“Outcome of conservative approach in the management of postoperative adhesive small bowel obstruction”
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 3
Abstract
Intestinal obstruction is a common problem encountered in surgical practice. Adhesions are most frequent cause of small bowel obstruction (SBO) in the developed world and are responsible for 60-70 percent of SBO. Adhesive SBO requires appropriate management with a proper diagnostic and therapeutic pathway. The management of postoperative adhesive small bowel obstruction is controversial because surgery can induce new adhesions prediposes recurrence, whereas conservative treatment neither removes the cause of the obstruction nor prevents the recurrence. So study in this field is very important. Current practice in many centres recommends conservative approach in the management of postoperative adhesional SBO until surgical indication arises. The principle of conservative treatment includes nasogastric decompression, intravenous hydration and clinical observation to identify surgical indication. In Rajshahi medical college hospital, the outcome of this approach is not yet studied. This is a Prospective descriptive study and was carried out in Surgery department of Rajshahi Medical College & Hospital, Rajshahi; during the period of july 2015 to December 2015 on 100 patients who presented with the features of postoperative adhesional small bowel obstruction. The objective of this study is to find out the outcome of conservative approach in the management of postoperative adhesive small bowel obstruction. Plain abdominal x-ray in erect posture and in some selected cases CT scan of abdomen was done along with clinical assesment to confirm the diagnosis. The decision of laparotomy was taken if there was any sign of bowel strangulation or clinical deterioration or if obstruction was not relieved within 72 hours of conservative treatment . All the cases received a course of conservative treatment under frequent monitoring. Completely symptomatic relieve of obstruction was observed in 72 (72%) cases and remaining patients required surgery. Among the 72 relived cases 1st attack of SBO patients was found 55 (72.36%) and recurrent cases was 17 (70.83%). In this study total 64 patients were female and 34 were male patients, among the female 50 (78.12%) cases responded completely by conservative treatment. 4 (6.25%) cases developed strangulation and 10 (15.62%) cases neither responded nor became strangulated within 72 hours of onset of symptoms. On the other hand, among the male 22 (61.11%) responded completely, 7 (19.44%) developed strangulation and remaining 7 (19.44%) was unchanged. Non operative management should be attempted in absence of signs of peritonitis or strangulation because a certain group of patients with adhesive small bowel obstruction will benefit from conservative treatment as the resolution rate is high (72%).
Authors and Affiliations
Dr. Md. Mohibul Hassan, Dr. Subal Chandra Paul, Dr. Asim Sarkar, Dr. Sanchita Sarker
Keywords
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- EP ID EP552586
- DOI 10.9790/0853-1803013236.
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