Outcomes of management of intestinal obstruction at an urban tertiary hospital in sub Saharan Africa: a cross-sectional study

Background Intestinal obstruction (IO) is a common cause of acute abdomen globally, it remains challenging as it increases surgical financial expenditure while also causing major morbidity. Clinically it presents with nausea, vomiting, colicky abdominal pain and cessation of bowel movements or passage flatus and stool. Diagnosis, especially in resource limited settings, can be clinical but is usually confirmed radiologically. We studied the current diagnosis, management and outcomes of IO in Mulago Hospital. Materials and methods This was a prospective study done at all the surgical units of Mulago from January to May 2014 to assess general diagnosis and management of IO. Ethical approval was got in line with Helsinki declaration, we used pretested and validated questionnaires to collect data. Informed consent was got with eligible and consenting/assenting patients that fitted the inclusion criteria of age and presenting with suspected intestinal obstruction. Uni-variate and bi-variate variables analysis was done plus measures of association. Results We enrolled 135 patients, excluded 25 and recruited 110 patient. We had more males than females i.e. 71.8% males and 28.2% females. Colicky abdominal pain, abdominal distension, and vomiting were commonest symptoms, then abdominal distension, increased bowel sounds and abdominal tenderness were the commonest signs. Most patients’ (51%) were diagnosed radiologically with a lesser number clinically diagnosed. “Dilated bowel loops” was the commonest radiological sign. Surgery was the main stay of management at 72.7% while 27.3% were conservatively managed. Postoperatively the bowels opened averagely on the 3rd post-operative day (POD) with return of bowel sounds occurring on 5th POD. Most discharges (73%) occurred by the 7th POD. Unfavourable outcomes were prolonged hospital stay followed by wound sepsis (surgical site infection) and then Mortality. Conclusion This study noted that In Mulago we mostly diagnosed patients radiologically with most surgically managed and which is similar to regional practices. Postoperatively bowel opening happening on third POD with return of bowel sounds on fifth POD. Prolonged hospital stay followed by wound sepsis and then mortality were commonest unfavorable management outcomes.

Diagnosis, Management and Outcomes of Intestinal Obstruction at an Urban Tertiary Hospital in Sub Saharan Africa: a Cross-Sectional Study.

BACKGROUND: Intestinal Obstruction (IO) is among the commonest causes of acute abdomen worldwide and globally it remains a challenge because it is a major cause of morbidity and surgical financial expenditure. Clinically it presents with nausea, vomiting, colicky abdominal pain and cessation of bowel movements or passage flatus and stool. Diagnosis can be clinical but is confirmed usually by radiologic imaging. We studied the current diagnosis, management and outcomes of IO in Mulago HospitalMATERIALS AND METHODS: This was a Prospective Descriptive Study in all the surgical units of Mulago from January to May 2014. Ethical approval was got in line with Helsinki declaration and then a pretested and validated questionnaire was used to collect data. Informed consent was got with eligible and consenting/assenting patients recruited among those patients of all ages and sex presenting with suspected Intestinal Obstruction. Uni-variate and bi-variate of the variables plus measurements of associations were done.RESULTS: We enrolled 135 patients, excluded 25 and recruited 110 patient with more males than females i.e. 71.8% males and 28.2% females. Colicky abdominal pain, abdominal distension, and vomiting were the 3 commonest symptoms with abdominal distension, increased bowel sounds and abdominal tenderness as commonest signs. Majority of the patients were diagnosed radiologically (51%) and the rest (48.2%) clinically diagnosed accounting. “Dilated bowel loops” was the most frequent radiological sign. Return of bowel sounds occurred within 5 days of the POD, while opening of bowels on average, occurred on the 3rd POD. The mean day of discharge was the 5th POD and 73% of the patients were discharged by the 7th Post-Operative Day. The commonest unfavourable management outcome noted was prolonged hospital stay followed by wound sepsis (Surgical Site Infection) and MortalityCONCLUSION: Majority of the patients were diagnosed radiologically (51%). surgical management was done for 72.7% of the cases and 27.3% conservatively managed. Prolonged hospital stay was the commonest unfavorable outcome of management

Ileo Ileo COLIC INTUSSUSCEPTION IN 1 YRS OLD CHILD: A RARE CASE REPORT

Intussusception is a common cause of intestinal obstruction and colicky abdominal pain in the children, particularly infants, the commonest being the ileocolic variety with colocolic variety being a very rare entity. We present a case of colocolic intussusception in a 1-year-old girl. A 1-year-old girl presented with history of colicky abdominal pain since 6 hours and non-passage of stools and flatus since 8 hours.The parents also gave history of 4 episodes of vomiting, vomitus contained food particles. Vomitus was not blood stained, foul smelling or bilious. Intraoperative findings included a polypoidal growth in the descending colon as the leading point with the formation of a colo-colic intussusception. The child was taken up for emergency laparotomy. Intraoperatively ilio-ileal intussception was noted at 2 levels with multiple enlarged mesenteric lymph nodes. The intussceptions were reduced manually. On further exploration of the distal end of bowel, appendix was found to be elongated and inflamed. Appendectomy was done, and the sample sent for histopathological examination.

A rare case: ileo-ileal intussusception with acute appendicitis

The occurrence of intussusception and appendicitis in the same patient has seldom been described in the pediatric population. Authors report a case of two- level ileo- ileal intussusception associated with acute appendicitis. A 2-year-old boy presented with colicky abdominal pain, vomiting and non-passage of stools and flatus since 4 hours. On physical examination, he was irritable and restless. Abdomen was distended, borborygmi was heard on auscultation, ultrasound of abdomen suggested ileocolic intussusception. Emergency laparotomy was performed and an ileoileal intussusception was visualized and was reduced manually. After reduction, appendix was visualized, and it was found to be inflamed and elongated. Appendectomy was performed. Authors present this case because of its rarity in occurrence in a toddler in a rural setup as ours.

Cystic Duplication Cyst of Ascending Colon in an Adult

ABSTRACTGastrointestinal duplication cysts are rare congenital abnormalities that are usually seen in childhood. Colonic duplication cyst is very rare in adults and is usually asymptomatic. We report a 42‑year‑old female with a duplication cyst in the proximal ascending colon who presented with recurrent episodes of colicky abdominal pain. The cyst could be well visualized on colonoscopy and the patient underwent successful right hemicolectomy with ileotransverse anastomosis.

Magnetic Resonance Enterography Findings of Intestinal Behçet Disease in a Child

Behçet’s disease (BD) is a multisystem disorder of unknown aetiology, characterized by recurrent oral ulcers, genital ulcers, uveitis, skin lesions, and pathergy. Gastrointestinal disease outside the oral cavity is well recognized and usually takes the form of small intestinal ulcers, with the most significant lesions frequently occurring in the ileocaecal region. Symptoms usually include nausea, vomiting, colicky abdominal pain, and change in bowel habit and it is not unusual that patients may present late, with life-threatening complications requiring surgery. Diagnosis has been hindered for many years by limitations in imaging the small bowel and it is usually achieved by means of endoscopy and CT of the abdomen. Magnetic resonance enterography (MRE) is a relatively new technique, which has a high diagnostic rate in patients with Crohn’s disease (CD). Although many similarities between CD and intestinal BD have already been described in literature, the role of MRE in the evaluation of intestinal BD has never been defined up to now. We report a case of a 12-year-old female patient with diagnosis of BD who presented at our institution for recurrent colicky abdominal pain and diarrhoea. The patient underwent MRE that demonstrated the gastrointestinal involvement.

Retained enteroscopy capsule in a patient with diaphragm disease

Introduction Diaphragm disease is a rare consequence of small-bowel enteropathy, and usually occurs as a result of longstanding ingestion of non-steroidal anti-inflammatory drugs. DD is characterized by multiple strictures and saccular dilatations leading to symptoms of subacute intestinal obstruction. Often, the diagnosis is made on histological examination after laparotomy and resection of diseased small bowel. Case History Here, we report a case of an elderly female who suffered for many years from chronic, colicky abdominal pain and anaemia due to undiagnosed diaphragm disease. Eventually, she was referred to our surgical team because of a retained enteroscopy capsule. The diagnosis was made after laparotomy and bowel resection. This surgical intervention alleviated chronic symptoms, and the patient remained well at 1-year follow-up. Conclusions This case highlights the difficulty of diagnosing diaphragm disease without laparotomy and bowel resection. A high index of suspicion must be exercised in any patient with chronic, colicky abdominal pain and anaemia together with multiple strictures and saccular dilatations on computed tomography even in the absence of longstanding NSAID ingestion. Moreover, capsule enteroscopy should be avoided as a diagnostic modality of small-bowel disease if computed tomography raises the suspicion of strictures.

A 16-Year-Old Female with Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome is a rare autosomal dominant disorder of hamartomatous polyposis of the gastrointestinal tract, with pigmentation around lips and macules on the buccal mucosa that typically manifests itself as recurrent colicky abdominal pain and intestinal obstruction due to intussusception. Here we report a case of a 16-year-old girl who presented with abdominal pain, vomiting and previous history of laparotomy for intussusception. Multiple well demarcated black pigmented macules on lips, perioral region, buccal mucosa, digits, palms and soles were noted. She was diagnosed as a case of Peutz-Jeghers syndrome and managed conservatively. DOI: http://dx.doi.org/10.3329/jemc.v4i3.20958 J Enam Med Col 2014; 4(3): 184-187