Predictive factors for strangulated intestinal obstruction

Abstract

This prospective study was carried out on 160 patients with acute intestinal obstruction admitted to the surgical unit at Al-Diwaniyah Teaching Hospital from January 2012 to June 2013 .The patients were divided, according to the results of treatment , into two groups : (1) patients who received early operation (76 patients ) , and (2) patients who received initial conservative treatment with nasogastric decompression and observation (84 patients). The conservative treatment was successful in 52 patients but in 32 patients, delayed operation was required .There were 54 cases of strangulated intestinal obstruction (33.75%) and 106 cases of simple obstruction (66.25%) .The causes of obstruction were adhesions in 52.5%, obstructed external hernia in 20%, tumor in 10% ,intussusception in 5% and miscellaneous group of causes which accounts for 12.5% of patients. There was positive correlation between bowel strangulation and the following factors: constant abdominal pain, feculent vomiting ,generalized tenderness ,rebound tenderness , rigidity ,absent bowel sounds, tachycardia (PR >110\ min.) , fever (temperature >38ËšC), signs of shock (systolic BP <90 mmHg) and WBC count above 18000\mm3.The mean period of conservative treatment was 48 hours and the period of hospitalization was shorter in the conservative group as compared with the operative group . The morbidity was less in the conservative group than in the operative group. There was no death in the conservative group, while in the operative group the mortality rate was 7.4%. The mortality was closely related to the age, and the state of bowel involved by obstruction , since most deaths occurred in old aged patients and in patients with gangrenous bowel.