A. Muzira1, S. Kijjambu1, P. Ongom1, T. Luggya1, D. Ozgediz2 1Mulago Hospital,Kampala, , Uganda 2Yale University School Of Medicine,New Haven, CT, USA
Introduction:
Bowel obstruction is one of the most common surgical emergencies faced in the low-income setting. In this Ugandan tertiary hospital, an average of 50 patients per month are admitted with bowel obstruction, with 31 operations performed in the emergency OR. Previous work confirmed that intestinal helminths accounted for over half of cases of intestinal obstruction in this hospital, but deworming programs have decreased this burden over the last decades. Meanwhile, adhesions are the predominant cause in high-income settings. . This study aimed to characterize the presentation of these patients and the causes of bowel obstruction, to compare with past data, and with high-income settings. We also examined factors associated with outcome.
Methods:
This was a prospective study from December 2013 to May 2014 of patients admitted with a suspected diagnosis of bowel obstruction, to this tertiary hospital in Kampala, Uganda. Inclusion criteria required at least one imaging study suggestive of partial or complete intestinal obstruction. Ethical approval was obtained from the hospital and university IRB. A questionnaire was developed and piloted before being revised and used. Univariate analysis was performed of age, gender, marital status, religion, education, and income level along with presenting symptoms, and signs to assess association with ‘favorable’ or ‘unfavorable’ outcomes.
Results:
110 patients were enrolled, with 72% males and 41% were children under 12 years old. 50% of the patients presented 72 hours after symptom onset with 25% receiving initial management in a lower level health center before reaching the tertiary hospital, while 7% presented within 24 hours of symptom onset. Colicky abdominal pain, vomiting, distension and relative constipation were the most common presenting symptoms. The most common causes were obstructed hernias (21%), volvulus (12%), and adhesions and tumors (9%). Among children (<13), the most common causes were intussusception (9%), anorectal malformations (8%) and atresia (6%). 48% of patients underwent surgery without imaging. Laparotomy with bowel resection and anastomosis was required in 82% cases, and 62% of the patients with obstructed hernias required herniorraphy. Male gender, extremes of age (<1 or >50), marital status (single), and symptoms were associated with unfavorable outcomes (p<0.05) on univariate analysis. In multiple logistic regression, only symptoms were associated with unfavorable outcomes (p<0.05).
Conclusion:
Men more frequently presented with intestinal obstruction, with typical symptoms. Obstructed hernias are the most common cause of bowel obstruction now, compared to previously, when intestinal worms were more common. Children comprise a significant portion of the burden, underscoring the need for pediatric emergency surgical services. Clinical symptoms have a greater degree of association with unfavorable outcomes than demographic factors.