Clinical Study of Simple and Strangulated Intestinal Obstruction

Park, Sung Keun; Park, Cheol Ho; Lee, Jong Chan

Abstract

Ninety-six cases of intestinal obstruction that were surgically managed at the Department of General Surgery, Pohang St. Mary,s Hospital, during the 5 years from July 1991 to June 1996 were analyzed, and the results are as follows; 1) The most frequent age group was the first decade(32.3%), and the male to female ratio was 2.56:1. The most prevalent age group for strangulated intestinal obstructions was the third decade, and the male to female ratio was 1:2.93. 2) The main causes of intestinal obstruction were postoperative adhesion(41.7%) and incarcerated hernia(18.8%). The main causes of simple intestinal obstruction were postoperative adhesion(37%) and incarcerated hernia(18.5%) and those of strangulated intestinal obstruction were postoperative adhesion (66.6%) and incarcerated hernia(20%). 3) Previous abdominal operations leading to an intestinal obstruction were appendectomies(34.6%) and gastroduodenal operations(28.8%). The most common previous abdominal operation leading to a simple intestinal obstruction was appendectomy(39.0%), but the most common ones for a strangulated intestinal obstruction were a gastroduodenal operation(36.4%) and a gynecologic operation(36.4%). 4) The presence of continuous abdominal pain, rebound tenderness, localized tenderness, fever(>38oC) or the presence of 2 or more of the 6 classic findings(continuous abdominal pain, rebound tenderness, localized tenderness, fever(>38oC), tachycardia(>100/min), and leukocytosis(>10,000/mm3)) were more prevalent in the group with strangulated intestinal obstructions. 5) As for operative procedure, an adhesiolysis was done in 30 cases(31.3%), a resection of the small bowel in 18 cases(18.8%), a hernioplasty in 16 cases(16.7%), and a surgical reduction in 13 cases(13.5%). The most common operative procedure for a simple intestinal obstruction was an adhesiolysis, but that for a strangulated intestinal obstruction was a resection of the small bowel. 6) The incidence of postoperative complications was 14.5%. The incidence of postoperative complications for a simple intestinal obstruction was 9.9%, and that for a strangulated intestinal obstruction was 40%. The overall mortality rate was 2.1%.