Magnitude, pattern and management outcome of intestinal obstruction among non-traumatic acute abdomen surgical admissions in Arba Minch General Hospital, Southern Ethiopia

Abstract

Background Intestinal obstruction is defined as a blockage or partial blockage of the passage of the intestinal contents. It is a potentially risky surgical emergency associated with high morbidity and mortality. Its pattern differs from country to country and even from place to place within a country. Therefore, this study aimed to find out the magnitude, pattern and management outcome of intestinal obstruction in Arba Minch General Hospital. Methods A retrospective cross-sectional study was conducted in Arba Minch General hospital from January 09, 2015, to November 09, 2018. The data collection period was from December 15, 2018, to February 09, 2019. A simple random technique was applied to select 801 study participants. Then, the required data entered into Epi Info version 7.2.1.0 and exported to the statistical package for the social sciences software package version 20 for analysis. The binary logistic regression analysis has been done to determine crude statistical associations between independent variables and dependent variables. Linearity, Multivariate normality and multicollinearity were checked between independent and dependent variables by using scatter plot and Q–Q plot respectively. Variables with a p-value of less than 0.25 in the binary logistic regression analysis were entered into multivariable logistic regression. Statistical significance factors were identified based on a p-value of < 0.05 and with a 95% confidence interval. Result This study revealed that the overall magnitude of intestinal obstruction was 40.60% with 95% CI (34.95–45.95). The magnitude of unfavorable management outcomes and deaths during the study period were 22.3% with 95% CI (18.00–27.00) and 7.1% with 95% CI (4.00–10.00) respectively. Persistent tachycardia 10.3 (3.28–32.42), Dehydration 13.7 (3.34–56.56), elevated serum creatinine 10.2 (1.89–54.94), gangrenous small bowel volvulus 2.7 (1.27–5.84), ischemic bowel 3.4 (1.17–9.81) and perforated bowl 7.68 (2.96–19.93) were significantly associated with the management outcome of intestinal obstruction. Conclusion and recommendation Intestinal obstruction was the most common among all acute abdomen cases and its management outcome highly associated with dehydration. Adequate early preoperative resuscitation and proper post-operative care with appropriate surgical techniques and wound care with sterile techniques would help to reduce further mortality. This could be achieved by increasing public awareness of health-seeking behavior. Moreover, health facilities capable of handling patients with small bowel obstruction should be available within the reach of the community.

Surgical management outcome and its associated factors among intestinal obstruction patients admitted to adult surgical ward of Wollega University Referral Hospital, Ethiopia

“…This study found that 116 (59.2%) of patients managed for bowel obstruction had favorable management outcome. Although this result is comparable to the result of the study in Turkey (58.1%) [ 22 ], it is lower than the findings of the study done in Nekemte specialized hospital 73.5% [ 10 ], Adama Hospital 75.4% [ 11 ], Asella hospital-75.7% [ 12 ], Arba Minch General Hospital-77.7% [ 13 ], Chiro Hospital-78.7% [ 14 ], Dilla Hospital-86.4% [ 15 ], University of Gondar Comprehensive Specialized Hospital-83.3% [ 16 ], Debre Birhan Referral Hospital-83.3% [ 5 ], 82% in south Wollo Zone Hospitals [ 17 ], 77% in Wolayita [ 18 ], Kenya-86.4% [ 28 ], and India-74% [ 29 ]. The possible reason for the observed discrepancy might be due to the difference in the professionals involved in the surgical management, the difference in the study settings, study period, and population.…”

Surgical Management Outcome and Its Associated Factors Among Intestinal Obstruction Patients Admitted to Adult Surgical Ward of Wollega University Referral Hospital, Ethiopia

“…This study found that − 116 (59.2%) of patients managed for bowel obstruction had favorable management outcome. Although this result is comparable to the result of the study in Turkey (58.1%) [20], it is lower than the ndings of the study done in Nekemte specialized hospital-73.5% [10], Adama Hospital-75.4% [11], Asella hospital-75.7% [12], Adama Hospital-75.4% [11], Arba Minch General Hospital-77.7% [13], Chiro Hospital-78.7% [14], Dilla Hospital-86.4% [15], University of Gondar Comprehensive Specialized Hospital-83.3% [16], Debre Birhan Referral Hospital-83.3% [4], 82% in south Wollo Zone hospitals [17], 77% in Wolayita [18], Kenya-86.4% [26], and India-74% [27]. The possible reason for the observed discrepancy might be the difference in the way the management outcome was operationalized and measured, the difference in the professionals involved in the surgical management, the difference in the study settings, study period, and population.…”

“…In our study, favorable management outcome was affected by gangrenous intraoperative nding. This is supported by the study conducted in Wolayita [18], Asella hospital [12], Arba Minch General Hospital [13], Chiro, Dilla, and Adama hospitals in which patients with viable small bowel volvulus and viable sigmoid volvulus were more likely to have favorable surgical management outcome compared to their counterparts [11,14,15].…”

“…As of pocket studies conducted in different parts of Ethiopia, the prevalence of favorable outcome for bowel obstruction management ranges from 73.5%-86.4% [4,[10][11][12][13][14][15][16][17][18]. The incidence of intestinal obstruction and its surgical management outcome may be affected by different factors.…”

Pattern and management outcome of acute abdomen and review of the role of task-sharing in leku general hospital,sidama,Ethiopia

“…[2][3][4][5][6][7] Bowel obstruction was found the second most common cause of non traumatic acute abdomen in this study which accounted 34.2% of all cases.This nding is in agreement with study done in NRH,TAH and Goba referral hospital.The most common cause of obstruction was found to be SBO and volvulus of small bowel(48.05% from total obstruction and 61.6% from SBO) was the leading cause of SBO.This is in contrast with study in addis abeba,Teklehaimanot general hospital ,Adama general hospital and certain African country study done from Nigeria by Adesunkami which all reported adhesion as frequent cause of SBO.Sigmoid volvulus was the most frequent cause of LBO in agreement with most studies in Ethiopia and other African countries. (1,7,(8)(9)(10)(11)(12)(13)18) …”