A five year retrospective study on pattern of intestinal obstruction in adults as seen at the Kenyatta National Hospital: (January 1996 – December 2001).

SUMMARY.

 

This was a descriptive retrospective study on the pattern of acquired intestinal obstruction in adults as seen at Kenyatta National Hospital between January 1996 and December 2000.

With permission from the ERC (KNH), files were retrieved from the records department and data obtained as per set criteria.  Confidentiality was observed and data analysed using SPSS version 10 computer soft ware.  A total of 441 case files with adequate data were retrieved and included in the study.

Majority of the patients 407 (92.3%) came from within Nairobi while 34 (7.7%) were referred from other health institutions outside Nairobi.

The male to female ratio was 3.2:1 with 335 (76%) male and 106 (24%) female patients.

The youngest patient in this study was 13 years while the oldest was 94 years with a mean age of 37.50 years.  The peak age was between 21-40 years.  Most of the patients 56.9% presented within the first 3 days.

The frequencies of common presenting symptoms were abdominal pain 96.1%, vomiting 87.3%, constipation 77.3% and abdominal distension in 66.4% of the cases.  The main physical findings included abdominal distension 73%, abdominal tenderness 68.5%, increased bowel sounds in 59.2% and previous abdominal surgical scars in 32.4%.  Other signs included decreased bowel sounds in 26.1% of  cases, dehydration recorded in 15.4%, while tarchycardia and visible peristaltic movements were recorded in 10.9% and 8.8% respectively.

Digital rectal examination was performed in 50.8% of the cases.

The most commonly used investigation was plain abdominal x-rays 354 (80.3%), followed by haemogram, urea and electrolytes in 56.5%  each while abdominal ultrasound was taken in 6.3% of the cases.

Mechanical obstruction accounted for 92.3% as mechanical SBO, 65.1%,  mechanical LBO, 25.4% and mechanical SBO/LBO 1.8% overall.  Paralytic ileus was found in 6.1% of the cases while the type of obstruction was not determined in 1.6% of the cases.

Overall, adhesions (36.7%) from previous abdominal surgery  was the leading cause of small bowel mechanical obstruction followed by stangulated hernias, 20%, while sigmoid volvulus, 12.7%, led in the large bowel category.  The main cause of paralytic ileus was TB peritonitis 5.0%.

Operative management was performed in 266 (60.3%) patients depending on requirement while 175 (39.7%) patients were managed conservatively.

The main complications recorded were peritonitis, 58 (13.2%), bowel gangrene,  47 (10.7%), electrolyte imbalance, 25 (5.7%), septicaemia, 22 (5%), recurrence, 16 (3.6%) and wound sepsis, 12 (2.7%).  Less common complications included gut perforation, enterocutaneous fistula, renal failure, burst abdomen and DVT (Deep venous thrombosis) of the calf.

The overall mortality rate was 17.7% (78) of the 441 reviewed cases.  This was higher in referred patients 41.2% (14) out of 34 referrals and patients who presented late.

 

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A FIVE YEAR RETROSPECTIVE STUDY ON PATTERN OF ACQUIRED INTESTINAL OBSTRUCTION IN ADULTS AS SEEN AT KENYATTA NATIONAL HOSPITAL, JANUARY 1996-DECEMBER 2000.pdf300.17 KB