Objective: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and causes of bowel ischemia, necrosis, and perforation. Methods: This is a prospective observational study of adult patients admitted with acute mechanical bowel obstruction between September 2010 and August 2011. Results: Of the 100 patients included in the study, 73 (73%) presented with small bowel and 27 (27%) with large bowel obstruction. Absence of passage of flatus and/or feces (96%) and abdominal distension (92%) were the most common symptoms and physical finding, respectively. Adhesions (51%), incarcerated hernias (14%), Volvulus (14%) and large bowel cancer (12%) were the most frequent causes of obstruction. Sixty-seven patients (67%) were treated operatively and 33 (33%) were treated conservatively. Bowel ischemia was found in 20 cases (20%), necrosis in 13 (13%), and perforation in 3 (3%). Bands and adhesions, hernias, and volvulus, were the most frequent causes of bowel ischemia (65%, 20%, 10%), necrosis (38.46%, 23.08%, 38.46%), and perforation (33.33%, 33.33%, 33.33%). A comparatively higher risk of strangulation was noticed in incarcerated hernias and volvulus than bands and adhesions. Conclusion: Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patient'> with acute mechanical bowel obstruction, respectively. Adhesions, hernias, volvulus and large bowel cancer are the most common causes of obstruction, as well as of bowel ischemia, necrosis, and perforation. Although an important proportion of these patients can be non-operatively treated, a major portion requires immediate operation. Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.
Background: Mechanical bowel preparation (MBP) for elective available colorectal surgical procedure has been practiced as a clinical routine for many decades. However, earlier randomized medical trials (RCTs) and meta-analyses endorse that MBP ought to be deserted earlier than colorectal surgical treatment due to the fact of the futility in decreasing postoperative problems and motility. The new published outcomes from three RCTs evaluating MBP with no MBP in colorectal surgical treatment in 2010 make the updating of systemic overview and meta-analysis necessary. Objectives: The aim of this study is to assess the safety of colorectal surgery without mechanical bowel preparation. Methods: This is an observational study. The study used to be carried out in the admitted patient’s Department of Surgery Rajshahi Medical College Hospital, Rajshahi, Bangladesh. In Bangladesh for the duration of the period from June 2014 to May 2015. Results: This study shows that the according to age of 80 patients aged 20-above 51 years where, 4(10%) were 20-30 years, 10(25%) were 31-41 years, 10(25%) were 41-50 years, 16(40%) were 51 and above years in Group A, and 6(15%) were 20-30 years, 6(15%) were 31-40 years, 13(32.5%) were 41-50 years and 15(37.5%) were 51 and above years in Group B. And 28(70%) were males and 12(30%) were females in group A. And 27(67.5%) were males and 13(32.5%) were females in group B. Conclusions: Mechanical bowel preparation before elective colon and rectal surgery cannot prevent complications like anastomotic leakage, wound infection, intra-abdominal sepsis, abdominal abscess and extra abdominal complications.
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