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5- PATTERN OF INTESTINAL OBSTRUCTION IN BASRAH; A PROSPECTIVE STUDY

Zaki Al-Faddagh --- Adel Salih Mushari

Basrah Journal of Surgery مجلة البصرة الجراحية
ISSN: 16833589 Year: 2011 Volume: 17 Issue: 1 Pages: 22
Publisher: Basrah University جامعة البصرة

Abstract

PATTERN OF INTESTINAL OBSTRUCTION INBASRAH; A PROSPECTIVE STUDYAdel Salih Mushari@& Zaki Al-Faddagh#@MB,ChB, FICMS, AlQurna Hospital. # MB,ChB, CABS, Professor, Department of Surgery, BasrahCollege of Medicine, Basrah University.AbstractIntestinal obstruction remains one of the commonest surgical emergencies, with hernias beingelectively repaired; adhesive obstruction has emerged as the leading cause of intestinalobstruction in the west, while the obstructed hernia remaining the main cause in developingcountries.This is a prospective study involving 464 patients admitted with intestinal obstruction to thesurgical unit in AL-Mawane general hospital, Al-Sadir teaching hospital, Al-Basrah maternity andchild hospital and Al-Basrah general hospital during the period between (January 2004-December 2007).All patients were admitted and thorough careful history, particularly history of previous surgeryand examination were done involved the hernial orifice. Type of treatment, time surgicalintervention, operative finding and period of hospital stay were noted.Most of our patients were attended for postoperative followed up for complications and recordingthe mortality in the hospital.The study included 464 patients, their age ranged from 2 days to 75 years. (Mean 33.8years),and they are more frequent in female 258 patients (55.7%) than male206 patients (44.3%).Acute onset of presentation was found in 296 patients (63.7%). Constipation in 419 patients(90%) and abdominal pain in 380 patients (82%) were the main presenting symptoms. Previousadmissions for same complain were reported by 64 patients (13.7%). History of previoussurgery were reported by 71 patients (15.4%), and time interval from previous surgery, variesfrom one month to (5) years. Simple obstruction was the most common form of intestinalobstruction (67.7%). Of all patients included in the study, 288 patients (62%) present with smallbowel obstruction and 176 patients (38%) with large bowel obstruction. The commonest causeof intestinal obstruction was strangulated external hernia in 99 patients (21.3%), intestinaladhesions in 73 patients (15.7%). The hernia (29.2%) together with adhesions from previoussurgery (25.4%) constitute the bulk of causes of small bowel obstruction , while volvulus ofsigmoid colon (23.6%)and tumours (22.7%) form the main cause of large bowel obstruction.Intussusception was the most prevalent variety of intestinal obstruction in child age group(27.2%), followed by hirschsprungs disease (22.2%). Of strangulated hernia, inguinal herniawas the most frequent type of hernia seen (71.7%). Surgical intervention was necessary in 409patients (88.2 %).The period of conservative treatment ranges from 3-14 days, with average(6.3) days. Post operative complication occurred in 167 patients (40.8%). The mortality was 6.8% and it was related to extreme of life, delay in presentation and mismanagements.The study concluded that simple intestinal obstruction is the commonest type of obstruction,higher rate of strangulated hernia than the rate of obstruction due to adhesions, which isopposite to a typical pattern of developed countries. Intussusception is the most frequentscause of intestinal obstruction in children, early presentation and diagnosis is the key toreducing morbidity and mortality.

Keywords

Intestine --- Basrah