A Descriptive Study of Clinical Presentation, Etiology and Management in Acute Mechanical Bowel Obstruction

Background: Acute mechanical bowel obstruction is a common surgical emergency and a frequently encountered problem in abdominal surgery. It constitutes a major cause of morbidity in hospitals around the world and a significant cause of admissions to emergency surgical departments. Intestinal obstruction belongs to highly severe conditions, requiring a quick and correct diagnosis as well as immediate, rational and effective therapy. Method: This is a prospective observational study which was carried on 130 patients of abdominal obstruction in the department of general surgery Sawai Man Singh Hospital Jaipur. Results: The majority of patients in our study were 31-40 years of age group. Mostly patients were male account about 86.15%. Pain abdomen was the most frequent presenting symptoms (95.38%) and absence of passage of flatus and feces was next complain (89.23%). Nausea and vomiting was present in 84.62% of patients. Abdominal tenderness was the most common physical finding on clinical examination (96.92%). Abdominal distension was present in 81.54% patients. Adhesions and bands were the most prevalent etiology of obstruction in the small bowel obstruction (58.45%) and tumour and volvulus were the most common etiology in the large bowel (12.31%). Conclusion: Intestinal obstruction is most commonly caused by intra-abdominal adhesions, Koch’s abdomen, malignancy and obstructed hernia. Conservative treatment with bowel rest and fluid resuscitation is successful in a variable proportion of patients. Patients with clinical degradation on assessment and radiological scans evoking ischemia or strangulated bowel obstruction need urgent surgery. Keywords: Bowel Obstruction, Pain, Adhesions, Tumour.

Download Full-text

A clinical study of surgical management of acute intestinal obstruction

International Surgery Journal ◽

10.18203/2349-2902.isj20184085 ◽

2018 ◽

Vol 5 (10) ◽

pp. 3342

Author(s):

Gayathri V. ◽

Praveen Mali ◽

Harindranath H. R.

Keyword(s):

Intestinal Obstruction ◽

Bowel Obstruction ◽

Acute Intestinal Obstruction ◽

Emergency Laparotomy ◽

Hernia Surgery ◽

Number Of Patients ◽

General Surgeons ◽

Mechanical Bowel Obstruction ◽

The Common ◽

Obstructed Hernia

Background: Mechanical bowel obstruction remains one of the most common intra-abdominal problems faced by general surgeons in their practice and continues to be a major cause of morbidity and mortality.Methods: This retrospective study was carried out on data obtained from 50 patients who underwent emergency laparotomy for acute intestinal obstruction in Victoria and Bowring and Lady Curzon Hospital from January 2016 to December 2016.Results: Adhesions (26%) were found to be the most common cause followed by obstructed hernia (22%). The common age group was 51-60 years. The commonest symptom was abdominal pain followed by vomiting and constipation. The average duration of presentation was 2 days. Strangulation was found in 20% of cases. Mortality rate in the study was 16%.Conclusions: In conclusion, we have found that adhesions are becoming an ever-increasing underlying cause of bowel obstruction. A trend of elective hernia surgery has reduced the number of patients of hernias presenting with obstruction of bowel.

Download Full-text

SMALL BOWEL OBSTRUCTION SECONDARY TO OBTURATOR HERNIA: A PRE-OPERATIVE DIAGNOSIS AT COMPUTED TOMOGRAPHY

Journal of Clinical and Health Sciences ◽

10.24191/jchs.v6i1.8868 ◽

2021 ◽

Vol 6 (1) ◽

pp. 46-49

Author(s):

Marlina Tanty Ramli ◽

Mohd Shukry Mohd Khalid ◽

Kartini Rahmat

Keyword(s):

Computed Tomography ◽

Small Bowel ◽

Elderly Patients ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Surgical Intervention ◽

Obturator Hernia ◽

Uneventful Recovery ◽

Presenting Symptoms

Obturator hernia is rare, but it must be considered in elderly patients who present with small bowel obstruction. The diagnosis is challenging unless there is a high index of suspicion as the presenting symptoms and signs are usually non-specific. Presence of positive Howship-Romberg sign is considered pathognomonic. Early diagnosis and rapid surgical intervention will reduce the high morbidity and mortality associated with undiagnosed obturator hernia. We report a case of a 93-year-old female patient who was admitted to our surgical department with symptoms of intestinal obstruction of 3-days duration. Howship-Romberg sign was negative. Computed tomography (CT) demonstrated the presence of left obturator hernia with proximal small bowel obstruction and no sign of strangulation. The patient had emergency laparotomy post-CT where the incarcerated bowel loop was released and the obstructed bowel was decompressed without any complication. The hernial defect was close with a mesh and the patient had an uneventful recovery post-surgery. In this case, we highlight that diagnosis of obturator hernia must always be considered in elderly patients who present with intestinal obstruction. Urgent CT could establish a rapid pre-operative diagnosis and aids inappropriate surgical intervention planning which is crucial in optimising the outcome.

Download Full-text

TOURNIQUET APPENDIX: RARE ETIOLOGY OF ORGANIC ACUTE INTESTINAL OBSTRUCTION

International Journal of Advanced Research ◽

10.21474/ijar01/13334 ◽

2021 ◽

Vol 9 (08) ◽

pp. 834-836

Author(s):

Bicane Ma. ◽

◽

Malaaynine Mf. ◽

Rabbani K. ◽

Louzi A. ◽

...

Keyword(s):

Acute Appendicitis ◽

Intestinal Obstruction ◽

Bowel Obstruction ◽

Paralytic Ileus ◽

Rare Case ◽

Acute Intestinal Obstruction ◽

Ileal Loop ◽

Surgical Emergency ◽

Mechanical Bowel Obstruction

Acute appendicitis is the most common surgical emergency. A bowel obstruction due to the appendicitis is in most cases functional with a paralytic ileus mechanical bowel obstructions are rare or exceptional. We describe a rare case of a mechanical bowel obstruction due to a strangulation of the last ileal loop by the appendix.

Download Full-text

Laparoscopic Treatment of Gallstone Ileus

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s16512 ◽

2014 ◽

Vol 7 ◽

pp. CCRep.S16512 ◽

Cited By ~ 9

Author(s):

Huseyin Y. Bircan ◽

Bora Koc ◽

Umit Ozcelik ◽

Ozgur Kemik ◽

Alp Demirag

Keyword(s):

Intestinal Obstruction ◽

Bowel Obstruction ◽

Intestinal Tract ◽

Rare Complication ◽

Gallstone Ileus ◽

High Morbidity ◽

Enteric Fistula ◽

Laparoscopic Treatment ◽

Mechanical Bowel Obstruction ◽

Biliary Enteric Fistula

Gallstone ileus is a rare complication of cholelithiasis that has high morbidity and mortality. An intestinal obstruction can be caused by migration of a large gallstone through a biliary enteric fistula or by impaction within the intestinal tract. In this study, we present the case of an 81-year-old woman with a mechanical bowel obstruction by a gallstone that was treated by laparoscopy.

Download Full-text

A study of forty eight patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome

International Surgery Journal ◽

10.18203/2349-2902.isj20203056 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2563

Author(s):

Himanshu Gupta ◽

Sumikesh Anand

Keyword(s):

Intestinal Obstruction ◽

Surgical Management ◽

Surgical Intervention ◽

Secondary Data ◽

Hand Surgery ◽

Abdominal Distension ◽

Favourable Outcome ◽

Unfavorable Outcome ◽

Presenting Symptoms ◽

Adequate Care

Background: Intestinal obstruction is defined as obstruction of the passage of the intestine for its contents. Successful conservative treatment may leave adhesions that could cause recurrence; on the other hand, surgery may be the source of new adhesions like any other abdominal surgery. Hence, the present study was undertaken for assessing the 48 patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome.Methods: Of a total of 48 patients with ilecoceacal masses who presented with intestinal obstruction and underwent surgical intervention for the same. Surgical management outcome was classified as “favorable” or “unfavorable” outcome according to the retrospective secondary data extracted from their medical records. Unfavorable outcome was considered if the patient died or has one or more postoperative complications. Favorable outcome was considered if the patient was discharged alive and does not have any history of postoperative complications.Results: Abdominal pain, abdominal distension, vomiting and failure to pass faeces were the prominent presenting symptoms among intestinal obstruction patients. Favourable outcome was seen in 76 percent of the patients while unfavourable outcome was seen in 24 percent of the patients. Mortality occurred in 6 patients. Prolonged ileus was found to be present in 1 patient. Failure to wean from ventilator for more than 48 hours was seen in 2 patients. Conclusions: Surgical management had high efficacy of more than 75 percent in managing patients with intestinal obstructions. With precise technique and adequate care, complication rate can be reduced.

Download Full-text

Intestinal Obstruction: An Overview of Aetiology, Evaluation and Management

Journal of Surgical Sciences ◽

10.3329/jss.v17i2.43783 ◽

2019 ◽

Vol 17 (2) ◽

pp. 89-95

Author(s):

ABM Khurshid Alam ◽

Kazi Lsrat Jahan ◽

Mohammad Ali

Keyword(s):

Intestinal Obstruction ◽

Clinical Symptoms ◽

Abdominal Distension ◽

Initial Study ◽

Abdominal Adhesions ◽

Radiologic Imaging ◽

Vascular Compromise ◽

Intestinal Decompression ◽

Bowel Rest ◽

Bowel Decompression

Intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often depend on the level of obstruction. Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal herniation. The clinical presentation generally includes colicky abdominal pain, vomiting, abdominal distension and constipation. Radiologic imaging can confirm the diagnosis. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention. Journal of Surgical Sciences (2013) Vol. 17 (2): 89-95

Download Full-text

Intestinal Obstruction Caused by Persimmon Bezoar: A Case Report

International Surgery ◽

10.9738/intsurg-d-14-00269.1 ◽

2015 ◽

Vol 100 (7-8) ◽

pp. 1194-1198 ◽

Cited By ~ 2

Author(s):

Naotake Funamizu ◽

Tomotaka Kumamoto ◽

Atsushi Watanabe ◽

Tomoyoshi Okamoto ◽

Katsuhiko Yanaga

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Abdominal Distension ◽

Dietary History ◽

Japanese Female ◽

Old Japanese ◽

History Of ◽

Patient’S History

Owing to their rare occurrence, persimmon bezoars are often overlooked as a cause of small bowel obstruction. We herein report a small bowel obstruction in a 67-year-old Japanese female who regularly consumed persimmons in autumn. The patient presented to our hospital with typical complaints of abdominal distension with pain for 2 days. Based on the patient's history of a cesarean section 34 years ago, we initially diagnosed her with small bowel obstruction resulting from adhesions and placed an ileus tube. At first, the patient rejected the operation in spite of our recommendation. After 10 days, because the ileus tube was unable to relieve the obstruction, finally surgery was scheduled. Upon releasing the obstruction by partial resection of the small bowel, we found an impacted bezoar without any evidence of adhesions. After stone analysis, we first realized her regular persimmon intake. This case serves as an important reminder to obtain dietary history in order to investigate all possible causes of small bowel obstruction when intestinal obstruction is suspected.

Download Full-text

STUDY OF CURRENT PATTERN OF MECHANICAL INTESTINAL OBSTRUCTION IN ADULTS AT DMCH, LAHERIASARAI, BIHAR

10.36106/ijsr/2027427 ◽

2020 ◽

pp. 46-47

Author(s):

Ravindra Kumar Ravi ◽

Vijay Shankar Prasad ◽

Debarshi Jana

Keyword(s):

Mortality Rate ◽

Intestinal Obstruction ◽

Bowel Obstruction ◽

Case Series ◽

Abdominal Tuberculosis ◽

Clinical Findings ◽

Current Pattern ◽

Female Ratio ◽

Mechanical Intestinal Obstruction ◽

Mechanical Bowel Obstruction

Objective : To evaluate the current pattern of mechanical bowel obstruction in adults. Study design : Descriptive case series. Place & Duration of study : Upgraded Department of Surgery, DMCH, Laheriasarai, Bihar, from March 2019 to February 2020. Methodology : The criteria for diagnosis were on the basis of history, clinical findings, radiological examination, exploration of abdomen and histopathological confirmation in selected cases. Results : A total of 252 surgically treated cases of mechanical bowel obstruction were included. Out of the total, 187 (74.2%) presented with acute and 65 (25.8%) with sub-acute intestinal obstruction. The mean age was 37.4 years with male to female ratio of 2:1. Abdominal tuberculosis was found in 77 (30.6%) patients. Among the other causes bands/adhesions were found in 57 patients (22.6%) and obstructed hernias in 44 patients (17.5%). In 161 patients (64%) the intestinal obstruction was without gut compromise, while in 91 patients (36%) strangulated bowel obstruction was present. Forty patients (15.9%) developed postoperative complications mainly wound sepsis and chest problems in the form of atelectasis and pneumonia. The mortality rate was 2.4% (n 6). Conclusions : Tuberculosis is still the common cause of intestinal obstruction, with overall mortality rate of 2.4% which needs attention.

Download Full-text

COMPUTED TOMOGRAPHY EVALUATION OF BOWEL OBSTRUCTION

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.4.4 ◽

2017 ◽

pp. 29-36

Author(s):

Van Phuong Nguyen ◽

Van Ngoc Cuong Le

Keyword(s):

Computed Tomography ◽

Intestinal Obstruction ◽

Bowel Obstruction ◽

Malignant Lesion ◽

Abdominal Distension ◽

University Hospital ◽

Common Symptom ◽

Surgical Emergencies ◽

Common Causes ◽

Common Sign

Background: Bowel obstruction (intestinal obstruction) is one of the most common surgical emergencies, occurring at all ages and for many reasons. Computed tomography (CT) has great value to diagnosis bowel obstruction, especially to determine the cause of bowel obstruction. Therefore, we conducted this study to investigate the common causes as well as the severe signs of bowel obstruction by CT scan. Materials and methods: The study including 47 patients who have image of bowel obstruction on CT at Hue Central Hospital and Hue University Hospital from April 2016 to May 2017. These variables were included a number of clinical features, the causes and some signs suggesting complications of bowel obstruction. Results: Abdominal pain is the most common symptom while abdominal distension is the most common sign. 72.3% of bowel obstructions occur in the small intestine; the other 27.7% occur in the colon. Adhesion is the most common cause (27.7%), other common causes are: malignant lesion (25.5%), bezoar (12.8%), volvulus (8.5%); 4.3% of cases cannot be found cause on CT image. The most common sign suggesting complications are mesenteric fluid (59.6%). Conclusion: Computed tomography can determine most of causes of bowel obstruction and itcan show complications of bowel obstruction. Key words: bowel obstruction, intestinal obstruction, computed tomography

Download Full-text

THREE CASES OF BOWEL OBSTRUCTION BY BROAD LIGAMENT HERNIA

British Journal of Surgery ◽

10.1093/bjs/znab160.017 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

M Soto Dopazo ◽

E Pérez Prudencio ◽

A Arango Bravo ◽

C Nuño Iglesias ◽

C Mateos Palacios ◽

...

Keyword(s):

Small Bowel ◽

Bowel Obstruction ◽

Broad Ligament ◽

Intestinal Resection ◽

Laparoscopic Approach ◽

Exploratory Laparotomy ◽

X Rays ◽

Intestinal Necrosis ◽

Urgent Surgery ◽

Internal Hernias

Abstract INTRODUCTION Internal hernias caused by broad ligament defects are an infrequent cause of bowel obstruction. These defects may be congenital or acquired mainly by gynecological antecedents. Small bowel is the most common affected and the diagnosis is difficult due to nonspecific symptoms and absences of characteristic radiological signs. MATERIAL AND METHODS We report the cases of three women aged from 43 to 56 years old, who came to the emergency with abdominal pain, vomiting and bloating of hours duration. One patient has a history of laparoscopic appendectomy, the rest of them with no surgical history. In all of the cases, x-rays showed dilatation of small bowel loops and air-fluid levels and the abdominal TC revealed a generalized distention of bowel loops with transition point in the terminal ileum with no identifiable cause compatible with small bowel obstruction. RESULTS We decided to perform an urgent surgery with an exploratory laparotomy in one case and the rest by laparoscopic approach, finding an internal hernia occasioned by incarceration of small bowel through a broad ligament defect. In all cases, the hernia content was liberated without evidence of ischemia with no need for intestinal resection, and the defect was closed. All patients had a favourable postoperative course without complications. DISCUSSION Broad ligament defects are a rare cause of internal hernias. These are difficult to diagnose clinically as well as radiologically for an absence of characteristic signs. A high level of clinical suspicion allows early diagnosis and the treatment should be performed as soon as possible to reduce the chances of intestinal necrosis.

Download Full-text