A study of preoperative predictive factors of strangulation in acute small intestinal obstruction

Abstract

INTRODUCTIONAcute intestinal obstruction is a common surgical emergency with small bowel obstruction being the most common cause accounting for more than 80% of the cases. 1 Obstructed hernias had been the commonest cause for acute intestinal obstruction in the past. In the recent times with increase in the number of laparotomies performed for various reasons, post-operative adhesions has been the most common cause documented.The most critical factor affecting the outcome among these patients is whether obstruction has progressed to the point of strangulation or not. 2The accurate and early recognition of the presence of intestinal strangulation in patients with mechanical bowel obstruction is important to plan an early exploratory laparotomy as delayed diagnosis and intervention can result in higher incidence of postoperative morbidity and mortality. [2][3][4] Although advances in diagnosis and management have reduced the mortality rate of simple intestinal obstruction ABSTRACT Background: Acute small intestinal obstruction is a common surgical emergency where outcomes are often influenced by the presence of strangulation. Identification of criteria which can predict strangulation among patients presenting with acute small intestinal obstruction can help in early decision making regarding management and thereby can ensure better outcomes. A prospective observational study was carried out among 54 patients presenting with acute small intestinal obstruction to document clinically the signs and symptoms which can predict strangulation early along with laboratory parameters and findings on imaging using ultrasound and color doppler. Methods: A delayed presentation beyond 72 hours with bleeding per rectum and fever along with marked tachycardia with hypotension were the significant criteria observed among patients with strangulated obstruction. Results: On laboratory evaluation, leukocytosis with an elevated serum lactate was significant in strangulated obstruction whereas on imaging ultrasound abdomen supplemented with a color doppler proved to be an investigation of choice in predicting strangulation. Conclusions: A combination of clinical, laboratory and imaging criteria can be useful in predicting strangulation among patients presenting with acute small intestinal obstruction thereby ensuring an early surgical intervention and better outcomes.

Predicting Intestinal Ischaemia in Patients with Adhesive Small Bowel Obstruction: A Simple Score

“…Like our study, several previous publications found a significant correlation between II (and/or strangulation and/ or bowel resection) on the one hand, and pain duration before admission [5,15], body temperature [10,16], and WBC [1,5,[16][17][18] on the other hand.…”