A retrospective study on the pattern, management and outcome of acute intestinal obstruction in the Ho Teaching Hospital during the timeframe of January 2013 to January 2018
Authors/Creators
-
1.
University of Health and Allied Sciences
- 2. Ho teaching hospital
Description
ABSTRACT
Background: Intestinal obstruction is defined as any hindrance to the passage of intestinal contents. It is one of the most common conditions resulting into hospital admissions. The clinical features of intestinal obstruction include abdominal pain, vomiting, distention and absolute constipation. Intestinal obstruction may be of acute or chronic onset. It may be classified as small and large bowel obstruction. In our local set up, intestinal obstruction is definitely a major cause of acute abdomen. Intestinal obstruction accounts for a great proportion of morbidity and mortality.
Aim: The aim of the study is to determine the pattern, management and outcome of intestinal obstruction as seen at the HTH.
Method: Study site: The surgical wards and accident/ emergency department at the HTH. Subjects: Patients diagnosed with intestinal obstruction and managed at the HTH between January 2013 and January 2018. Study design: Hospital-based retrospective study. Sampling method: File review of cases that meet he inclusion criteria. Sample size: A total of 100 case folders were made available that meet the inclusion criteria. Data management: Data was collected through the review of medical records. The data was entered in MS Access, coded and SPSS version 21 used for analysis. Statistical tests used in analysis were Chi square, student-t test and Fisher’s exact tests.
MAIN RESULTS: A total of 100 patients were studied. The age of the patients ranged from 2 years to 85 years old, with a median of 47years (mean of 47.96). The male to female ratio was 1.2:1. The age group 40-50 years had the most patients (22 patients, 22.0%). Abdominal pain 99.0%, vomiting 97.0%, constipation 92.0%, abdominal distension 77.0% and dehydration in 24.0% of cases. None of the symptoms was found in isolation, they co-existed. Overall, strangulated hernias were the commonest, 42.9%, cause of obstruction followed by postoperative adhesions, 28.6%, and volvulus 14.3% (large gut 10.0% and small gut 4.3%). Of the 69 patients managed operatively, 33.7% had laparotomy and herniorrhaphy, 32.6% had intestinal resection and primary end to end anastomosis, 20.7% had lysis of bands and adhesions, 7.6 % had resection of sigmoid and Hartman colostomy, 2.2% had a right hemicolectomy with the rest having had other procedures. All cases, 100 (100.0%) had a satisfactory discharge after management with no mortality case recorded.
CONCLUSION: Strangulated hernias, postoperative adhesions, volvulus and intussusception are the common causes of intestinal obstruction at HTH. Conservative management forms the basis of care in intestinal obstruction until its outcome will show the need for surgical intervention or not.
RECOMMENDATION: Public awareness of the need for elective repair of hernias would reduce the occurrence of hernia obstruction in the general population. Improved medical care at all levels is necessary so that speedy and prompt treatment can be offered earliest possible and reduces compromise of vascularization of obstructed bowel may help improve the outcome.
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References
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