Associated factors and management outcome of surgically treated adult intestinal obstruction at nekemte referral hospital, oromia, western Ethiopia

Abstract

Background: Intestinal obstruction remains one of the most common surgical diagnoses made in emergency departments worldwide [1]. Its magnitude and causes have kept changing over time within various parts of country, varies from time to time and from area to area even in the same country and affected by different factors. Objective: -The objective of this study is to assess associated factor and management outcome of adult intestinal obstruction patients managed operatively at Nekemte Referrals Hospital, from January to September 2018. Method: - Institution based cross-sectional study was conducted in Nekemte Referral Hospital, Oromia region, Western Ethiopia from January to September 2018. Data was collected from surgically managed adult patients who were admitted in Nekemte Referral Hospital surgical ward with the diagnosis of intestinal obstruction. The data was collected directly from the patient and from the patient’s card. The collected data checked for any inconsistencies, incorrectness, and incompleteness. Then, data entered to epidata software and exported to SPSS version 22.0 for data analysis. Data was analyzed and presented by frequency distribution and logistic regression. On binary logistic regression analysis, a p-value <0.25 was used as a reference to be a candidate for multivariable logistic regression analysis. P-Value<0.05 at 95% confidence interval (CI) was considered as statistically significant. Result: Totally, 206 surgically managed adult intestinal obstruction patients get admission from January to October 2018. SBO accounts 126 (61.8%) and LBO 80 (38.2%). Patients’ age ranges between 15-80 years with a mean of 42.66(SD±16.15) and M: F ratio of 1.4:1. Independent factors that predict the management outcome were age, intra-operative finding and anastomosis leak (see table 6). Overall mortality was 12.1%, which is mainly due to sepsis 19(76%) %. 44 (21.3%) patients developed postoperative complication. Conclusion and recommendation: SBO was the leading site of obstruction caused by small bowel volvules, inguinal hernia, and adhesion. Sigmoid volvules and colo-rectal mass were the two most common causes of LBO. The mortality rate and postoperative complication were high and needs careful peri-operative multidisciplinary patient evaluation and monitoring. Elective surgery for inguinal and femoral hernia repair should be widely performed in NRH and its sub region hospitals that have general surgeons.