Prevalence and Management Outcomes 0f Intestinal Obstruction among Surgically Treated Acute Abdomen Patients at Saint Paul’s Hospital Millennium Medical College, Addis Ababa Ethiopia

Abstract

ABSTRACT Background: Intestinal obstruction is the most common surgical emergency worldwide and the cause of intestinal obstruction is either mechanical or non mechanical. Its incidence varies from country to country as well as from area to area with in a country. In Africa, acute intestinal obstruction accounts for a great proportion of morbidity and mortality. Ethiopia is one of countries where intestinal obstruction is a major cause of morbidity and mortality. Depending on the findings intestinal obstruction managed conservatively or surgically even if several factors contribute to poor management outcome, like age of the patients, duration of illness, extent of bowel involved, and initial management and length of hospital stay. Objective:-The objective of this study is to assess prevalence and management outcomes of intestinal obstruction among surgically treated acute abdomen patients at Saint paul hospital millennium medical college,Addis Ababa, Ethiopia. Method:- A two year hospital facility based cross-sectional document review study was done from September 1,/2016 to August 30, 2017 at SPHMMC. Secondary data collected by trained data collectors (Intern physicians, Nurses and HIMS trained person) from operation book, ICU and surgical ward registrations book, Anesthesia book and patient’s charts. Socio-demographic characteristics, preoperative diagnosis, duration of symptoms, operative findings, procedure done, length of hospital stay and outcome of management was collected. Coded data entered into SPSS Version 21. Data was explored to see any missing values and outlier’s .Then data analysis was performed using SPSS 21 software. Descriptive statistics was used to describe socio-demographic variables and binary logistic regression analysis was applied to explore the association between management outcome of surgically treated intestinal obstruction and independent variables. Results: There were a total of 506 surgically treated cases of acute abdomen within the study period, among them 186 cases were surgically treated intestinal obstructions. The prevalence of intestinal obstruction among surgically treated acute abdomen cases was 36.7%. The male to female ratio of intestinal obstruction cases was 2.6:1. Among intestinal obstruction cases small bowel obstruction accounted for about 113 cases[60.7%] and large bowel obstructions 73 cases[39.3%]. The ages ranged from 16 year to 85 years with a mean and standard deviation of 42.9 and 18.5% respectively. The leading cause of small bowel obstruction was adhesion band in 31(16.7%) patients followed by small bowel volvulus 28(15.05%) and hernia 27(14.5%) respectively. The commonest cause of large bowel obstruction was sigmoid volvulus 44[23.6%] followed by colorectal malignancy 33[17.7%]. Bowel resection rate was at 67(36.0%).The commonest complications were surgical site infection 25(13.4%) followed by anastomotic leak 10(5.4%) and Mortality rates was 15[ 8.06%]. Length of hospital stay and initial management were found to be significantly associated with management outcome of patients with intestinal obstruction. Conclusions: the prevalence of intestinal obstruction is high [36.7%] among surgically treated acute abdomen cases. The study showed 130(69.9%) had good management outcome and length of hospital stay and initial management were found to be significantly associated with management outcome of patients with intestinal obstruction. Recommendations Early diagnosis, adequate preoperative resuscitation and proper post operative care would help to reduce further observed mortality. This could be achieved by increasing public awareness on clinical features of intestinal obstruction adequate pre-operative resuscitation and initiate of antibiotic for those who develop gangrenous at preoperatively and importance of early referral to higher center. Moreover, health facilities capable of handling patients with intestinal obstruction should be available within the reach of the community. Further research using prospective study design is warranted as a way to overcome the limitations of secondary data in the current retrospective research that preclude generalization to the whole population.