Managing small intestinal obstruction: a Sheikh Zayed Hospital experience

ABSTRACT

Managing intestinal obstruction continuous to challenge surgeons all over the World. Between January 2001 to December, 2004, 54 patients with maw to female ratio of 1.81 and mean age of 51 presented with small bowel obstruction. They were divided in to two groups; group A and B. Group A comprised of 30 patients [55%] and were managed conservatively. Whereas group B had 24 patients [44%] who required surgery. Conservative management was observed for 12 to 36 hours and beyond this time patients were explored in the face of deterioration. In group a, 83% patients had history of previous surgery whereas 17% patients had no prior surgical intervention. In group B 38% patients had abdominal surgery in the past whereas 62% had no previous surgical intervention. Predominant symptoms of bowel obstruction were abdominal pain, [100%] constipation [60%] and vomiting [48%]. Common causes of obstruction were post-operative adhesions 38% [n=7] obstructed hernias 25% [n=6] ileoceacal tuberculosis 21% [n=3] intestinal ischemia 8% [n=2] and ceacal carcinoma 8% [n=2]. Two patients died to septicemia, subsequent to anastomotic leak. We conclude that adhesive bowel disease and obstructive external hernias are the commonest causes of small bowel obstruction. A good clinical acumen and repeated clinical examinations are necessary to avoid the stage of bowel gangrene while managing small intestinal obstruction