Department of Surgery, University of California, San Francisco, San Francisco, California.
Department of Surgery, St. Paul Millennium Medical College, Addis Ababa, Ethiopia.
J Surg Res. 2024 Jan;293:239-247. doi: 10.1016/j.jss.2023.08.017. Epub 2023 Oct 4.
Small bowel obstruction (SBO) is one of the most common causes for hospital admission in Ethiopia. The use of water-soluble contrast agents (WSCAs) such as Gastrografin to manage adhesive SBO can predict nonoperative resolution of SBO and reduce decision time to surgery and length of hospital stay. However, nothing is known about practice patterns and Gastrografin use in low-income settings. We sought to characterize current management practices, including use of WSCAs, as well as outcomes for patients with SBO in Addis Ababa, Ethiopia.
We conducted a mixed-methods study consisting of a survey of surgeons throughout Ethiopia and a retrospective record review at five public, tertiary care-level teaching hospitals in Addis Ababa.
Of the 76 surgeons who completed the survey, 63% had heard of the use of WSCAs for SBO and only 11% used oral agents for its management. Chart review of 149 patients admitted with SBO showed the most common etiology was adhesion (39.6% of admissions), followed by small bowel volvulus (20.8%). Most patients (83.2%) underwent surgery during their admission. The most common diagnosis in patients who did not require surgery was also adhesion (68.0%), as well as for those who had surgery (33.9%), followed by small bowel volvulus (24.2%).
The etiology of SBO in Ethiopia may be changing, with postoperative adhesions becoming more common than other historically more prevalent causes. Although a Gastrografin protocol as a diagnostic and potentially therapeutic aid for SBO is feasible in this population and setting, challenges can be anticipated, and future studies of protocol implementation and effectiveness are needed to further inform its utility in Ethiopia and other low-income and middle-income countries.
小肠梗阻（SBO）是埃塞俄比亚患者住院的最常见原因之一。使用水溶性造影剂（WSCAs），如胃复安，来治疗粘连性 SBO 可以预测 SBO 是否可以非手术解决，并减少手术决策时间和住院时间。然而，在低收入环境中，关于实践模式和胃复安的使用情况尚不清楚。我们旨在描述当前的管理实践，包括 WSCAs 的使用情况，以及埃塞俄比亚亚的斯亚贝巴 5 所公立三级保健教学医院 SBO 患者的结局。
我们进行了一项混合方法研究，包括对埃塞俄比亚各地外科医生的调查以及在亚的斯亚贝巴 5 所公立三级保健教学医院的病历回顾。
在完成调查的 76 名外科医生中，63%听说过使用 WSCAs 治疗 SBO，只有 11%使用口服药物治疗。对 149 名因 SBO 住院的患者进行病历回顾，显示最常见的病因是粘连（39.6%的住院患者），其次是小肠扭转（20.8%）。大多数患者（83.2%）在住院期间接受了手术。不需要手术的患者最常见的诊断也是粘连（68.0%），以及需要手术的患者（33.9%），其次是小肠扭转（24.2%）。
埃塞俄比亚 SBO 的病因可能正在发生变化，术后粘连比其他历史上更常见的原因更为常见。虽然胃复安方案作为 SBO 的诊断和潜在治疗辅助手段在这一人群和环境中是可行的，但预计会存在挑战，需要进一步研究方案的实施和有效性，以进一步了解其在埃塞俄比亚和其他低收入和中等收入国家的实用性。
