A five-year audit of acute mechanical intestinal obstruction in adults in Port Harcourt, Nigeria

Abstract

Background: Acute mechanical intestinal obstruction is a common surgical emergency worldwide. The presentation varies between and within countries.
Aim: To determine the  pattern of presentation of acute mechanical intestinal obstruction in adults in Port Harcourt, Nigeria.
Methods: This is retrospective study of all patients aged 15 years and above with a diagnosis of acute intestinal obstruction at the University of Port Harcourt Teaching Hospital from 1st January 2006 to 31st December 2010. Data extracted from the hospital records of those operated upon included  age, gender, presenting complaints, clinical findings, causes, treatment, complications and outcome. These were analysed by descriptive statistics.
Results: Of the 228 cases reviewed, 96(42.1%) were non-mechanical while 132  (57.9%)  were mechanical and met the inclusion  criteria. Of the 132 patients, 76(57.6%) were males and 56(42.4%) were females. The peak incidence was in the third decade of life [34 (25.8%)], followed by the fourth and fifth decades [30 (22.7%) each]. The  commonest complaint was abdominal pain while the  commonest  clinical finding was abdominal tenderness . All the patients had surgery with 70(53%) cases having bowel resection. The  commonest  causes of acute mechanical intestinal obstruction were obstructed/strangulated hernia [ 65(49.2%)], postoperative adhesions [25(18.9%)],  volvulus [ 17(12.9%)], colonic tumours [12(9.1%)] and intussusceptions [9(6.8%)]. The complications included wound infection and septic shock. Overall, the mortality was low,  occurring in 11 (8.3%) cases.
Conclusion: Obstructed/strangulated hernias and postoperative adhesions were the most common causes of acute mechanical intestinal obstruction. Early presentation with prompt diagnosis  and early surgical intervention remain the key factors for a good outcome.


Keywords: Mechanical, Intestinal obstruction,  Pattern, Outcome