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Abstracts: Background: To study the different modes of clinical presentation and study clinical outcome in various causes of large bowel obstruction in adults and to accomplish the operative management and to anticipate the postoperative complications and their management. Methodology: This is a prospective observational study of large bowel obstruction in adults and was carried out in 2012-2014. Results: A total 50 cases of large bowel obstruction were studied. Maximum patients11(44%) cases belonged to age group 51-60yrs. Obstipation is seen in50(100%), pain in 44(88%), distension in 50(100%), tenderness in 44(88%), constipation in 50(100%),rigidity in 14(28%). In present study, malignancy was the commonest (24 cases – 48%) cause of large bowel obstruction. There were 10 cases (20%) of stricture, 8 cases (16%) of volvulus, two case (4%) of endometriosis and two case (4%) of intussusception causing large bowel obstruction. Pseudo-obstruction comprised 4 cases.20 cases (43.5%)were operated for resection anastomosis of pathological part to relieve obstruction, while 18 cases (39.1%) were operated for temporary colostomy due to lack of definitive procedure either due to unresectable mass or gross contamination of bowel loop. Rest of the cases 8(17.3%) were operated for end colostomy or ilestomy. Wound infection was the commonest complication observed in 10 cases.6 patients died due to septicaemia.Pleural effusion was present in 4 patients.Skin excoriation around colostomy occurred in 6 cases. Mortality of the study was 6 (12%) cases. Conclusion : Old age (51-60) was the most common age group affected by large bowel obstruction.Colorectal carcinoma was the leading cause of large bowel obstruction . In our study. Distention and constipation were predominent symptoms.. Plain X-ray erect abdomen is the single most important diagnostic tool for diagnosing obstruction and its level of obstruction.CT SCAN abdomen confirmed the type and site of obstruction and spread of tumor in cases of large bowel malignancy.Early recognition and timely intervention is important to prevent the bowel from going for gangrenous changes.
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PURPOSE: The purpose of this study was to review our experience with the use of self-expandable metallic stents as the initial interventional management for acute malignant large-bowel obstruction. METHODS: The records of 35 patients who underwent placement of a colonic stent for acute malignant obstruction at our institution between January 2003 and December 2004 were reviewed. RESULTS: Stents were placed for palliation in 19 patients and as bridge to surgery in 16 patients. Technical success of stent placement was achieved in all patients (100%), but clinical failure occurred in two patients due to limited expansion of the metallic stent. One of them who had clinical failure underwent an emergency operation, and the other needed no further procedure because of his death. Complications occurred in 4 patients (12%), including one pelvic abscess associated with colon perforation, two minor bleedings, and one anal pain. All the patients in the bridge-to-surgery group underwent an elective colon resection without stoma. In the palliative group, stent reocclusion was observed in three patients during the follow-up (median: 65 days; range: 27~440 days), two of which were managed by reinsertion of a stent. In the remaining patients, the stent was patent until death or the last follow up date (median: 65 days). CONCLUSIONS: Placement of a self-expandable metallic stent is a safe and effective procedure for immediate decompression of acute malignant large-bowel obstruction. It provides a chance of elective surgery for patients with resectable disease, as well as relief of symptoms for those with unresectable disease.