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  3. 2. Causes and Management of Acute Mechanical Small Bowel Obstruction in Adults
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2. Causes and Management of Acute Mechanical Small Bowel Obstruction in Adults

Shahnawaz Abro1, Muhammad Anwer Memon2, Khalid Rashid3 and Imtiaz Ali Soomro4

ABSTRACT

Objective: To determine causes and management of acute mechanical small bowel obstruction in adults. Study Design: Randomized clinical study.  

Place and Duration of Study: This study was conducted at the Surgical Department, People’s Medical College Hospital, Nawabshah, Jamshoro and Jinnah Post Graduate Medical Centre Karachi from August 2014 to July 2015. Materials and Methods: The study pertains to patients admitted into the hospital casualty surgical department during the emergency with diagnosis of acute mechanical small bowel obstruction on the basis clinical features like abdominal pain, vomiting, distension, constipation and radiological evidence of small bowel obstruction with multiple fluid levels. Clinical examination were inspection of abdomen any distension, peristalsis or old scar was noted. Any tenderness, rigidity, distension, palpable mass were noted on palpation. Groins, hernial orifices and scrotal examination was done for strangulated hernias. Any fluid thrill and shifting dullness was recorded. On auscultation normal, borborygmi or absent bowel sounds were also recorded. All base line investigations, ultrasound and C.T scan were not carried out preoperatively. All cases in this study were treated surgically.

Results: Out of 50 patients 19(38%) were 14-25 years of age. This was the age group with highest incidence of the disease. Only 6 patients (12%) were above 65 years in this study. Out of 50 patients 30 (60%) were male and (40%) were female . Distension was the most commonly found physical finding in 40 (80%) cases followed by dehydration was second common sign in 23 (46%) cases, tenderness 20 (40%) cases, previous operation scar 15 (30%) cases and external hernias 11(22%) in descending order of frequency. The main cause of obstruction was adhesion, band and strictures in 30 (60%) cases, external hernias 11(22%) cases, internal hernias 4(8%) cases, volvulus 3(6%) cases, congenital anamolies 1(2%) case, worms 1(2%) case and other rare causes 1(2%) case. All patients in this study were treated surgically. Out of 50 patients complications encountered in 6(12%) cases, out of these 6 cases 3 (6%) were wound infection, all responded well to simple drainage and antibiotic cover. 1(2%) cases of wound dehiscence, responed to tension sutures, antibiotic cover and abdominal bandage. Chest infection was seen in 1(2%) cases ranging from mild bronchitis to sever respiratory distress. 

Conclusion: We conclude that management of bowel obstruction is careful, pains taking and repeated clinical assessment of the patient. 

Key Words: Bowel Obstruction, Acute Mechanical, Causes of Bowel Obstruction

Citation of article: Abro S, Memon MA, Rashid K, Soomro IA. Causes and Management of Acute Mechanical Small Bowel Obstruction in Adults. Med Forum 2017;28(1):6-9.