Causes and Management Outcome of Small Intestinal Obstruction in Nekemte Referral Hospital, Nekemte, Ethiopia, 2017

Background. Small bowel obstruction is a common and dangerous surgical emergency which is associated with high morbidity and mortality if not managed appropriately and timely. Objective. To determine the causes and management outcome of small bowel obstruction in Nekemte Referral Hospital, Nekemte, Ethiopia. Method. Institution-based retrospective cross-sectional study design was used. Three-year data (from January 1, 2014, to December 30, 2016) were collected from July 1 to August 30, 2017. Data were collected from medical records and checked for any inconsistency, coded, and entered into SPSS version 20 for analysis. Descriptive, binary, and multivariate logistic regression analyses were used. On binary logistic regression analysis, variables with p ≤ 0.25 were selected as a candidate for multivariate logistic regression analysis. The level of statistical significance was set at p ≤ 0.05 . Results. With 100% response rate, records of 211 patients with small intestinal obstruction were retrieved for analysis. One hundred thirty-seven (64.9%) were males. The commonest cause of small bowel obstruction was adhesion (35.1%). More than a quarter (26.5%) participants developed postoperative complications, and wound infection was the commonest postoperative complication (49.2%). A majority (84.8%) of patients improved and were discharged, and the rest 15.2% of patients died. Sex (AOR = 3.98, 95% CI: 1.51–10.52), duration of illness before surgical intervention (AOR = 4.4, 95% CI: 1.69–11.45), level of hematocrit (AOR = 4.25, 95% CI: 1.56–11.57), types of intestinal obstruction (AOR = 3.73, 95% CI: 1.09–12.64), and length of hospital stay (AOR = 4.69, 95% CI: 1.82–12.07) were independent predictors of the management outcome of patients with small bowl obstruction. Conclusion. Small bowel obstruction is a commonly encountered surgical emergency. Adhesion, small bowel volvulus, and intussusception were the leading causes of small bowel obstruction, respectively.

Adenocarcinoma ileum: a rare cause of ileal stricture mimicking intestinal tuberculosis: a case report and literature review

One of the commonest causes of small intestinal obstruction in India is tuberculosis. The terminal ileum and ileocaecal junction are the most common sites of small bowel involvement, and the most common abnormality is short-segment strictures. We report a patient who presented with small intestinal obstruction due to a solitary ileal stricture, but turned out to be a rare condition that can mimic intestinal tuberculosis. A 60-years-old man, with recurrent episodes of pain abdomen for 1 year, presented to our surgical emergency with evidence of small intestinal obstruction. A CT scan revealed a short segment stricture (2.7 cm) in mid ileal loop with luminal narrowing and marked proximal dilation of proximal ileal loops with a few sub centimetric mesenteric lymph nodes. On laparotomy with a suspected diagnosis of intestinal tuberculosis, it turned to be an adenocarcinoma of the ileum- a rare condition that can mimic intestinal tuberculosis. One of the commonest causes of small intestinal obstruction in India is abdominal tuberculosis. However, all cases of small intestinal obstruction are not tuberculosis. Adenocarcinoma of ileum is a very rare entity. This case report shows that a surgeon should have a high index of suspicion in an elderly patient presenting with small intestinal obstruction, with CT demonstrating isolated short-segment small bowel thickening, as it could be a presentation of obstructing type adenocarcinoma of the small intestine.

Laparoscopic correction of midgut volvulus due to malrotation in a patient with Marfans syndrome

This case describes 13-year-old female with Marfans syndrome who presented recurrent small intestinal obstruction which was later diagnosed as acute midgut volvulus due to malrotation after extensive workup. Laparoscopic Ladd’s procedure was performed. Patient had uneventful recovery and discharged on post-operative day five. To best of our knowledge the index case is the first case of laparoscopic ladds procedure in known case of Marfans syndrome.