ADMISSION PATTERNS AND OUTCOMES OF OPERATIVE AND NONOPERATIVE MANAGEMENTS OF POSTOPERATIVE ADHESIVE SMALL BOWEL OBSTRUCTION IN ST. PAUL’s HOSPITAL MILLENNIUM MEDICAL COLLEGE

Abstract

ABSTRACT Background: - Intra-abdominal adhesions related to prior abdominal surgery account for up to 75% of cases of small bowel obstruction. It has high morbidity with associated poor quality of life and predisposition to repeated hospitalization. Commonest cause of bowel obstruction in developed countries is postoperative adhesions with extrinsic compression of the intestine. Most of them can be managed conservatively. Objective: - To determine the admission pattern and treatment outcomes of adhesive bowel obstruction Methodology: -A retrospective study of patients admitted with the diagnosis of post operative adhesive bowel obstruction in SPHMMC was conducted from September 11, 2013 to January ,2018G. Demographic data, clinical presentation including duration, previous surgical procedures, treatments options received for the condition Results: postoperative adhesion small obstruction was the commonest cause of small bowel obstruction, making 41.5%. The majority of these patients 68(81.93%) were treated surgically among whom 41(60.29%) patients operated immediately or within 24hrs and 27(39.71%) after trial of conservative management. Among 42(50.60%) patients who had treated conservatively, only 14 (33.33%) of them treated successfully, 27(68.29%) them operated and 1(3.38%) patient died.The most commonly encountered complications are surgical site infection and hypokalemia .There were five(7.35% ) deaths from operated patients.Length of hospital stay is comparable between treatment groups. Conclusion: The most common cause of small bowel obstruction is postoperative adhesion in this study. The patients had been treated both surgically and conservatively with comparable out come in both. Complication was higher in operated patients..Significant number of patients on conservative management were intervened surgically without indication. There is no difference in length of hospital stay. Recommendations: Proper follow up and handover patients is recommended to avoid unnecessary operative intervention. Keywords: postoperative adhesion small bowel obstruction, conservative management, operative management