Pattern and management outcome of intestinal obstruction among operatively managed adults in Attat Catholic Hospital, Gurage Zone, Southern nations and nationalities regional state, Ethiopia.

Abstract

Background: Intestinal obstruction is a common and potentially dangerous surgical emergency with high morbidity and mortality universally if managed inappropriately. It is essential to distinguish between its various types even though; its pattern and incidence varies from country to country as well as from area to area within a country. Several factors contribute to poor management outcomes in the case of intestinal obstruction. Objective: The objective of this study is to determine the prevalence, common causes and management outcome as well as to compare the preoperative and postoperative diagnosis of intestinal obstruction in operatively treated adult patients at Attat Catholic Hospital from January 2011-December 2013. Method: A three year Hospital based retrospective study design of data collection method was conducted in Attat Catholic Hospital to collect a total of three hundred two (302) cases applying a single proportion formula of sample size determination. The data were collected and checked for its completeness and coded, entered into SPSS version 16.0. Data were analyzed and presented using frequency distributions and logistic regression. On binary logistic regression analysis a p-value < 0.25 was used as a reference to be a candidate for multivariate logistic regression analysis. PValue<0.05 at 95% confidence interval (CI) was considered as statistically significant. Result: - A total records 302 adult cases of intestinal obstruction were observed, of which 229 (75.83%) were males and 73(24.17%) were females. The prevalence of intestinal obstruction was 21.56% of all acute abdomens and 5.42% of total surgical admissions. The commonest site of obstruction was small bowel 205(67.88%), of which small bowel volvulus was the leading 78(38.05%) followed by intussusception 55(26.83%) and adhesions 30(14.63%) whereas Large bowel was second with 97(32.12%) cases due to primarily sigmoid volvulus 61(62.89%) followed far by colonic tumors 11(11.34%). All cases were managed operatively by untwisting volvulus, anastomosis and laparotomy accounting 91(30.13%), 82(27.15%) and 60(19.87%) respectively and 64 (21.19%) of them developed post operative complications mainly surgical site infections (SSI) 31(48.44%). About 285 (94.37%) of the cases were discharged after smooth post operation time or improved from their complications while 17(5.63%) passed away in the hospital on their post operative time.4 Conclusion: - Generally, acute intestinal obstruction remains a major cause of mortality in our environment. Small bowel volvulus is geographically the leading cause and Untwisting (derotation) of volvulus was the most performed intraoperative procedure of intestinal obstruction. Viability of intraoperative finding and duration of presenting illness before surgical intervention has significant association statistically with management outcome of patients. Recommendations: As shown in the report, majority of the patients that ended up in complications and deaths were those who presented and managed late with their bowel found to be gangrenous for which primary bowel resection and anastomosis has been underwent to relieve the obstruction. And should be alleviated by: incrasing public awareness, improving knowldg of health professionals and reducing intraoperative anastomosis.