Dynamic bowel obstruction: aetiology, clinical presentation, management and outcome at Bugando Medical Centre, Mwanza, Tanzania

Abstract

 

Dynamic bowel obstruction is a common and potentially dangerous surgical emergency with high morbidity and mortality worldwide. No prospective study has been done on this subject in our setting. This study was conducted to describe in our region, the aetiology, clinical presentation, management and outcome of dynamic bowel obstruction. Data were analyzed using SPSS software system. A total of 342 patients were studied. Males outnumbered females by a ratio of 2.1: 1. The median age of patients at presentation was 34 years (range 11 to 78 years).  Obstructed hernias (32.7%) were the commonest cause of dynamic bowel obstruction. Abdominal pain (100%) and vomiting (86.5%) were the most frequent presenting symptoms. Thirty-one (9.1%) patients were HIV positive. Small bowel was the commonest site of obstruction accounting for 89.2% of cases.  Herniorrhaphy was the most frequent surgical procedure performed in 112 (32.7%) patients. Surgical site infection (38.8%) was the most common post-operative complication and it was significantly associated with HIV positivity and low CD 4+ count (p<0.001). The overall median of length of hospital stay was 26 days (range 1 to 72 days).  Patients who had postoperative complications stayed longer in the hospital and this was statistically significant (p=0.022). Mortality rate was 14.3%. Delayed presentation, HIV positivity, low CD 4 count (<200 cells/μl), high ASA class and presence of complications were the main predictors of mortality (p<0.001). Obstructed hernias remain the commonest cause of dynamic bowel obstruction in our setting and contribute significantly to high morbidity and mortality. The majority of patients present late when the disease becomes complicated.  Early diagnosis and timely definitive treatment are essential in order to decrease the morbidity and mortality associated with this disease.