A Descriptive study on Conservative Management of Subacute Intestinal Obstruction and Its Outcome in Tirupati

BACKGROUND Intestinal obstruction can be defined as the partial or complete blockage of either the small intestine or large intestine or both, causing failure of intestinal contents to pass beyond the point of obstruction. Subacute intestinal obstruction implies incomplete obstruction. It is characterized by continuous passage of flatus and /or feces beyond 6 -12 hours of the onset of symptoms. We wanted to study the conservative management of subacute intestinal obstruction and its outcome. METHODS Data was collected from patients presenting to outpatient Department of General Surgery, SVRRGGH, Tirupati and emergency with the features of subacute intestinal obstruction during the period of March 2019 to April 2020 were included in the study. RESULTS The incidence is high in patients of age group 41-50 years with Male: Female ratio is 2.1:1. The most common presenting symptom is pain abdomen (92 %), followed by vomiting (84 %). In our study, exaggerated bowel sounds (60 %) are the most common physical finding. The most common cause of obstruction is Postoperative adhesions (36 %), followed by obstructed hernias (22 %). Out of 50 cases, 72 % of cases were managed successfully by conservative management. In the patients who were managed conservatively, most of them are due to postoperative adhesions. In the patients who underwent emergency surgical intervention, 50 % of cases operated on the 2nd day of admission. Most commonly done Surgery include Adhesiolysis (28.6 %), Herniorrhaphy (28.6 %) and Resection and anastomosis (21.5 %). CONCLUSIONS Our study showed that conservative management is successful in about 72 % of patients with subacute intestinal obstruction. Not all the patients attending the emergency ward with features of intestinal obstruction need emergency surgical intervention. Conservative management can be tried in selective cases in patients with SAIO, thereby reducing the rate of negative laparotomies and morbidity and mortality. KEYWORDS Sub-Acute, Intestinal, Obstruction Conservative, Outcome

Download Full-text

Small bowel volvulus: a rare twist in an adult

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20160503 ◽

2016 ◽

Vol 2 (2) ◽

pp. 44 ◽

Cited By ~ 1

Author(s):

Madhuri Barabde ◽

Saurabh Tiwari ◽

Vasant Lavankar

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Surgical Intervention ◽

Rare Condition ◽

Small Bowel Volvulus ◽

Ischemic Bowel ◽

Mechanical Intestinal Obstruction ◽

Emergency Surgical Intervention ◽

Resection And Anastomosis ◽

Primary Small Bowel

<p class="abstract"><span lang="EN-US">Volvulus is a special form of mechanical intestinal obstruction. It is most commonly seen in sigmoid colon. It results from abnormal twisting of a loop of bowel around the axis of its own mesentery. Small bowel volvulus (SBV) is a rare condition even though the incidence in Africa and Asia is high. It is of two types; primary and secondary. It requires emergency surgical intervention; more so as consuming time increases the risk of bowel getting gangrenous. Here is a case of primary small bowel volvulus in an elderly man with evidence of ischemic bowel and perforation who was managed surgically by resection and anastomosis.</span></p>

Download Full-text

CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.3.7 ◽

2017 ◽

pp. 50-55

Author(s):

Duc Luu Ngo ◽

Tu The Nguyen ◽

Manh Hung Ho ◽

Thanh Thai Le

Keyword(s):

Clinical Features ◽

University Hospital ◽

Female Ratio ◽

Tube Obstruction ◽

Level Ii ◽

Study Results ◽

Male Female Ratio ◽

Hospital Patients ◽

Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

Download Full-text

THE PATTERN OF ACUTE INTESTINAL OBSTRUCTION: A HOSPITAL BASED. STUDY..

10.36106/ijsr/8502423 ◽

2019 ◽

pp. 1-3

Author(s):

Sunil Kumar Patanaik ◽

Chaitali Pattanayak*

Keyword(s):

Intestinal Obstruction ◽

Age Groups ◽

Operative Management ◽

Acute Intestinal Obstruction ◽

Common Symptom ◽

Common Procedure ◽

Therapeutic Modalities ◽

Study Results ◽

Obstructed Hernia ◽

Subacute Intestinal Obstruction

BACKGROUND: Intestinal obstruction is a surgical emergency that causes confusion both in the diagnosis and the management. It is related by important disease and mortality. The goal of this study was to classify the etiology, to analyse the methods of performance of acute duodenal obstruction in different age groups, various therapeutic modalities of treatment, to accomplish operative management, anticipate the post-operative complications and outcomes of patients with acute intestinal obstruction. MATERIAL& METHODS: 82 patients of all age groups (except infants) presenting with acute intestinal obstruction were studied between June 2017 and December 2018 in a multispeciality hospital in Eastern India. Patients with history of subacute intestinal obstruction and paralytic ileus were excluded from this study. RESULTS: Males were found to be affected much more than females. Pain abdomen was the most common symptom found in 94% cases followed by distension and vomiting in 86.6% and 68.3% cases respectively. Most common etiology of intestinal obstruction was due to adhesion and bands (40.3%) followed by obstructed hernia (22%) and malignancy (17%). The most common procedure done in intestinal obstruction in present study was release of adhesions and bands (37.8%) followed by resection and anastomosis (26.8%). CONCLUSION: Bowel obstruction continues to be one of the most common abdominal problems faced by general surgeons. Success in the treatment of intestinal obstruction depends largely upon early diagnosis, skilful management and treating the pathological effects of the obstruction just as much as the cause itself.

Download Full-text

A CLINICOPATHOLOGICAL STUDY IN PATIENTS OF ACUTE APENDICITIS AND CORRELATION OF SYMPTOMS WITH DIFFERENT POSITIONS SEEN INTRAOPERATIVELY

10.36106/gjra/4703067 ◽

2021 ◽

pp. 25-29

Author(s):

Sandip Kumar Ghosh ◽

Ajay Halder ◽

Arnab Mishra ◽

Prabir Biswas

Keyword(s):

Acute Appendicitis ◽

Prospective Observational Study ◽

Signs And Symptoms ◽

Vermiform Appendix ◽

Female Ratio ◽

Medical College ◽

Study Results ◽

Male Female Ratio ◽

Recurrent Appendicitis ◽

Pelvic Position

INTRODUCTION: The appendix, another named vermiform appendix (from the Latin ward-appendix means “dangling” + “vermis”+ “form” i.e.-dangling worm-shaped thing) is a diverticulum of caecum and marks the beginning of the colon in the conuence of taenias. The appendix is posteromedially attached to the caecum, about 2cm below the ileocecal junction. Taking into account that often the appendix is a mobile structure, the medical 9 importance of its relative position has been questioned by some authors. In general, however some authors describe a signicant relationship between its location and sign and symptoms of acute appendicitis. OBJECTIVES:1.To study the commonest position of appendix seen intraoperatively among the patients with acute appendicitis present in Emergency and OPD of Burdwan Medical College. 2.To identify the commonest position responsible for of gangrenous appendix and appendicular perforation. 3.To identify various signs and symptoms according to their different anatomical position and correlation with intraoperative ndings MATERIALS AND METHODS: This is a Prospective Observational Study in Burdwan Medical college and hospital ,May 2019 to July 2020 on 100 patients. All willing patients in Emergency and OPD of BMCH with acute and recurrent appendicitis who underwent surgery are included in this study. RESULTS: rd th Appendicitis is commonest during 3 decade (43%) followed by 4 decade (36%).Appendicitis is slightly commoner in females with male: female ratio 1:2.4..The most common position of appendix in our study is pelvic position.

Download Full-text

Non-traumatic intestinal perforation in the regional hospital Borgou of Benin: epidemiological and therapeutic characteristics

International Surgery Journal ◽

10.18203/2349-2902.isj20171145 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1376

Author(s):

Alexandre S. Allode ◽

Francis M. Dossou ◽

Adrien M. Hodonou ◽

Morel Séto ◽

Gaspard D. Gbessi ◽

...

Keyword(s):

Intestinal Perforation ◽

Average Duration ◽

Bowel Perforation ◽

Sub Saharan Africa ◽

Average Hospital ◽

Female Ratio ◽

Acute Peritonitis ◽

Male Female Ratio ◽

Sub Saharan ◽

Resection And Anastomosis

Background: Non-traumatic small bowel perforation is common condition in our income countries. This study aims to determine the pattern of non-traumatic intestinal perforation in our environment.Methods: The demographics, clinical features, relevant investigations, surgery performed and outcome of all the patients confirmed at surgery with intestinal perforation were collected for five years and the data analyzed using version 3.5.1 of Epi Info.Results: Out of the 69 cases involved in this study, there were 46 (66.7%) males and 23 (33.3%) females with a male/female ratio of 2; their mean age was 22.5±13.7 years (range 2 - 68 years). Young people in school constituted 23 (33,34%) of the cases and typhoid intestinal perforation was responsible for 64 (92.8%) cases while ischemic perforation as a result of postoperative flange, strangulated hernia and acute intussusception was responsible in 5 (7.2%) cases. The average duration before presentation in the hospital was 3 days while the average duration between presentation at the hospital and surgery was 2 days. The surgery offered was simple closure after freshening the edges in 35 (50.7%) cases, resection and anastomosis in 28 (40.5%) cases and resection with ileostomy in 6 (8.8 %) cases. The immediate postoperative course was uneventful in 64 (92.8%) case while the mortality was 10 (14.5%). The cause of death was not identified in 3 cases. The average hospital stay was 14.5±12.8 days with extremes of 7 and 55 days.Conclusions: NTIP is relatively common among the causes of widespread acute peritonitis in sub-Saharan Africa and its management remains difficult with high mortality.

Download Full-text

THE PATTERN OF ACUTE INTESTINAL OBSTRUCTION: A HOSPITAL BASED STUDY

10.36106/8502423 ◽

2019 ◽

pp. 1-3

Author(s):

Sunil Kumar Patanaik ◽

Chaitali Pattanayak*

Keyword(s):

Intestinal Obstruction ◽

Age Groups ◽

Operative Management ◽

Acute Intestinal Obstruction ◽

Common Symptom ◽

Common Procedure ◽

Therapeutic Modalities ◽

Study Results ◽

Obstructed Hernia ◽

Subacute Intestinal Obstruction

Download Full-text

Rare case of midgut volvulus with malrotation in an elderly patient

International Surgery Journal ◽

10.18203/2349-2902.isj20195991 ◽

2019 ◽

Vol 7 (1) ◽

pp. 303

Author(s):

Mezhuneituo Raleng ◽

Anant Prakash Pore ◽

Vickey Katheria ◽

Worshim Khamrang ◽

R. S. Wungramthing

Keyword(s):

Elderly Patient ◽

Intestinal Obstruction ◽

Conservative Management ◽

Rare Case ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Midgut Volvulus ◽

History Of ◽

Subacute Intestinal Obstruction

A 70 year old male who was under treatment for lymphoma, presented with a 2 day old history of not passing stool, flatus, associated with vomiting and abdominal distension. Patient was diagnosed as subacute intestinal obstruction and put on conservative management. However since his condition worsen exploratory laparotomy was performed. On laparotomy a midgut volvulus was detected and subsequently de-rotation of small gut was done. Through this paper we would like to stress out the difficulties in diagnosis and the challenges that we faced.

Download Full-text

A CLINICAL STUDY ON VARIOUS PRESENTATION AND MANAGEMENT OF ACUTE INTESTINAL OBSTRUCTION

10.36106/0543029 ◽

2021 ◽

pp. 69-73

Author(s):

Mohit Birla ◽

Heeralal Jakhar ◽

Amit Bagra ◽

Siddhartha Verma

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Bowel Obstruction ◽

Large Bowel ◽

Acute Intestinal Obstruction ◽

Morbidity And Mortality ◽

Abdominal Hernia ◽

Medical Illness ◽

Female Ratio ◽

Study Results

BACKGROUND: The diagnosis and management of patient with intestinal obstruction is one of the more challenging emergency that a general surgeon can come across. With better understanding of pathophysiology, improvement in diagnostic techniques, uid and electrolyte correction, much potent antibiotics and surgical management the complications arising due to late presentation can be limited. AIMS AND OBJECTIVES: To analyze different modes of presentation, various etiological factors of acute intestinal obstruction and to evaluate the different lines of management and its outcome. METHDOLOGY: This study was conducted in M.B Government Hospital attached to R.N.T. Medical College Udaipur. 50 patients fullling the inclusion criteria were part of this study. RESULTS: Intestinal obstruction is more common in the age group of 41-50 years. Male to female ratio is 2.6:1. Small bowel obstruction is more common than large bowel obstruction. Four cardinal features of intestinal obstruction are pain abdomen, vomiting, distension and constipation. Most common etiological factor is postoperative adhesions followed by abdominal hernia. Malignancy as a cause for obstruction is more common in large bowel than small bowel. Most patients were treated by operative procedure in comparison to conservative management; adhesiolysis (14 cases) was carried out commonly. CONCLUSION: Obstruction due to adhesions is increasing in incidence due to increased abdominal & pelvic surgeries. The obstruction due to external hernias is decreasing due to early elective surgeries. The morbidity and mortality depends on the age of the patient, etiology of obstruction, site of obstruction, state of hydration, viability of the bowel, delay in diagnosis and surgical intervention and associated medical illness. Early diagnosis of possible strangulation will markedly decrease morbidity and mortality.

Download Full-text

ACUTE INTESTINAL OBSTRUCTION IN CHILDREN DUE TO ROUND WORMs.

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2012.2.2.153-158 ◽

1969 ◽

Vol 2 (2) ◽

pp. 153-158

Author(s):

Ajmal Khan ◽

Samiullah ◽

Manzoor Ali ◽

Saifur Rehman

Keyword(s):

Intestinal Obstruction ◽

Surgical Intervention ◽

Iliac Fossa ◽

Abdominal Ultrasound ◽

Acute Intestinal Obstruction ◽

Ultrasound Finding ◽

X Rays ◽

Female Ratio ◽

History Of ◽

Per Oral

Objective: To know about the various presentations and management of acute intestinal obstruction due toworms in children.Design:An observational studyPlace and duration of study: This study was conducted at the saidu teaching hospital Swat, from Jan 2010to December 2010.Material and method: Total 118 children were included in the study. The necessary work up was carriedout. 68 children (patients) were treated conservatively. 50 Patients were operated upon as there was noimprovement with conservative treatment.Result: 118 children were studied, 70 male 48 female (ratio of 1.4:1). Abdominal pain was the leadingsymptom in all patients. 108 patients (91%) presented with abdominal distention. Vomiting present in 88patients (74%). History of worms pass per rectally or in vomits in 99 patients (84%). 73 patients (62%)presented with absolute constipation. 54 patients (45%) attend the OPD with pain in right iliac fossa. 03(2%)patients presented with jaundice. Low hemoglobin level was observed in 89(75%) patients, deranged LFTsin 03(2%), air fluid levels in 91 (77%) patients on abdominal X-Rays, abdominal ultrasound finding weresuggestive of acute intestinal obstruction in 77(65%) patients. All patients were treated conservatively, bykeeping nil per oral, nasogastric decompression, IV antibiotics, fluids, kleen enema per rectum. 68 patient(57%) improved with conservative treatment. While surgical intervention was carried out in 50 patients(43%). Mean hospital stay for conservatively treated patients were four days, while for surgically treatedpatients it ranged from 7-12 days. Morbidity were noticed in 7 operated patients (8.26%), 4 patients withparalytic ileus and 3 patients with wound infection. Three patients died among the surgically treatedpatients, mortality is 2.5% in our study.Conclusion: Acute intestinal obstruction due to round worms, can be treated conservatively but if noresponse, then surgical intervention must be planned.

Download Full-text

Intestinal obstruction in cystic fibrosis: a surgeon’s perspective

International Surgery Journal ◽

10.18203/2349-2902.isj20183712 ◽

2018 ◽

Vol 5 (9) ◽

pp. 2948 ◽

Cited By ~ 1

Author(s):

Ayodeji Odofin

Keyword(s):

Cystic Fibrosis ◽

Intestinal Obstruction ◽

Small Bowel Resection ◽

Term Outcome ◽

Female Ratio ◽

Acute Presentation ◽

Post Surgery ◽

Tertiary Teaching ◽

Male Female Ratio ◽

Effective Option

Background: Distal intestinal obstruction syndrome(DIOS) is one of the commonestgastrointestinal manifestation of Cystic Fibrosis. It occurs as a result ofimpaction of mucofeculent material in the ileocaecum and ascending colon. Themedical management is effective in the chronic presentation, but the optimummanagement in the acute presentation is still a grey area.The aim of this study is to retrospectively follow up patients presenting withfeatures of DIOS who had surgical resection of the ileocaecum to assess thelong-term outcome in terms of recurrence of symptoms.Methods: Case notes of eight patients presenting with features of acute DIOS between 2000 and 2006 were retrieved from the Cystic fibrosis unit of a tertiary teaching hospital and analysed.Results: Eight patients were included in this study, male: female ratio of 5:3age range: 18-24. Acute presentation: 6, elective presentation:2. The mainpresenting features were abdominal pain, constipation, vomiting and RIF mass.Six patients had ileocaecectomy; one had a small bowel resection and one anextended right hemicolectomy.Six patients had no further symptoms of DIOS four years post-surgery, two hadfurther symptoms with one requiring further surgery.Conclusions: Ileocaecal resection in patients presenting with acute DIOS is aviable and effective option in management.

Download Full-text