Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome

Table 1 Demographic, clinical, and laboratory data of the total study group on arrival at the Emergency Department (n = 150)

Value	Variable
Age (yr)1	63.8 ± 1.3 (65.0) (range: 16-98)
Sex (Male/Female)2	M: 60 (40%)/F: 90 (60%)
Time between onset of symptoms and arrival (h)1	33.5 ± 2.3 (24.0) (range: 2-120)
Systolic arterial blood pressure (mmHg)1	121.2 ± 1.7 (120.0) (range: 80-170)
Diastolic arterial blood pressure (mmHg)1	62.1 ± 0.9 (65.0) (range: 40-90)
Heart rate (/min)1	80.4 ± 0.8 (79.5) (range: 60-130)
Breathing rate (/min)1	15.4 ± 0.1 (15.0) (range:11-22)
Body temperature (°C)1	36.4 ± 0.03 (36.4) (range: 35.5-37.4)
Fever (temperature > 38.0°C)2	0 (0%)
Absence of passage of flatus2	135 (90%)
Absence of passage of feces2	121 (80.6%)
Vomiting2	118 (78.6%)
Nausea2	89 (59.3%)
Abdominal discomfort2	99 (66%)
Abdominal distension2	98 (65.3%)
Colicky abdominal pain2	111 (74%)
Continuous abdominal pain2	22 (14.6%)
Abdominal muscle guarding2	56 (37.3%)
Rebound tenderness2	7 (4.6%)
Small bowel obstruction2	114 (76%)
Large bowel obstruction2	36 (24%)
White blood cell (WBC) count (109/L)1	9.93 ± 0.29 (8.90) [range: 3.58-24.4]
Leukocytosis2 (WBC count > 10.8 × 109/L)2	55 (36.6%)

¹Values are expressed as mean ± SE and median (parenthesis);

²Values are expressed as number of patients and percentage (parenthesis).

Table 2 Etiology of acute mechanical bowel obstruction n (%)

Cause	Small bowelobstructiongroup (n = 114)	Large bowelobstructiongroup (n = 36)	Total studygroup(n = 150)
Adhesions	84 (73.8%)	13 (36.3%)	97 (64.8%)
Hernia	21 (18.5%)	1 (2.7%)	22 (14.8%)
Large bowel cancer	3 (2.6%)	17 (47.4%)	20 (13.4%)
Small bowel tumor	3 (2.6%)	0 (0%)	3 (2.0%)
Retroperitoneal tumor	0 (0%)	2 (5.5%)	2 (1.3%)
Crohn’s disease	2 (1.7%)	0 (0%)	2 (1.3%)
Small bowel volvulus	1 (0.8%)	0 (0%)	1 (0.6%)
Ovarian cystadenocarcinoma	0 (0%)	1 (2.7%)	1 (0.6%)
Acute diverticulitis	0 (0%)	1 (2.7%)	1 (0.6%)
Sigmoid volvulus	0 (0%)	1 (2.7%)	1 (0.6%)

Table 3 Management and outcome of the patients

Value	Small bowelobstructiongroup (n = 114)	Large bowelobstructiongroup (n = 36)	Total studygroup(n = 150)
Operative treatment1	35 (30.7%)	27 (75%)	62 (41.3%)
Nonoperative treatment1	79 (69.3%)	9 (25%)	88 (58.7%)
Time between arrival and operation (h)2	30.2 ± 4.1 (10.0) [range: 2-96]	71.2 ± 3.2 (78.0) [range: 4-164]	48.1 ± 4.2 (26.0) [range: 2-164]
Operation on the 1st day1	22 (19.3%)	7 (19.4%)	29 (19.3%)
Operation on the 2nd day1	4 (3.5%)	2 (5.5%)	6 (4%)
Operation on the 3rd day1	5 (4.3%)	3 (8.3%)	8 (5.3%)
Complication1	4 (3.5%)	2 (5.5%)	6 (4%)
Intensive Care Unit (ICU) admission1	6 (5.2%)	3 (8.3%)	9 (6%)
ICU length of stay (d)2	6.3 ± 0.5 (2.0) [range: 1-25]	4.0 ± 0.7 (5.0) [range: 2-5]	5.5 ± 2.4 (3.0) [range: 1-25]
Hospital length of stay (d)2	6.0 ± 0.6 (5.0) [range: 2-32]	9.8 ± 1.1 (11.0) [range: 3-20]	6.9 ± 0.3 (6.0) [range: 2-32]
Mortality1	1 (0.8%)	1 (2.7%)	2 (1.3%)

¹Values are expressed as number of patients and percentage (parenthesis);

²Values are expressed as mean ± SE and median (parenthesis).

Table 4 Incidence of bowel ischemia, necrosis, and perforation n (%)

Value	Small bowelobstructiongroup (n = 114)	Large bowelobstructiongroup (n = 36)	Total studygroup(n = 150)
Ischemia	15 (13.2%)	6 (16.6%)	21 (14%)
Necrosis	8 (7%)	6 (16.6%)	14 (9.3%)
Perforation	4 (3.5%)	4 (11.1%)	8 (5.3%)

Table 5 Etiology of small bowel ischemia, necrosis, and perforation (small bowel obstruction group, n = 114) n (%)

Cause	Ischemia(n = 15)	Necrosis(n = 8)	Perforation(n = 4)
Hernia	11 (73.3%)	5 (62.5%)	3 (75%)
Adhesions	2 (13.3%)	2 (25%)	1 (25%)
Small bowel volvulus	1 (6.7%)	1 (12.5%)	0 (0%)
Large bowel cancer	1 (6.7%)	0 (0%)	0 (0%)
Small bowel tumor	0 (0%)	0 (0%)	0 (0%)

Table 6 Etiology of large bowel ischemia, necrosis, and perforation (large bowel obstruction group, n = 36) n (%)

Cause	Ischemia(n = 6)	Necrosis(n = 6)	Perforation(n = 4)
Large bowel cancer	3 (50%)	3 (50%)	2 (50%)
Adhesions	1 (16.6%)	1 (16.6%)	1 (25%)
Hernia	1 (16.6%)	1 (16.6%)	1 (25%)
Sigmoid volvulus	1 (16.6%)	1 (16.6%)	0 (0%)
Retroperitoneal tumor	0 (0%)	0 (0%)	0 (0%)
Ovarian cystadenocarcinoma	0 (0%)	0 (0%)	0 (0%)

Table 7 Etiology of bowel ischemia, necrosis, and perforation (total study group, n = 150) n (%)

Cause	Ischemia(n = 21)	Necrosis(n = 14)	Perforation(n = 8)
Hernia	12 (57.2%)	6 (42.8%)	4 (50%)
Large bowel cancer	4 (19.1%)	3 (21.4%)	2 (25%)
Adhesions	3 (14.3%)	3 (21.4%)	2 (25%)
Small bowel volvulus	1 (4.7%)	1 (7.2%)	0 (0%)
Sigmoid volvulus	1 (4.7%)	1 (7.2%)	0 (0%)
Small bowel tumor	0 (0%)	0 (0%)	0 (0%)
Retroperitoneal tumor	0 (0%)	0 (0%)	0 (0%)
Ovarian cystadenocarcinoma	0 (0%)	0 (0%)	0 (0%)