Changing pattern of mechanical bowel obstruction and management outcome in north-eastern Nigeria
- 1. *Corresponding Author: Dr Suleiman Aliyu, Email: drsuleiman.aliyu@yahoo.co RESEARCH ARTICLE www.ijms.co.in Innovative Journal of Medical Sciences,2017; 1(1):07-09 Changing pattern of mechanical bowel obstruction and management outcome in north-eastern Nigeria 1Dr. S. Aliyu*, 2Dr M.B. Tahir, 3DR U.D. Babayo, 4DR A.B. Zarami, 5Prof A.G. Ibrahim, 6Prof A. G. Madziga *Department Of Surgery And Histopathologt University Of Maiduguri Teaching Hospital Maiduguri Borno State Nigeria Received on: 12/09/2016, Revised on: 21/09/2016, Accepted on: 03/10/2017 ABSTRACT Background The study reviewed mechanical bowel obstruction over a five year period in North-Eastern Nigeria. Patients and Methods. The study retrospectively reviewed all patients that presented with mechanical bowel obstruction between January 2011 and December 2015. Permission for the study was granted by the Hospital management and informed consent obtained from all patients. Information extracted from clinical and laboratory records and data analyzed using SPSS statistical analysis. All patients were resuscitated using intravenous fluids, antibiotics (ceftriaxone/ metronidazole), tetanus toxoid, blood, and diverting colostomy where necessary. All patients had bowel preparation before definitive surgery under general anesthesia. Results. A total of 94 patients were managed age ranged between 20 and 72 years with male to female ratio of 1.4:1. The peak age group was 21- 30years accounting for 29.78%, followed by age group 51-60 years in 27.66% table 1. Tumour was the commonest cause in 27.66% followed by external hernias and intra peritoneal adhesions that failed to resolve on conservative management in the same proportion of 25.53% each table 2. The procedures carried were bowel resection in 54.26% and herniorrhapy in 25.53% table 3. The post operative complications were surgical site infection in 22.34%, enterocutaneos fistula in 3.19%. The mortality recorded was 15.96% majority due to metastatic colonic tumour. Conclusion. The rising incidence of colonic tumours and late presentation in the developing world and falling complicated external hernias due to availability of elective operations makes the former to become the most frequent cause of mechanical bowel obstruction in this environment. Keywords: Mechanical bowel obstruction, Changing pattern, Management outcome. INTRODUCTION Mechanical bowel obstruction is one of the commonest indications for emergency laparotomy, perhaps second to peritonitis1 . Among such causes of mechanical obstructions are obstructed external hernias, volvolus, colonic tumour obstruction, and adhesions2-4 . There is a changing pattern in clinical presentation of external abdominal hernias favoring elective procedures for such hernias when compared to a decade ago where complicated hernia presentation were common. There is a rising incidence in colonic tumours with bowel obstruction at presentation5 . The rising incidence is being attributed to changing diet, urbanization with its attendant social habit like alcohol ingestion and smoking6-8 . One of the cardinal principles in the management of intestinal obstruction is adequate resuscitation before definitive surgery in order to reduce morbidity and mortality9 . The aim of this study was to determine the pattern and outcome of mechanical bowel obstruction. Patients and methods The study retrospectively reviewed all patients presented with mechanical bowel obstruction between January 2011 and December 2015. Permission for the study was granted by the Hospital management and informed consent obtained from all patients. Information extracted from clinical and laboratory records and data analyzed using SPSS statistical analysis. All patients were resuscitated using intravenous fluids, antibiotics (ceftriaxone/ metronidazole), tetanus toxoid, blood, and diverting colostomy where necessary. Investigations done were full
- 2. Aliyu suleiman et al. Changing pattern of mechanical bowel obstruction and management outcome in north-eastern Nigeria 8 © 2017, IJMS. All Rights Reserved. blood count; blood chemistry, random blood sugar, proctosigmoidoscopy, colonoscopy and biopsy. Others were barium enema, abdominopelvic ultrasound scan; chest x-ray, plain abdominal x-rays (erect and supine), and ECG. Computerized Tomography scan and MRI were done where indicated. All patients had bowel preparation before definitive surgery under general anesthesia. RESULTS A total of 94 patients were managed age ranged between 20 and 72 years with male to female ratio of 1.4:1. The peak age group was 21- 30years accounting for 28(29.78%) table 1. TABLE 1: Age Distribution Age years No % 10-20 21-30 31-40 41-50 51-60 61-70 71-80 2 28 12 16 26 8 2 2.13 29.78 12.77 17.02 27.66 8.51 2.13 Total 94 100.00 Tumour was the commonest cause in 26(27.66%) table 2. TABLE 2: Diagnosis Diagnosis No % Hernia Tumour Volvolus Adhesion Faecal mass 24 42 4 24 3 25.53 44.68 4.24 25.53 3.19 Total 94 100.00 The procedures carried were bowel resection in 51(54.26%) table 3. TABLE 3: Procedures Procedures NO Herniorrhapy Bowel resection Adhesiolysis Faecal evacuation 24 51 24 3 NB: Bowel resection: Tumour- 42, Volvolus-4, hernia-5 The post operative complications were surgical site infection in 21(22.34%), and enterocutaneos fistula in 3(3.19%), which closed on conservative treatment. The mortality recorded was 7(7.45%), and 5(5.32%) due to metastatic colonic tumour. DISCUSSION The incidence of MBO was found to be higher among the age groups 21-30 years accounting for 29.78% which is similar to the findings by Soressa et al (2016) 10 . Colonic tumours was found to be the commonest cause of mechanical bowel obstruction in 44.68% which is in sharp contrast to similar study in the same environment a decade ago by Madziga et al(2008) 11 that reported external hernias as the commonest. Obstructed external hernias are declining due to increase in elective herniorrhapy on the other hand there is increasing incidence in colonic tumours in the young due to change in diet and social habit. The highest procedure performed was bowel resection because it is the recommended primary treatment for volvolus and tumour as a global best practice12-13 . In addition, late strangulation of hernia contributed to the high bowel resection rate. The commonest post operative complication was surgical site infection in 22.34% which was similar to the findings by Chang et al (2000)14 due to the fact that colonic procedures are dirty. Enterocutaneos fistula was 3.19%, due to the fact that colonic anastomosis has potential to leak. This was similar to the findings by Moghadamyeghaneh et al (2016)15 that recorded 3.8% in their studies. The current study had a mortality of 7%, which was higher than Bjorg(2000) et al16 who recorded a declining mortality of 4% from 5% over a decade. The higher mortality in this study can be attributed to tumour patients presenting with metastatic disease. REFERENCES 1. Lewis S. P. Laparotomy for Intestinal obstruction. Ann Surg. 1888, 3(3): 214 – 221. 2. Andrew K. The management of Incisional Hernia. Ann R Coll Surg. Engl. 2006 may; 88(3): 252 – 260 3. Daniel G., Zuri M. Management of colonic volvolus. Clin Colon Rectal Surg. 2012 Dec; 25(4): 236 – 244 4. Evaghelos X., Nicolaos G., Charina T. et al. Clinical practice guidelines for the surgical management of colon cancer: a concensus statement of the Hellenic and Cypriot colorectal cancer study Group by the HeSMO. Ann Gastroenterol . 2016 Jan-March; 29(1): 3 – 17 5. Micheil K., Agis E. Increasing incidence of colon cancer in patients< 50 years old: a new entity? Ann Transl Med. 2016 May; 4(9): 164 doi:10.21037/atm.2016.04.13 6. Marinos P., Dalvinder M., Martyn E. C. Diet and supplements and their impact on colorectal cancer. J. Gastrointest Oncol 2013 Dec; 4(4): 409 – 423 IJMS, Sep-Oct, 2017, Vol. 1, Issue 1
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