Evaluation of treatment of patients with mechanical intestinal obstruction at Kenyatta National Hospital

Abstract

SUMMARY The choice between initial surgical or non-operative management of mechanical bowel obstruction still remains a challenge. This was a prospective study carried out over a period of ten months from 1st September 2005 to 30th June 2006. The broad objective was to evaluate the pattern and treatment of patients with mechan ical intestinal obstruction at Kenyatta National Hospital. Methodology: Data on demographic characteristics, management, and outcome were collected using questionnaires. The main outcome measures were duration of hospital stay, the need of operative treatment, and the incidence of bowel strangulation, complications and death. This data was analyzed and presented in tables, charts and graphs. Results: A total of 120 patients with intestinal obstruction were recruited into the study. The ages ranged from 13 to 84 years with a mean of 38 years. The male to female ratio was 2:l.Thirty six percent of the patients [43] had previous laparotomies. The small-gut was involved in 65% of the cases while the large gut was involved in 35% of the cases. The underlying lesions were: adhesions and bands [44%], volvulus [20%], faecal impaction [17%], tumours [8%], helminthiasis [4%], hernia [4%] and intussusception [3%]. Fifty two percent of the patients were managed conservatively, 29% were managed by early operation and 19% were managed by late operation. The main indications for early operative management were signs of peritonitis [49%], intractable pain [20%], leukocytosis [17%], and hernia [14%]. The indications for late operation were failure of resolution [49%], peritonitis [38%], and worsening of the general condition [13%]. Intra-operatively the definitive surgical procedures included; resection and primary anastomosis [49%], adhesiolysis [22%], resection and colostomy [18%], derotation and decompression [11%]. The resection rate in the early operation group due to non-viable strangulation was 22/35 [63%] and 15/20 [75%