INTESTINAL OBSTRUCTION: A SPECTRUM OF CAUSES

Objective: To study the spectrum of causes of acute intestinal obstruction in local set up. Material and Methods: This was a descriptive study, conducted in the Department of Surgery Hayatabad Medical Complex Peshawar Pakistan. Study included patients admitted in General Surgery Ward, with acute intestinal obstruction from January 2004 to June 2008. Detailed history, physical examination and necessary investigations (baseline, and x-ray abdomen erect and supine in all cases and ultrasound and CT scan in selected cases) were carried out. Informed written consent was taken from every patient and was counseled about his or her condition and prognosis. After resuscitation all patients were explored through midline laparotmy incision. Operative information of every case was recorded on proforma. Frequency and pattern of different causes of intestinal obstruction were recorded and analyzed. Results: Total number of patients was 576. Male patients were 352 (61.1%) while female were 224 (38.9%). Ileus secondary to intraperitoneal sepsis was noted in 31.25 % (n=180) cases, ileus due to spinal injury in 3.47% (n=20), ileus due to ileal gangrene in 4.86% (n=28), volvulus in 24.31% (n=140), tumours in 12.15% (n=70), hernias in 10.76% (n=62), Ileal stricture in 6.94% (n=40), feacal  impaction in 4.16% (n=24) and adhesion in 0.69% (n=4) patients. No definite cause was found in 1.38% (n=8) cases. Conclusion: Adynamic obstruction due to intraperitoneal sepsis has come out to be the most common cause of intestinal obstruction. Volvulus and tumour were not uncommon, but hernias and adhesions were seen less frequently.