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Abstract

Background: Small Intestinal obstruction is defined as any hindrance to the passage of small intestinal contents. It is one of the most common causes of acute abdomen. If not treated on timely manner the outcome will be bad. The causes are varying from region to region, as well as from season to season. Knowing this variety helps us for appropriate management. Most of the time, it is difficult to differentiate these causes clinically. So it is important to know the commonest cause in our area. The objective of this research was to assess the causes and management outcome of small intestinal obstruction among patients admitted with acute abdomen in the hospital.
Methods: A retrospective cross-sectional study design was conducted during a period between January 1, 2012 to December 30, 2014. Data was collected from patients’ medical record charts and operation registration book of patients admitted to surgical ward with the diagnosis of intestinal obstruction. All the cases found in the study period and who are eligible were included in the study. One hundred twenty six of patient charts were analyzed.
Results: Over the course of three years there were 297 patients with intestinal obstruction Admitted to Mizan Aman General Hospital, From which 157 (53%) were small bowel obstruction. The male to female ratio was 2.15:1. The ages ranged from 2 years to 65 years with and a mean age of 28.45 years with standard division of 13.04years. The leading cause of obstruction was adhesion in 48 (47%) patients followed by small bowel volvulus in 34 (33, 3%). Hernia was third in 7 (6.9%). Bowel resection rate was at 40.2%. Length of stay ranged from 4 days-23 days with a mean of 9.39 days and standard division of 4.024 days. The commonest complication was wound infection (21.7%). Complication and Mortality rates were 37.3% and 9.52% respectively.
Conclusion: Adhesion was the leading cause of obstruction followed by small bowel volvulus. There is a lower morbidity and mortality rates in our study which can be explained by improvement in post-operative care. There are few causes of obstruction caused by external hernia which means hernias are being repaired electively before causing obstruction. Early diagnosis, adequate preoperative resuscitation and proper post-operative care would help to reduce further the observed mortality. This could be achieved by increasing public awareness on clinical features of intestinal obstruction as well as by improving the knowledge of mid and lower level health professionals on the diagnosis, resuscitation and importance of early referral to higher center. Moreover, health facilities capable of handling patients with intestinal obstruction should be available within the reach of the community. External hernias should always be repaired before strangulation and obstruction.

Keywords: Small bowel obstruction; Adhesion; Primary small bowel volvulus; Hernia; Gangrenous bowel