acute mechanical small bowel obstruction (SBO). Worm (ascaridial) obstruction is the most common cause of obstruction followed by postoperative adhesions. Although all patients were managed conservatively to start with, the operative rate in our series remained very high because it is very difficult to distinguish simple from strangulation obstruction on clinical, biochemical and/or radiological grounds with certainty.