Prevalence,causes and management out come of small intestinal obstruction in nekemte referral hospital, oromia, western Ethiopia

Abstract

Background;-Small Intestinal obstruction is defined as any failure/ blockage of passage of small intestinal contents from proximal to distal segment. It is one of the most causes of acute abdomen. If not managed timely , the outcome will be grave. The causes of small intestinal obstruction vary from region to region, as well as from season to season. Knowing this variation in causes of intestinal obstruction helps us in selecting appropriate management. Most of the time, it is difficult to differentiate these causes clinically. So it is important to know some of the commonest causes in our area. But there is not enough research done in our country. Objective: To assess causes and management outcome of small intestinal obstruction in Nekemte referral Hospital Method:- A three years hospital based cross sectional study design was used from January 1, 2014 to December 30, 2016 and the data was collected from July 1-August 30,2017. The data were collected from medical records.The collected data were checked for any inconsistency coded and entered into SPSS version 20 for data processing and analysis.Descriptive, binary and multivariate logistic regression analyses were used.On binary logistic regression analysis a p-value < 0.25 was used as a candidate for multivariate logistic regression analysis. Statistical significant association was tested at a p-value of < 0.05. Result:- The records of 161 patients with small intestinal obstruction were retrieved for analysis. One hundred five (65.2%) were males.The commonest cause of small bowel obstruction was adhession in 57(35.4%) followed by small bowel volvulus in 40(24.8%) & intususception in 34(21.1 %) respectively.Resection and anastomosis being the commonest procedure done in 36% of patients.Thirty eight (23.6%) developed post-operative complications. The commonest postoperative complication was wound infection 17(44.7%). About 140(87%) patients improved and discharged and 21(13%) died. Conclusion & recommendation :- Small intestinal obstruction is a commonly encountered surgical emergency.Its causes are variable in different parts of the world. In this study Adhession , small bowel volvulus & intususception were the leading causes of small bowel obstruction respectively. Laparatomy is the most common means of small intestinal obstruction management. Wound infection in the study area should be improved because it is the most common postoperative complication.This can be decreased by appropriate surgical technique and wound care with sterile techniques. Government and other concerned body should be involved on this by improving the sanitation of the hospital.