Adhesive post operative small bowel obstruction in adult patients as seen at the Kenyatta National Hospital.

Abstract

Background: Adhesions are the leading cause of small intestinal obstruction worldwide. The commonest risk factor to the formation of adhesions has been shown to be previous abdominal surgery. The degree of peritoneal inflammation and injury by pathological processes or surgery contributes to the type and severity of the adhesions. A paucity of data exists locally and regionally on adhesive small bowel obstruction. Any delay in intervention and the choice of intervention greatly impact on the morbidity, length of hospital stay, and timing of recurrence. Objective: To determine the prevalence of adhesive small bowel obstruction in KNH. The etiologies, modes of presentation and their relationship to the modes of management. Design: A descriptive prospective study. Methodology: All adult patients with prior history of abdominal or pelvic surgery and presenting with signs and symptoms of intestinal obstruction were included in the study upon consenting. Their demographic details, previous surgical history, current clinical presentation and modes of management were entered in a structured questionnaire. Data management and analysis: A structured questionnaire was used to collect data prior to entry in SPSS version 17 for analysis. Data are presented in the form of tables, pie charts, tables and graphs. Results The mean age of patients with ASBO was 36.6 years (SD ± 13.1) and the age range was between 14 and 72 years. There were 31 (62%) male patients with ASBO. During the period of the study there were 50 ASBO cases in a total population of 354 patients undergoing intestinal surgery. This yielded an incidence of 14.1 (95 % CI 10.7 to 18.2) for ASBO in KNH. The etiologies of ASBO were colorectal surgery 28 (48%), upper GIT 10 (20%), small bowel 8 (16%) and pelvic 8 (16%) surgeries. ASBO etiology was not significantly associated with ASBO presentation or its management. Conclusion The study has demonstrated that ASBO is common (14.1%) in abdominal surgery in KNH with a male preponderance, occurring before 50 years of age. Common etiologies are surgery involving extensive peritoneal dissection and patients commonly present within 2 years of surgery with high chance of needing operative management.