Department of Surgery, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Anaesthesia and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
BMC Surg. 2021 Nov 30;21(1):408. doi: 10.1186/s12893-021-01405-x.
Intestinal obstruction (IO) is a common cause of acute abdomen globally, it remains challenging as it increases surgical financial expenditure while also causing major morbidity. Clinically it presents with nausea, vomiting, colicky abdominal pain and cessation of bowel movements or passage flatus and stool. Diagnosis, especially in resource limited settings, can be clinical but is usually confirmed radiologically. We studied the current diagnosis, management and outcomes of IO in Mulago Hospital.
This was a prospective study done at all the surgical units of Mulago from January to May 2014 to assess general diagnosis and management of IO. Ethical approval was got in line with Helsinki declaration, we used pretested and validated questionnaires to collect data. Informed consent was got with eligible and consenting/assenting patients that fitted the inclusion criteria of age and presenting with suspected intestinal obstruction. Uni-variate and bi-variate variables analysis was done plus measures of association.
We enrolled 135 patients, excluded 25 and recruited 110 patient. We had more males than females i.e. 71.8% males and 28.2% females. Colicky abdominal pain, abdominal distension, and vomiting were commonest symptoms, then abdominal distension, increased bowel sounds and abdominal tenderness were the commonest signs. Most patients' (51%) were diagnosed radiologically with a lesser number clinically diagnosed. "Dilated bowel loops" was the commonest radiological sign. Surgery was the main stay of management at 72.7% while 27.3% were conservatively managed. Postoperatively the bowels opened averagely on the 3rd post-operative day (POD) with return of bowel sounds occurring on 5th POD. Most discharges (73%) occurred by the 7th POD. Unfavourable outcomes were prolonged hospital stay followed by wound sepsis (surgical site infection) and then Mortality.
This study noted that In Mulago we mostly diagnosed patients radiologically with most surgically managed and which is similar to regional practices. Postoperatively bowel opening happening on third POD with return of bowel sounds on fifth POD. Prolonged hospital stay followed by wound sepsis and then mortality were commonest unfavorable management outcomes.
肠阻塞（IO）是全球常见的急性腹痛原因，它会增加手术的财务支出，同时导致重大发病率，因此仍然具有挑战性。临床上表现为恶心、呕吐、绞痛性腹痛以及停止排便或排气和粪便。诊断，特别是在资源有限的环境中，可以是临床诊断，但通常通过放射学确认。我们研究了穆拉戈医院肠阻塞的当前诊断、治疗和结果。
这是 2014 年 1 月至 5 月在穆拉戈所有外科病房进行的一项前瞻性研究，以评估 IO 的一般诊断和管理。我们根据赫尔辛基宣言获得了伦理批准，使用了经过预测试和验证的问卷来收集数据。对符合年龄并表现出疑似肠梗阻的纳入标准的合格和同意/同意的患者进行了知情同意。进行了单变量和双变量变量分析以及关联度量。
我们共纳入 135 名患者，排除 25 名，招募 110 名患者。男性多于女性，即 71.8%为男性，28.2%为女性。绞痛性腹痛、腹胀和呕吐是最常见的症状，然后是腹胀、肠鸣音增加和腹部压痛是最常见的体征。大多数患者（51%）通过放射学诊断，少数通过临床诊断。“扩张的肠袢”是最常见的放射学征象。手术是主要的治疗方法，占 72.7%，而 27.3%的患者保守治疗。术后平均在第 3 个术后日（POD）排便，第 5 个 POD 出现肠鸣音。大多数患者（73%）在第 7 个 POD 出院。不良结局是住院时间延长，其次是伤口败血症（手术部位感染）和死亡率。
本研究表明，在穆拉戈，我们主要通过放射学诊断患者，大多数患者接受手术治疗，这与区域实践相似。术后第 3 天排便，第 5 天出现肠鸣音。住院时间延长、伤口败血症和死亡率是最常见的不良治疗结局。
