Author(s): Ramani Ranjan Mund1, Naresh Dayaldas Badlani2, Pratyusha Priyadarshini3, Sanjib Kumar Meher4
Small bowel obstruction is a common surgical emergency. The small bowel is involved in about 80 percent of cases of mechanical intestinal obstruction. Mode of presentation is same in all but underlying cause varies in each age group. The dictum of never let the sun set or rise in small bowel obstruction has made early surgical intervention for small intestinal obstruction. This in turn has reduced the incidence of strangulation of bowel, which was major cause of mortality in already ill patient. Success in treatment of patient with acute intestinal obstruction depends largely upon early diagnosis, skilful management and appreciation of importance of treating the pathological effects of obstruction just as much as the cause itself.
This is a prospective study which was done on patient with small bowel obstruction between September 2013 to August 2015 in M.K.C.G. Medical College and Hospital, Brahmapur, Odisha. All the patients were subjected to questionnaires and clinical examination, routine and special investigations like abdominal X-ray in erect posture, treatment modality based on laparotomy findings and postoperative observation for any complications.
In this study, it is observed that bands and adhesions followed by hernia were the commonest causes of small bowel obstruction in adults. Pain abdomen, vomiting, distention, constipation, tenderness over abdomen and increased bowel sounds are seen in majority of cases. Maximum incidence occurred in 3rd decade of life with M:F ratio of 1.73:1. Plain X-ray erect abdomen was almost conclusive in all cases. Resection and anastomosis followed by adhesiolysis were the two procedures which were commonly performed. Morbidity increased in old age patients and those whose presentation was late.
Small bowel obstruction remains a frequently encountered problem in abdominal surgery. The risk of strangulation with adhesive and neoplastic SBO is relatively low as compared with incarcerated hernia and that of due to bands. The timing of surgical intervention is very important in the initial evaluation of a patient with suspected SBO. The recent advances in surgery, the improvement in the techniques, aseptic and antiseptic measures, the rapid advances in anaesthesiology, better understanding of the fluid and electrolyte management, nasogastric tube decompression, antibiotics, and the basic and specific investigations make the patient safer for modern surgery and greatly reduce the mortality rate.