Acute bowel obstruction presents as a frequently encountered emergency in hospitals throughout the world

Acute bowel obstruction presents as a frequently encountered emergency in hospitals throughout the world, accounting for a great proportion of emergency room visits. This poses a challenge to the surgical trainee. Its treatment requires careful pre-operative preparation, good surgical judgment and technique and post-operative care which are often very demanding (3,4). This hospital based study has tried to address prevalence of causes and management outcome of intestinal obstruction in Nekemte referral hospital. Accordingly, some of the common causes and its management outcome in the hospital were identified with their Prevalence’s.
In this study small intestinal obstruction was common at both extremes of age; in the age group 45 years 52(32.3%), another peak incidence was observed in the age group of 15-24 years 40(24.8%), the age ranged from 04 months to 76 years of age and with mean age of 27.2 years(standard deviation ± 19.2).Age range from 45-54 had significant statistical association with management outcome of patients(AOR=0.001,CI:0.000-0.290,P-value=0.016).This is consistent with study conducted in Larkana (1).
The study shows small intestinal obstruction is more prevalent in males; 105 (65.2%) than females; 56 (34.8%) and with male to female ratio of 1.9:1.This is comparable with other studies (1,3,7, 13,19, 20).Sex had a statistical significant association with management outcome of patients(AOR=0.037,CI:0.001-1.454,P-value=0.048).Females are with 96.3 % higher mortality rates as compared to males.
When we see the educational status ; occupation of the patients majority of them were illiterates 59(36.6%),those who learned one to eight 37(23 %),college and above 21(13%) ; farmers 43 (26.7 %),house wives 32(19.9%) and 31 (19.3 %) were students and which is similar with a study done in GUH and Gonder region, north western Ethiopia(7,12).
More than two thirds 109(67.7%) of patients with small intestinal obstructions were from rural and 1/3 was from urban residence, which is consistent with a study done in Sudan, GUH ; Nigeria (4,7,8) respectively.
About 80 years ago, Mr. Hamilton Bailey used to say: “The sun should not both rise and set on
unrelieved case of intestinal obstruction”. With early diagnosis and prompt appropriate management,
most of patients suffering from intestinal obstruction can be saved. The situation is quite very different
most of the time. Some patients come after subjecting themselves to relatively long periods of
observation. They usually present to us when they really feel very sick(3).In this study 106(65.8 %) of patients presented within 24 hours duration of illness while 55(34.2%) presented after 24 hours but study in Rwanda shows 78.1% presented after 24 hours while 21.9% presented within 24 hours. Delayed presentation and/or surgical intervention frequently results in relatively poor surgical outcome and/or longer hospital stay. Reasons for delay may include poverty, long distance to care centers, poor infrastructure and health seeking behavior (3,5,7). In this study Duration of illness before surgical intervention has significant statistical association with management outcome of patients (AOR=0.069, 95%CI:0.004-1.217, p-value=0.036). Patients who presented within 24 hours duration of illness are 93.1% less likely to develop unfavorable outcome as compared with patients who presented after 24 hours.
This study also showed majority of the cases 119(73.9 % ) were with hematocrit of ;=36 % ; majority of patients 90 (55.9 %) were with referral but most of the poor outcomes were with hematocrit level of = 36 % 8(4.9 %) which is consistent with a study done in GUH(7).