DIAGNOSIS AND MANAGEMENT OF SUBACUTE INTESTINAL OBSTRUCTION: A PROSPECTIVE STUDY

Intestinal obstruction can be defined as impairment to the abnormal passage of intestinal contents that may be due to either mechanical obstruction or failure of normal intestinal motility in the absence of an obstructing lesion. Intestinal obstruction is the most common surgical disorder of the small intestine. SAIO implies incomplete obstruction. It has been defined in a number of ways and there are many gray zones in the treatment protocols. It is characterized by continued passage of flatus and/or feces beyond 6-12 hrs. after onset of symptoms namely colicky abdominal pain, vomiting, and abdominal distension. The study was taken by considering the following aims and objectives: To study the clinical profile and clinical features of patients presenting with subacute intestinal obstruction (SAIO). To study the role of investigations in diagnosis of SAIO. To find out the underlying cause of SAIO in patients under study. To study the predictors of relief of symptoms in patients with SAIO. To study the indications and timing for surgery for SAIO. To follow-up the progress of patients and find out the outcome of management. This study included 63 patients who presented with clinical features of sub-acute intestinal obstruction in Surgery Out-Patient Department or Emergency. The mean age of patients included was 31.8 years (SD±16.6, ranged 4 to 72 years). The male to female was 1.5:1.0. The duration of symptoms ranged from 1 day to 365 days (median - 4 days). Thirty out of 63 patients had recurrent symptoms, with a median of 2 episodes per patient with range from 1 to 13 episodes. Colicky abdominal pain (89%) and vomiting (82%) were more frequent as compared to non- passage of feces /or flatus (46%) and distension of abdomen (44%). Eight patients (13%) had earlier received anti-tuberculosis treatment for abdominal disease. A total of 20 patients (31.7%) had history of previous abdominal surgery. On physical examination, the most frequent finding was presence of exaggerated bowel sounds in 60.3% of patients. Distension abdomen was observed only in one-fourth of the patients. Seven patients had no abnormal physical finding. Five patients had abdominal tenderness and 4 out of these needed surgery to relieve obstruction. On plain x-ray films, 47 patients (74.6%) had multiple air-fluid levels on erect films. Ultrasonography was undertaken in 60 patients. It showed abnormal findings in 48 patients while it was reported normal in 12 patients. Dilated bowel loops were the most frequent finding. CT scan was performed in 15 patients. The abnormal findings noted in 14 patients and it showed the cause of obstruction in 10 patients. Diagnostic laparoscopy delineated the cause of obstruction in all the 5 patients in whom it was undertaken. In 18 patients in whom special investigations were available for comparison with operative findings, ultrasound was able to point out the cause of obstruction correctly in 3 patients (17%). CT scan demonstrated the etiology correctly in 9/10 patients. Diagnostic laparoscopy was performed in 5 patients and showed correct cause of obstruction in all patients. Out of total 63 patients, surgery was needed to relieve obstruction in 30 patients. Out of remaining 33 patients who got relieved by conservative management, investigations revealed lesions