A Clinical analysis of Intestinal Obstruction in the Adult

ABSTRACT

Three hundred nine adult patients with the diagnosis of intestinal obstruction were treated at the Department of Surgery, Seoul National University Hospital during 5 years and three months from September 1989 to December 1994. A clinical analysis of those patients was done and the following results were obtained. The most prevalent age group was sixth decade in cases of 90(29%) and male to female ratio was 2.1:1. The etiologic factors included adhesions 206(66.7%), malignant disease 51(16.5%), hernia 10(3.2%), intussusception 9(2.9%), ischemic injury 7(2.3%), bezoar 6(1.9%), volvulus 6(1.9%), inflammatory disease 5(1.6%), intestinal tuberculosis 5(1.6%), and others 3(0.9%). Malignant obstructions increased and it may be caused by increased cases of cancer operation. The location of intestinal obstruction was small bowel in cases of 275(89%) and large bowel in the remained proportion. The frequency of strangulation was 14.2% and its causes were adhesion(56.8%), ischemic injury(15.9%), hernia(9.1%), malignant disease(6.8%), volvulus(6.8%), intestinal tuberculosis(2.3%), and intususception(2.3%). The main cardinal symptoms on admission were abdominal pain(93.9%), vomiting(79.3%), abdominal distension(72.8%), diarrhea(24.9%), obstipation(17.2%), bloody stool(11.7%) and the physical signs were abdominal tenderness(74.8%), abdominal distension(72.8%), altered bowel sound(55.0%), tachycardia(18.1%), fever(17.5%), rebound tenderness(8.4%) . Toxic signs such as fever, tachycardia, rebound tenderness with leukocytosis over 10,000/mm3 have the clinical significance in the strangulated obstruction. Operations were done in 196 cases and the types of operative procedures were resection (23.7%), bypass surgery (11.4%), adhesiolysis (11.1%), colostomy (8.4%), herniorrhaphy(1.8%), bezoar removal (1.8%), and others (0.6%). Operative complications occurred in 44 cases(22.4%) and among them, wound infection was the most common cause(7.7%).The overall mortality was 3.2% and sepsis was the most common cause(30%).