Acute mechanical intestinal obstruction: the problem of diagnosis of strangulation without CT scans

ABSTRACT

To assess the possibility of pre-operative differentiation of strangulated and non-strangulated intestinal obstruction based on clinical; radiological and laboratory features without CT scan, 66 patients with acute bowel obstruction were studied prospectively. Forty-nine [74%] were male, 17 [26%] female with a wide age distribution. In 56 [85%] the small bowel was obstructed, in ten [15%] the large bowel. Adhesions were the most common cause of obstruction [36%], followed by hernias [20%], volvulus [12%], intussusception [11%], malignancies [11%] and other causes [10%]. At surgery strangulation, defined as compromise of the blood supply and necessitating resection of gangrenous bowel, was found in 18 [27%] of the patients. Ten patients [15%] developed complications after surgery and ten patients died, mostly from age and cardiovascular conditions. Persistent abdominal pain, rebound tenderness, elevated temperature, leukocytosis, and air-fluid levels were considered as possible predictive factors for the pre-operative diagnosis of strangulation but it was concluded that such factors were not sufficiently reliable and early surgery was imperative to detect reversible ischemic bowel in strangulated obstruction