“STUDY OF LARGE BOWEL OBSTRUCTION IN ADULTS”
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2013, Vol 2, Issue 20
Abstract
[b]AIM[/b]: To study the Incidence, Etiology, Clinical features, Investigations undertaken to arrive at Diagnosis, Treatment and Post-operative outcomes of large bowel obstruction in adults. [b]METHODS[/b]: This is a prospective observational study of large bowel obstruction in adults and was carried out from Nov 2010 to Oct 2012. [b]RESULTS[/b]: A total of 211 cases of intestinal obstruction were diagnosed out of these 25(11.85%) cases were of large bowel obstruction. Maximum patients 8(32%) cases belonged to age group 51-60yrs and 15(60%) cases were males. Obstipation seen in 25(100%), pain 22(88%), distension 21(84%), tenderness 22(88%) and increased bowel sounds 21(84%). X-ray and ultrasonography was useful in 21(84%) cases while CT scan was used in only 7 cases and proved 100% effective.13(52%) cases were of sigmoid volvulus, 1(4%) of caecal volvulus and 9(36%) cases of malignancy.15(60%) cases underwent primary resection anastomosis and 10(40%) cases had a decompressive colostomy.8(32%) patients developed immediate wound complication, 3(12%) cases had anastomotic leak, 1(4%) case developed burst abdomen and 6(24%) cases had septicaemia. Mortality of the study was 6(24%) cases. [b]CONCLUSION[/b]: Patients with large bowel obstruction in adults form a small percentage of patients. Commonest causes are sigmoid volvulus and obstructing colorectal malignancies. X-ray abdomen, Ultrasound of abdomen and Computerized Tomography of abdomen are very helpful in diagnosing. Single stage resectional procedure without colostomies can be done in patients even in emergency surgeries and Proximal diverting colostomies may be safely performed in patients with pre-existing sepsis, shock, gangrene of large bowel and excessively loaded colon with reversal of colostomies and a definitive procedure may be performed later, after stabilisation of patients. Post-operative complications are more because of late presentation associated with comorbidities and large bacterial load of colon during resectional procedure large bowel obstruction carries an increased rate of mortality because of its presentation in old age with associated comorbid factors requiring major resectional procedures.
Authors and Affiliations
Atish Bansod, Ambrish Shamkuwar
Keywords
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- EP ID EP111850
- DOI 10.14260/jemds/713
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