Chalya Phillipo L, Mabula Joseph B, Chandika Alphonce B, Giiti Geofrey
Tanzan J Health Res. 2014 Jan;16(1):38-46. doi: 10.4314/thrb.v16i1.6.
Dynamic bowel obstruction is a common and potentially dangerous surgical emergency with high morbidity and mortality worldwide. No prospective study has been done on this subject in our setting. This study was conducted to describe in our region, the aetiology, clinical presentation, management and outcome of dynamic bowel obstruction. Data were analyzed using SPSS software system. A total of 342 patients were studied. Males outnumbered females by a ratio of 2.1: 1. The median age of patients at presentation was 34 years (range 11 to 78 years). Obstructed hernias (32.7%) were the commonest cause of dynamic bowel obstruction. Abdominal pain (100%) and vomiting (86.5%) were the most frequent presenting symptoms. Thirty-one (9.1%) patients were HIV positive. Small bowel was the commonest site of obstruction accounting for 89.2% of cases. Herniorrhaphy was the most frequent surgical procedure performed in 112 (32.7%) patients. Surgical site infection (38.8%) was the most common post-operative complication and it was significantly associated with HIV positivity and low CD 4+ count (p < 0.001). The overall median of length of hospital stay was 26 days (range 1 to 72 days). Patients who had postoperative complications stayed longer in the hospital and this was statistically significant (p = 0.022). Mortality rate was 14.3%. Delayed presentation, HIV positivity, low CD 4 count (< 200 cells/μl), high ASA class and presence of complications were the main predictors of mortality (p < 0.001). Obstructed hernias remain the commonest cause of dynamic bowel obstruction in our setting and contribute significantly to high morbidity and mortality. The majority of patients present late when the disease becomes complicated. Early diagnosis and timely definitive treatment are essential in order to decrease the morbidity and mortality associated with this disease.
动力性肠梗阻是一种常见且潜在危险的外科急症，在全球范围内发病率和死亡率都很高。在我们的地区尚未针对该主题开展前瞻性研究。本研究旨在描述我们地区动力性肠梗阻的病因、临床表现、治疗及预后。使用SPSS软件系统对数据进行分析。共研究了342例患者。男性与女性的比例为2.1:1。患者就诊时的中位年龄为34岁（范围为11至78岁）。嵌顿疝（32.7%）是动力性肠梗阻最常见的病因。腹痛（100%）和呕吐（86.5%）是最常见的就诊症状。31例（9.1%）患者HIV呈阳性。小肠是最常见的梗阻部位，占病例的89.2%。疝修补术是112例（32.7%）患者中最常进行的外科手术。手术部位感染（38.8%）是最常见的术后并发症，且与HIV阳性和低CD4 + 细胞计数显著相关（p < 0.001）。住院时间的总体中位数为26天（范围为1至72天）。有术后并发症的患者住院时间更长，这具有统计学意义（p = 0.022）。死亡率为14.3%。就诊延迟、HIV阳性、低CD4细胞计数（<200个细胞/μl）、高ASA分级及存在并发症是死亡的主要预测因素（p < 0.001）。在我们的地区，嵌顿疝仍是动力性肠梗阻最常见的病因，且对高发病率和死亡率有显著影响。大多数患者在疾病复杂化时才就诊较晚。早期诊断和及时的确定性治疗对于降低与该疾病相关 的发病率和死亡率至关重要。
