Pattern of intestinal obstruction among adult operated patients in jimma university specialized hospital, a two years retrospective review, jimma, south west, Ethiopia.

Abstract

Background: Intestinal obstruction is a commonly encountered emergency in the practice of General Surgery and accounts for large percentage of abdominal emergencies and surgical admissions. When intestinal obstruction is not relieved in time, the patient may die. Early diagnosis and prompt management are therefore mandatory. Several factors contribute to poor out comes in the case of intestinal obstruction. Some of this determinant may include poor health care seeking behavior, ignorance and poverty. The pattern of intestinal obstruction is an indicator of how well surgical services are developed in a certain region. Intestinal obstruction can be caused by many conditions that vary from country to country, from area to area within the same country. But there is no much study regarding the pattern and magnitude of intestinal obstruction in Ethiopia at large and Jimma University Specialized Hospital in particular. Objective: To assess the pattern of intestinal obstruction in adult operated patients in Jimma University Specialized Hospital. Methods: A two year retrospective, institution based cross sectional descriptive study was carried out in Jimma University Specialized Hospital by reviewing patient’s records, which were admitted and operated in a period from January 1, 2010 to December 31, 2011. The data was analyzed using SPSS version 16 and the results were displayed using frequency tables and figures. For all statistical significance test, the cutoff value set is P<0.05 as this was considered statistically reliable for the analysis of the study. Crude odds ratios of variables whose statistical significance values are <0.05 were checked in the binary logistic regression. Results: A total of 323 patients were admitted with a diagnosis of intestinal obstruction of whom the records of 248 patients were found and 216 patients were included which made the basis of this study. The male to female ratio was 2.8:1. The ages ranged from14 years to 73 years with a mean age of 38.3+ 3.88. Small bowel volvulus accounting for 33.3% of cases was the leading cause of intestinal obstruction followed by hernias (15.4%) and sigmoid volvulus (14.5%). There were 26 deaths giving an overall mortality of 12%. A higher mortality rate was observed in patients who presented late. Conclusion and Recommendations: Intestinal obstruction deserving emergency surgical management is quite common in Jimma University Specialized Hospital which is in line with earlier reports from Africa had shown. Small bowel volvulus was found to be the leading cause of intestinal obstruction in this study. The over all mortality of 12% is high and could be attributed to late presentation. Early diagnosis, adequate pre operative resuscitation and proper post operative care would be achieved by increasing public awareness on intestinal obstruction as well as by improving the knowledge of mid and lower level health professionals on the diagnosis, resuscitation and importance of early referral to higher center. More over, health facilities capable of handling patients with intestinal obstruction should be available with in the reach of the community.