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World J Gastroenterol. Jan 21, 2007; 13(3): 432-437
Published online Jan 21, 2007. doi: 10.3748/wjg.v13.i3.432
Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome
Haridimos Markogiannakis, Evangelos Messaris, Dimitrios Dardamanis, Nikolaos Pararas, Dimitrios Tzertzemelis, Panagiotis Giannopoulos, Andreas Larentzakis, Emmanuel Lagoudianakis, Andreas Manouras, Ioannis Bramis
Haridimos Markogiannakis, Evangelos Messaris, Dimitrios Dardamanis, Nikolaos Pararas, Dimitrios Tzertzemelis, Panagiotis Giannopoulos, Andreas Larentzakis, Emmanuel Lagoudianakis, Andreas Manouras, Ioannis Bramis, 1st Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School, University of Athens, Vasilissis Sofias 114 Avenue, Athens 11527, Greece
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Haridimos Markogiannakis, MD, Kerasoudos 54 street, 15771 Zografou, Athens, Greece. hmarkogiannakis@mycosmos.gr
Telephone: +30-697-6788806 Fax: +30-210-7707574
Received: November 12, 2006
Revised: November 28, 2006
Accepted: December 12, 2006
Published online: January 21, 2007
Abstract

AIM: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia, necrosis, and perforation.

METHODS: This is a prospective observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002.

RESULTS: Of the 150 consecutive patients included in the study, 114 (76%) presented with small bowel and 36 (24%) with large bowel obstruction. Absence of passage of flatus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms and physical finding, respectively. Adhesions (64.8%), incarcerated hernias (14.8%), and large bowel cancer (13.4%) were the most frequent causes of obstruction. Eighty-eight patients (58.7%) were treated conservatively and 62 (41.3%) were operated (29 on the first day). Bowel ischemia was found in 21 cases (14%), necrosis in 14 (9.3%), and perforation in 8 (5.3%). Hernias, large bowel cancer, and adhesions were the most frequent causes of bowel ischemia (57.2%, 19.1%, 14.3%), necrosis (42.8%, 21.4%, 21.4%), and perforation (50%, 25%, 25%). A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes.

CONCLUSION: Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction, respectively. Adhesions, hernias, and large bowel cancer are the most common causes of obstruction, as well as of bowel ischemia, necrosis, and perforation. Although an important proportion of these patients can be nonoperatively treated, a substantial portion requires immediate operation. Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.

Keywords: Acute mechanical bowel obstruction, Clinical presentation, Etiology, Management, Outcome