spectrum of disease and treatment outcome of gastro intestinal obstruction at three governmental referral hospitals in southern Ethiopia: hospital based prospective study

Abstract

BACKGROUND: Gastrointestinal tract (GIT) is a single long tube about 5–7 meters long extending from the mouth to the anus, and functions to digest food and provide nutrients to the body. Gastrointestinal obstruction is a major cause of morbidity and financial expenditure in hospitals around the world, accounting for almost 15% of surgical emergency department visits for acute abdomen. However, studies on gut obstruction are scarce in Ethiopia in general and in Southern Region in particular. OBJECTIVES: To assess the types, causes, management and treatment outcome of gastrointestinal obstruction and associated factors with the ultimate management outcome in Southern Ethiopia. METHODOLOGY: This is hospital based prospective study for three months from May 01 to August 01, 2018 at three governmental referral hospitals in Southern Ethiopia, namely Hawassa referral hospital, Yirgalem generalized hospital and Dilla referral hospital. Patients admitted at the surgical emergency units of the hospitals for acute abdomen and confirmed diagnosis of gastrointestinal obstruction were recruited as study participants and followed during the course of their management at the hospitals till discharge. The data were collected by trained data collectors about the objectives of the study. The collected data were entered into Epi Data 3.1 version and transported to SPSS for statistical analysis. Binary logistic regression analysis was conducted to identify factors associated with the management outcomes of gastrointestinal obstruction at the study hospitals. RESULTS: Altogether, a total of 156 patients with confirmed diagnosis of gut obstruction at the three hospitals were studied. The male to female ratio was 1.6:1. Age ranged 2 to 80 years, with a mean of 34.1±13.7 years. Large bowel obstruction (LBO), small bowel and gastric outlet obstructions were the common anatomical types of obstructions in decreasing order. The chief complaints of the patients at admission were abdominal pain, vomiting, abdominal distension and constipation. The majority of cases were managed surgically; resection and anastomosis was the most common intraoperative procedure underwent. The most common pathologies were volvulus and adhesion. Adhesiolysis was the most common post-operative complication evident in 18(12%) cases. In almost 12% (18 out of 150) of the study population, the treatment outcome was unfavourable with overall mortality rate of was 2.7% (4/150). The significant predictors of the outcome were length of time lapse from onset to admission, over 24 hrs [AOR=0.034; 95% CI: 0.004 -0.287; p=0.002] and gangrenous sigmoid volvulus [AOR=4.01; 95% CI: 1.445-15.118; p=0.010]. CONCLUSION AND RECOMMENDATION: Incidence of gastrointestinal obstruction in the study areas was relatively high, LBO being the commonest obstruction. Fortunately, mortality risk from the condition was less than 3.0%. Late admission was the independent predictor of mortality. Improving health seeking behaviour and public awareness on the role of timely admission to prompt treatment in reducing death from gut obstruction is recommended.