Changing pattern of mechanical bowel obstruction and management outcome in north-eastern Nigeria Changing pattern of mechanical bowel obstruction and management outcome in north-eastern Nigeria

Abstract

Background The study reviewed mechanical bowel obstruction over a five year period in North-Eastern
Nigeria. Patients and Methods. The study retrospectively reviewed all patients that presented with
mechanical bowel obstruction between January 2011 and December 2015. Permission for the study was
granted by the Hospital management and informed consent obtained from all patients. Information
extracted from clinical and laboratory records and data analyzed using SPSS statistical analysis. All
patients were resuscitated using intravenous fluids, antibiotics (ceftriaxone/ metronidazole), tetanus
toxoid, blood, and diverting colostomy where necessary. All patients had bowel preparation before
definitive surgery under general anesthesia. Results. A total of 94 patients were managed age ranged
between 20 and 72 years with male to female ratio of 1.4:1. The peak age group was 21- 30years
accounting for 29.78%, followed by age group 51-60 years in 27.66% table 1. Tumour was the
commonest cause in 27.66% followed by external hernias and intra peritoneal adhesions that failed to
resolve on conservative management in the same proportion of 25.53% each table 2. The procedures
carried were bowel resection in 54.26% and herniorrhapy in 25.53% table 3. The post operative
complications were surgical site infection in 22.34%, enterocutaneos fistula in 3.19%. The mortality
recorded was 15.96% majority due to metastatic colonic tumour. Conclusion. The rising incidence of
colonic tumours and late presentation in the developing world and falling complicated external hernias
due to availability of elective operations makes the former to become the most frequent cause of
mechanical bowel obstruction in this environment.