A Clinical Study in 226 Cases of Intestinal Obstruction

ABSTRACT

BACKGROUND: There is so different between Doctors at managing the patient with intestinal obstruction. Some prefer conservative management and prefer to delay the operation. But others prefer the early operation. So, we have studied in order to compare the clinical difference between early operation and delayed operation for intestinal obstruction. METHODS: This clinical report is based on a review of the records of 226 patients with intestinal obstruction that have been managed at the Department of General Surgery, Seventh Adventist Hospital in Seoul, during about 4 years from January, 1994 to October, 1997. RESULTS: 1) Male to female ratio was 2.32 1. The most frequent age group was within 1 year. 2) The common causes of intestinal obstruction were postoperative adhesion (35.8%), intussusception (19.1%), hernia (16.6%) and neoplasm (8.6%). 3) The chief complaints on admission were abdominal pain in 142 cases (62.8%), nausea and vomiting in 110 cases (48.7%), bloody stool in 43 cases (19.0%) and fever in 27 cases (11.9%). The physical findings were abdominal tenderness in 117 cases (51.8%), increased peristalsis in 98 cases (43.4%) and abdominal distension in 64 cases (28.3%). 4) The previous abdominal operation leading to intestinal obstruction were appendectomy in 16 cases (27.6%), small bowel operation in 13 cases (23.4%), gastro-duodenal operation in 9 cases (15.5%) and gynecologic operation in 7 cases (12.1%). 5) In patients who admit because of intestinal obstruction due to previous operation, most of them entered in hospital within 6months after previous operation. 6) Among 226 cases, 46 cases (20.4%) had emergency operation, 64 cases (28.3%) had only conservative treatment and 116 cases (51.3%) had elective delayed operation 7) In patients who was cured with only conservative management, 12 cases (18.8%) of them stayed for 1day on hospital and 32 cases (50%) of them stayed for 1 or 2 days. 8) Exploratory laparotomy was performed in 162 cases. The types of obstruction were composed of 36 cases (22.2%) of strangulated obstruction and 126 cases (77.8%) of simple obstruction. The frequency of strangulated obstruction was 14 cases (38.9%) when the early operation were done, and that ofstrangulated obstruction was 22 cases (61.1%) when the delayed operation were done. There was significant difference between early operation group and delayed operation. 9) As for operative procedure, adhesiolysis was done in 38 cases (23.5%), bandlysis was done in 30 cases (26.1%), manual reduction and incidental appendectomy was done in 28 cases (17.3%). 10) The incidence of postoperative complication was 46 cases (28.4%) and the most cause of death was septic shock. CONCLUSIONS: The early operation for the patient who suffered from intestinal obstruction due to previous operation is better than delayed operation.