Clinicopathological spectrum of small bowel obstruction and management outcomes in adults - experience at a regional academic hospital complex

Abstract

BACKGROUND: Delay in operative management of small bowel obstruction (SBO) results in increased morbidity and mortality. The objective was to evaluate clinical presentation and treatment outcome of SBO METHOD: Prospective cohort study between 2013-2014. Adult patients presenting with SBO were included. Demographics, clinical details, investigations, operative findings, in-hospital progress and outcomes were documented RESULTS: There were 156 patients (median age 37 [IQR 27-54 years]) with early (44) and delayed (112) presentation. :F ratio was 1.4:1. Common causes of obstruction were adhesions (94; 60.3%) and hernias (31; 19.9%). Non-operative management was feasible in 59 patients (37.3%) with a success rate of 71.2%. Nonviable bowel was present in 45.1% (early 31%, delayed 50%; p = 0.078). Sixty-one patients (54%) underwent bowel resection; nine patients (20.5%) in the early presentation group and 52 (46.4%) in the delayed group (p = 0.003). Thirty-one patients needed ICU admission (early 5, delayed 26; p = 0.091). The delayed group had longer ICU stay (p = 0.018) and longer hospital stay (p < 0.001). There were more complications (p = 0.084) and re-laparotomies (p = 0.156) in the delayed group. Eight patients died (5.1% CONCLUSION: The main causes of SBO were adhesions and hernias. Late presentation was associated with higher resection rate, higher critical care admission and longer hospital stay Keywords: small bowel obstruction, adhesive bowel obstruction, acute abdomen

Systematic review protocol of aetiology of mechanical bowel obstruction in low-and-middle income countries: Has anything changed in the last two decades?

“…This surgical pathology poses a significant challenge, especially in low- and middle-income countries (LMICs), where the majority of patients are seen in secondary care settings. The associated morbidity and mortality are notably higher in LMICs, reaching reported rates of 5–13.5% [ 3 , 5 , 6 ]. Recognizing the diverse causes of mechanical bowel obstruction is essential for timely and accurate diagnosis, ensuring appropriate therapeutic measures are undertaken.…”

“…The majority of these cases (more than two-thirds) are mechanical small bowel obstructions [2], characterized by a sudden onset of symptoms such as vomiting, abdominal pain, distension, and constipation. Prompt diagnosis and treatment are crucial, as delayed intervention may lead to strangulation and/or gangrene [1][2][3][4][5]. This surgical pathology poses a significant challenge, especially in low-and middle-income countries (LMICs), where the majority of patients are seen in secondary care settings.…”

Systematic Review Protocol of aetiology of mechanical bowel obstruction in Low-and-middle income countries: Has anything changed in the last two decades?

“…Mechanical bowel obstruction is an obstruction to the forward movement of bowel contents caused by a variety of causes and is characterised by a combination of the sudden onset of vomiting, abdominal pain, distension and constipation, with a high likelihood of strangulation and/or gangrene if not diagnosed and treated promptly (1)(2)(3)(4)(5) Therefore, this disease tends to be associated with high morbidity and mortality, especially in low-and-middle-income countries (LMICs) where the majority of patients are seen in secondary care settings. Several papers have reported a mortality rate of 5-13.5% associated with this mechanical obstruction, which is higher in LMICs (3,5,6). Preventing this mortality requires an up-to-date understanding of the common causes of this surgical pathology so that surgeons and trainees can make a correct and timely diagnosis and take appropriate therapeutic measures.…”

“…Whether there has been a change in this trend in LMICs is a matter of speculation in the surgical community. Although there are international empirical studies that have evaluated the changing trend in the causes of mechanical bowel obstruction in different countries of the LMICs, the results of these studies are contradictory (2)(3)(4)(5)7,10,11). While some showed that hernia remained the most common cause in LMICs (1,3,4,8), others showed changing patterns towards postoperative adhesions (2,5,11).…”

“…Although there are international empirical studies that have evaluated the changing trend in the causes of mechanical bowel obstruction in different countries of the LMICs, the results of these studies are contradictory (2)(3)(4)(5)7,10,11). While some showed that hernia remained the most common cause in LMICs (1,3,4,8), others showed changing patterns towards postoperative adhesions (2,5,11). As a result, this review intends to draw together the overall body of evidence to guide safe surgical practice.…”