INTRODUCTION:
Acute intestinal obstruction continued to be a emergency presentation till date. It is one of the gravest emergencies presenting to the surgeon in all aspects. It was said by Berkeley Moynihans in 1926 “when called upon to deal with a case of acute intestinal obstruction the surgeon is confronted with of the gravest and most disastrous emergencies. The patient may be, and often is, a man or woman in the prime of life, in full enjoyment of vigorous health, who, without, warning, is suddenly seized with the most intolerable pain in the abdomen…..”
Physical signs and their interpretation reach very much of importance in the diagnosis. It is one of the emergencies where as quickly as possible we act, the result will be remarkable. This fact was indicated by Sir Heneage Ogilvie that “in the acute abdominal emergencies the difference between the best and worst surgery is infinitely less than that between early and late surgery, and greatest sacrifice of all is the sacrifice of time” more apt in the present context.
AIM OF THE STUDY:
1. To evaluate the common causes of acute intestinal obstruction in this region.
2. To identify the aetiopathogenesis.
3. To evaluate the various modes of presentation.
4. To study the various modalities of treatment in this centre.
5. To evaluate the morbidity and mortality of acute intestinal obstruction.
6. Causes may vary in acute intestional obstruction in different cases.
MATERIALS AND METHODS:
A total of 90 cases of acute intestinal obstruction admitted in all surgical wards, Thanjavur Medical College Hospital, Thanjavur, over a span of 1 year form October 2014 – October 2015. Both men and women more than 15 years of age totaling 60 cases with features of acute intestinal obstruction were chosen. The paediatric patients were not included in this study. The Age, Sex detailed History relevant to the etiology were noted. The characteristic clinical features of acute intestinal obstruction were abdominal pain, vomiting, constipation/obstipation, Abdominal distension and clinical signs including Fever (>37.2C). Tachycardia (>100/mt), Palpable abdominal mass if any were noted.
All the patients were subjected to investigation while resuscitative measures were on progress:
1. Urine – albumin, sugar, 2. Hb%, 3. Blood Grouping with typing, 4. WBC count
5. Blood – urea, sugar, 6. Serum Creatinine, Electrolytes – in cases with severe dehydration. 7. X – ray chest PA view, 8. ECG, 9. Plain X-ray abdomen erect and supine position and results were recorded.
After adequate preoperative preparation, all patients were subjected to surgical procedures appropriate to the condition and preoperative pathology were noted.
The etiological incidence, Sex incidence, Age incidence, incidence of strangulation, value of plain X-ray Abdomen in diagnosis of acute intestinal
obstruction, importance of early treatment were studied.
CONCLUSION:
1. Among the causes of Acute Intestinal obstruction, 78.16% is contributed by Small bowel obstruction and 21.84% by Large bowel obstruction.
2. The major cause of acute intestinal obstruction is still External hernia (48.03%) here. Among this, inguinal hernia alone accounts for 81.82% in total.
3. Even though the inguinal hernia causing obstruction is highly prevalent, the Strangulation rate comes down dramatically to 13.33% (12) cases.
4. Adhesive obstruction accounts for 18.78% in total, of which the Postsurgical adhesion is the major cause.
5. Sigmoid volvulus ranks fourth in etiology of acute intestinal obstruction contributing 9.61%, next only to large bowel neoplasms contributing 10.48%.
6. Sigmoid volvulus contributes to large bowel obstruction accounting for 44 % and Neoplasm contributes to 48 % only.
7. Clinical parameters fail to differentiate between simple and strangulated obstruction exactly.
8. Plain X-ray abdomen is a valuable in the diagnosis of the acute obstruction (73%) and hence it is considered as minimal investigation before surgery.
9. Early surgical intervention and antibiotics has reduced the mortality of the simple bowel obstruction.
10. In Strangulated obstruction, the mortality rate is still significantly more, due to age, associated diseases and late arrival to hospital.
11. Mortality associated with large bowel obstruction is 14% compared to 7.26% with small bowel obstruction.
12. Early diagnosis and early surgical intervention is the key to reduce the mortality
