Causes of mechanical intestinal obstructions and diagnosis in adults

doi:10.21203/rs.3.rs-5178976/v1

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Causes of mechanical intestinal obstructions and diagnosis in adults

https://doi.org/10.21203/rs.3.rs-5178976/v1

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Objective

Intestinal obstruction is defined as the presence of a blockage in the intestines that prevents the passage of contents, slowing down or halting the digestive process. It can be either mechanical or paralytic. Therefore, this study aims to evaluate mechanical intestinal obstructions, accurately determine their causes, and diagnose them in adults.

Methods and Materials:

A retrospective study was conducted, including a sample of 197 patients admitted to the surgery department at Damascus Hospital due to mechanical intestinal obstruction, from June 2021 to June 2024. The sample included patients aged over 18 years, from both genders. Data analysis was performed by a statistical expert.

Results

In our study, there were 128 male patients and 69 female patients, with an average age of 45 years. The most common age group was 18–30 years. We found that the most common cause of intestinal obstruction was adhesions (73.51%), followed by hernias (12.19%) and tumors (6.28%). The most frequent symptom was cessation of gas and stool passage (82.2%), followed by abdominal pain (78.7%) and then nausea and vomiting. The most important signs were abdominal distension (70.7%) and abdominal wall swelling (12.2%). The most commonly used diagnostic tool was a standing abdominal X-ray, utilized in 98.2% of cases. Management included bowel resection and intestinal anastomosis for tumors, while fecal impaction was managed surgically. A group of patients was managed conservatively.

Conclusion

Establishing a protocol that defines the symptoms and signs of intestinal strangulation would be highly beneficial for the early diagnosis of adhesion-related intestinal obstructions. This would enable earlier treatment, reducing complications and mortality.

General Surgery

Mechanical intestinal obstruction

causes

management

diagnosis.

Mechanical bowel obstruction is generally categorized as involving the small or large intestine and can also be due to intraluminal, intraluminal, or extraluminal causes. Small bowel obstruction, which accounts for about 75% of mechanical bowel obstructions, is most commonly caused by intra-abdominal adhesions (from previous surgery, radiation, or other inflammatory processes) or hernia, whereas large bowel obstruction, which accounts for the remaining 25%, is most commonly caused by tumor, sprain, or stricture.{1}

The most worrisome complications of bowel obstruction are intestinal necrosis and perforation. Intestinal strangulation is caused by a fitted hernia or adhesive band. (A closed hernia refers to an unresectable hernia, while a strangulated hernia refers to the occurrence of ischemia and/or necrosis.) This usually occurs in the small intestine, but can also involve the movable portion of the colon (intra-abdominal). Necrosis of the bowel may develop due to increased pressure at the site of bilateral obstruction, also known as “closed loop” obstruction. Examples of this phenomenon include a closed hernia or a large bowel obstruction in the presence of an ileal valve. Intestinal necrosis can also develop due to direct compression of the mesenteric vessels at the hernia neck. Necrosis then leads to perforation, peritonitis (usually with the development of a nonmoving ileus), and sepsis.{2}

Less common are gallstone ileus (caused by gallstones passing through the cholecystoduodenal fistula), parasitic infections, and, in exceptional cases, small bowel tumors. Impacted stools can also obstruct the passage of the intestinal tract, sometimes causing symptoms similar to mechanical bowel obstruction.{3}

The purpose of this study is to evaluate and diagnose mechanical bowel obstruction in adults.

The study sample included 197 adult patients admitted to the surgery department at Al-Mujtahid Hospital in Damascus due to mechanical intestinal obstruction, from June 2021 until June 2024. The sample included patients aged 18 years and above, from both genders, whose mechanical intestinal obstruction was initially diagnosed based on symptoms, clinical signs, and other diagnostic tools. The final diagnosis of the cause of the obstruction was made after surgery or non-surgical procedures, which in our case were limited to reducing a strangulated hernia and breaking up a fecal mass. Patients treated conservatively were excluded due to the inability to confirm the cause of obstruction.

This was a retrospective study, covering 197 patients over four years, from June 2021 to June 2024. The number of male patients was 128, while female patients numbered 69. Mechanical obstruction was found in the small intestine in 175 patients and in the large intestine in 22 patients. The symptoms and signs with which patients presented, as well as laboratory and radiological findings, were studied.

The diagnostic methods used in our study included the clinical history, physical examination, plain abdominal X-ray, ultrasound, CT scan, and lower gastrointestinal endoscopy. A special research form was organized to study various variables, which included: the patient's gender, age, symptoms, signs, laboratory analyses, radiological investigations, initial diagnosis, surgical history, comorbidities, surgical treatment applied, and final diagnosis after surgery.

The timing of surgical intervention was categorized as early surgery within 12 hours of symptom onset or delayed surgery after 12 hours.

A study was conducted on 197 patients who were admitted and treated in the surgery department of Al-Mujtahid Hospital in Damascus with a diagnosis of mechanical intestinal obstruction over a 4-year period.

The distribution of patients by gender and age:

The average age of the affected patients was 45 years, with the age range spanning from 21 to 88 years. Male patients were more affected than female patients, with a ratio of 1:1.84. The highest proportion of mechanical obstructions was found in the age group of 18–50 years, accounting for approximately two-thirds of the cases.

The causes of mechanical intestinal obstruction ranked by prevalence:

Adhesions ranked first, accounting for 73.51% as the cause of mechanical intestinal obstruction, while hernias came in second with 24 cases (12.19%).

Other causes included: foreign bodies (2 cases), fecal impaction (2 cases), and one case each of intussusception, Crohn's disease, and diverticulitis.

The distribution of the causes of intestinal obstruction by gender and age:

We observe a predominance of intestinal obstructions due to adhesions in males compared to females, with a ratio of 8.1:1.

The causes of mechanical small bowel obstruction:

We observe that adhesions and hernias accounted for the vast majority of mechanical small bowel obstruction cases, approximately 96% of the total. Tumors and foreign bodies were present at much lower rates. Other causes included two cases each of Crohn's disease and intussusception.

Causes of mechanical large bowel obstruction:

Tumors were the primary cause of mechanical large bowel obstruction, accounting for 44% of cases. The tumors included: Left colon cancer(7 cases), right colon cancer(2 cases (,transverse colon cancer(1 case ( ,volvulus ranked second, accounting for 36% of cases, all 8 of which occurred in the sigmoid colon. Other causes included : adhesions(2 cases), hernias(1case).

The number of patients with mechanical intestinal obstruction who visited Al-Mujtahid Hospital in Damascus during the study period was 197, with a notable male predominance, accounting for approximately two-thirds of the sample size.

The patients' ages ranged from 21 to 88 years, with about half of them in their third and fourth decades of life.

The most frequently used diagnostic tool was the standing abdominal X-ray, performed on approximately 98% of patients.

We found that the majority of causes of mechanical intestinal obstruction (51.73%) were due to adhesions, which is slightly higher than global rates but consistent with it being the most common cause of mechanical intestinal obstruction. This increase can be attributed to the high number of surgical operations performed.

Strangulated hernias accounted for 19.12% of cases, which is slightly below the global range of 15–20%. This could be due to early diagnosis and repair of abdominal wall hernias, along with the increase in adhesion-related cases reducing this percentage. We observed a higher proportion of strangulated hernias in males, especially inguinal hernias leading to mechanical intestinal obstruction. In our country, this higher percentage is likely due to the delay in patients undergoing surgical repair for these hernias.

The prevalence of tumor-related obstructions (28.6%) is consistent with global studies, attributed to the increased incidence of tumors and delayed diagnosis. We also noted that many of the tumor-related obstructions originated in the left colon.

When comparing the causes of mechanical intestinal obstruction in our study with those reported in previous studies on similar populations, we found that adhesions were the most common cause, which aligns with Greek and Turkish studies, while hernias were the most common cause in Ghana, accounting for 18.63% of cases.

Establishing a protocol that defines the symptoms and signs of intestinal strangulation would be highly beneficial for the early diagnosis of adhesion-related intestinal obstructions, enabling earlier treatment, which in turn would reduce complications and mortality.

Ethics approval and consent to participate

The study protocol was approved by the Research Ethics Committee of Al-sham Private University and the relevant ethics committees of Al-sham Private University, and all procedures performed in the studies involving the participant and subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent for publication:

Not applicable.

Availability of data and materials:

All data produced in the present work are contained in the manuscript

Convict of interest:

The authors declare that they have no convict of interest.

Funding:

This research received no speciﬁc grant from ASPU or any other funding agency in the public, commercial or non-profit sectors.

Acknowledgments:

We are thankful to the management of AL-Sham Private University and

Damascus Hospital for their support in the eld of medical training and research.

van Steensel S, van den Hil LCL, Schreinemacher MHF, Ten Broek RPG, van Goor H, Bouvy ND. Adhesion awareness in 2016: An update of the national survey of surgeons. PLoS One. 2018;13(8):e0202418. [PMC free article] [PubMed]
Behman R, Nathens AB, Karanicolas PJ. Laparoscopic Surgery for Small Bowel Obstruction: Is It Safe? Adv Surg. 2018 Sep;52(1):15-27. [PubMed]
Behman R, Nathens AB, Look Hong N, Pechlivanoglou P, Karanicolas PJ. Evolving Management Strategies in Patients with Adhesive Small Bowel Obstruction: a Population-Based Analysis. J Gastrointest Surg. 2018 Dec;22(12):2133-2141. [PubMed]

The authors declare no competing interests.

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Causes of mechanical intestinal obstructions and diagnosis in adults

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Abstract

Introduction

Methods and materials

Results

Discussion

Declarations

References

Additional Declarations

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