Dynamic Bowel Obstruction: Aetiology; Clinical Presentation; Management and Outcome at Bugando Medical Centre; Mwanza; Tanzania

Dynamic bowel obstruction is a common and potentially dangerous surgical emergency with high morbidity and mortality worldwide. No prospective study has been done on this subject in our setting. This study was conducted to describe in our region; the aetiology; clinical presentation; management and outcome of dynamic bowel obstruction. Data were analyzed using SPSS software system. A total of 342 patients were studied. Males outnumbered females by a ratio of 2.1: 1. The median age of patients at presentation was 34 years (range 11 to 78 years). Obstructed hernias (32.7) were the commonest cause of dynamic bowel obstruction. Abdominal pain (100) and vomiting (86.5) were the most frequent presenting symptoms. Thirty-one (9.1) patients were HIV positive. Small bowel was the commonest site of obstruction accounting for 89.2 of cases. Herniorrhaphy was the most frequent surgical procedure performed in 112 (32.7) patients. Surgical site infection (38.8) was the most common post-operative complication and it was significantly associated with HIV positivity and low CD 4+ count (p0.001). The overall median of length of hospital stay was 26 days (range 1 to 72 days). Patients who had postoperative complications stayed longer in the hospital and this was statistically significant (p

Neonatal intestinal obstruction in Benin, Nigeria

BACKGROUND:Intestinal obstruction is a life threatening condition in the newborn, with attendant high mortality rate especially in underserved subregion. This study reports the aetiology, presentation, and outcome of intestinal obstruction management in neonates. MATERIALS AND METHODS: A prospective study of neonatal intestinal obstruction at the University of Benin Teaching Hospital, Benin, Nigeria, between January 2006-June 2008. Data were collated on a structured proforma and analysed for age, sex, weight, presentation, type/date of gestation/delivery, aetiology, clinical presentation, associated anomaly, treatment, and outcome. RESULTS: There were 71 neonates, 52 were males and 19 were females (2.7:1). Their age range was between 12 hours and 28 days (mean, 7.9 +/- 2.7 days) and they weighed between 1.8 and 5.2 kg (average, 3.2 kg). The causes of intestinal obstruction were: Anorectal anomaly, 28 (39.4%); Hirschsprung's disease, 8 (11.3%)' prematurity, 3 (4.2%); meconeum plug, 2 (2.8%); malrotation, 6 (8.5%); intestinal atresia, 8 (11.3%); necrotising enterocolitis (NEC), 4 (5.6%); obstructed hernia, 4 (5.6%); and spontaneous gut perforation, 3 (4.2%). Also, 27 (38%) children had colostomy, 24 (33.8%) had laparotomy, 9 (12.8%) had anoplasty, while 11 (15.4%) were managed nonoperatively. A total of 41 (57.7%) neonates required incubator, 26 (36.6%) needed total parenteral nutrition, while 15 (21.1%) require d paediatric ventilator. Financial constraint, late presentation, presence of multiple anomalies, aspiration, sepsis, gut perforation, and bowel gangrene were the main contributors to death. Neonates with lower obstructions had a better outcome compared to those having upper intestinal obstruction ( P < 0.0001).CONCLUSION: Outcomes of intestinal obstruction are still poor in our setting; late presentation, financial constraints, poor parental motivation and lack of basic facilities were the major determinants of mortality

Primary Malignant Tumours of the Small Intestine

Background: Primary malignant tumours of the small intestine are rare. These tumours constitute 1-5 of gastrointestinal tract malignancies despite the high rate of epithelial cell turnover and a large mucosal surface area. Clinical; radiological and endoscopic diagnostic difficulties continue to present challenges to surgeons. Primary malignant tumours cause intestinal obstruction necessitating emergency surgery following which diagnosis is made. The consequences of these are significant delay in diagnosis and finding of advanced tumour at surgery. Aim: This study set out to evaluate the management challenges of small intestinal malignancies and proffer solutions for improved outcome. Method : All the cases of primary malignant tumours of the small intestine were retrospectively reviewed for clinical presentation; diagnosis and outcome of treatment and compared with total gastrointestinal malignancies. Result: Seven patients were seen over a 10 - year period. The M: F ratio was 2.5:1 with an age range of 19-55 years and a mean of 43.3 years. The peak age group was in the 4th decade. Small intestinal malignancies accounted for 14.2 of gastrointestinal malignancies during the period of study. Intestinal obstruction was a common mode of presentation with the finding of advanced tumours at surgery. The most common tumour was adenocarcinoma 4(57.1) followed by lymphoma 2(28.6) and 1 case (14.3) of ileal carcinoid. The ileum was the most common site involved 6 (85.7). Conclusion: Malignancies of the small bowel should be considered in patients with recurrent abdominal pain; mass or intestinal obstruction. Aggressive investigation of patients with non specific abdominal symptomatology aimed at tumour localization and histologic diagnosis is important for early diagnosis and treatment for improved outcome

Spectrum of causes of intestinal obstruction in adult Nigerian patients : general surgery

Objective. To present changes in the cause of intestinal obstruction in an African setting. Design. Consecutive cases of acute intestinal obstruction from 1985 to 1994. Setting. Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria. Subjects. Adult patients with clinical and radiological evidence of intestinal obstruction. Results. There were 99 patients (60 males) aged 15 - 101 years (mean age 45 years). The majority of patients were young and middle-aged adults. Main causes of obstruction included adhesion (N = 44); volvulus (N =15); external hernias (N = 11); colorectal carcinoma (N = 10) and intussusception (N = 8). Approximately twothirds of patients (28/44) with adhesion had had previous abdominal operations. The overall mortality was 14; mainly owing to strangulation obstruction and colonic malignancy. Conclusions. The increasing role of adhesions as a cause of acute intestinal obstruction demands greater need for routine preventive measures against adhesion formation

Volvulus du caecum

Le volvulus du coecum se definit comme etant une plicature ou torsion; aigue ou chronique et recidivante du coecum; entrainant parfois une portion variable de l'ileon et limitee a la zone anormalement mobile du coeco-colon ascendant. Sans defaut d'accolement; le volvulus est impossible. Il s'agit d'une affection rare; de diagnostic difficile. Pourtant; il faut y penser dans le cadre d'une occlusion intestinale en urgence devant le faisceau d'arguments que nous avons developpe. L'interet de ce travail; est d'attirer l'attention sur le diagnostic precoce de cette pathologie et d'instituer un traitement chirurgical adequat afin de guerir le malade. Dans notre cas; le premier patient age de 62 ans; avec antecedent de constipation chronique; diabetique; tabagique admis dans nos services pour douleurs abdominales; vomissements et arret des matieres et des gaz. L'ASP amis en evidence une volumineuse image hydroaerique plus large que haute occupant la totalite de l'hypochondre droit. Une laparotomie exploratrice a ete pratiquee ce qui a permis: *d'identifier un volvulus du coecum necrose avec 20cm d'ileon; presence d'environ 150cc de liquide verdatre; nombreuses fausses membranes. *La seconde patiente avait presente a j 5 post operatoire d'une hysterectomie; une occlusion franche. Son ASP a mis en evidence des niveaux hydroaeriques dissemines et etages. La laparotomie exploratrice a permis. *D'identifier un volvulus d'un coecum mobile autour d'une bride reliant le fond caecal au ligament lombo-ovarien droit associes aux zones necrotiques verdatres perforees. Dans les deux cas; il a ete pratique unS resection large des lesions (amputation colo-coecale; associee aux dernieres anses ileales) suivie d'une anastomose immediate ileocolique termino- terminale. L'evolution a ete fatale pour le premier patient. Les suites operatoires ont ete favorables dans le deuxieme cas et la patiente a ete guerie. Devant toute occlusion intestinale mecanique basse; il faut evoquer en dehors des etiologies frequentes (volvulus du sigmoide; cancers coliques; etc...) le volvulus du coecum. Surtout que l'image caracteristique de I'ASP une image hydroaerique volumineuse qui occupe le coecum et deborde la region mesocoeliaque. Ce faisant; le diagnostic est pose precocement et le traitement entrepris rapidement empeche l'evolution des lesions vers un stade irreversible

Traitement du volvulus du colon pelvien a l'Hopital du Point G : a propos de 56 cas

En 10 ans; 56 cas de volvulus du colon pelvien ont ete colliges; chez lesquels l`anse volvulee a ete trouvee saine 30 fois; douteuse 17 fois et necrosee avec ou sans perforation 9 fois. La resection anastomose d`emblee a ete realisee dans 53;57 pour cent des cas; la resection avec colostomie type Hartmann dans 30;35 pour cent des cas et la detorsion simple avec ou sans colopexie dans 16;07 pour cent des cas. les taux de morbidite et de mortalite ont ete respectivement de 6;66 pour cent et de 3;33 pour cent dans le groupe des patients ayant subi une resection anastomose d`emblee. Si les conditions sont reunies; la resection anastomose d`emblee peut etre reussie a l`Hopital du Point G

Volvulus de l'intestin grele: revue de 55 cas operes au CHU de Lome (Togo)

Une enquete retrospective a ete menee sur les cas de volvulus de l'intestin grele operes dans le service de Chirurgie Generale du CHU de Lome dans le but de se faire une idee des caracteristiques etio-pathogeniques; cliniques; et du pronostic de cette affection peu etudiee dans notre sous-region. Le volvulus du grele; 55 cas; correspondant a 65;47 pour cent des volvulus intestinaux; a represente 14;66 pour cent des causes d'occlusion intestinale aigue mecanique. Il a ete d'une nette predominance masculine (67;27 pour cent) avec un age moyen de 40 ans. Sur le plan pathogenique; il y avait une legere predominance des volvulus secondaires (52;73 pour cent) qui etaient dus dans 82;75 pour cent des cas aux brides et adherences spontanees ou post-operatoires. Tous les patients ont ete operes avec le diagnostic d'occlusion intestinale aigue. Dans aucun cas le diagnostic de volvulus du grele n'a ete pre-operatoire. Le retard therapeutique a ete responsable; dans 31 cas; de gangrene intestinale obligeant a une resection chez des patients en mauvais etat general: d'ou une lourde mortalite de 34;54 pour cent. Il faut convaincre les patients de consulter plus tot pour esperer une amelioration du pronostic

Complications of Ascaris lumbricoides infection: case reports from south western Uganda

Two cases of intestinal obstruction due to Ascaris lumbricoides infection are reported from Ishaka Adventist Hospital; in south western Uganda. One was a male aged two and a half years and another was a female aged twenty. They were both treated surgically with good results. A review of the literature also revealed that intestinal obstruction due to A. lumbricoides is a common complication; though other surgical and nutritional complications also seem to be common; they are less reported