Management and Outcome of Acute Mechanical Bowel Obstruction in a Teaching Hospital

Abstract

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.