Clinical aspects of adhesive intestinal obstruction

Mechanical intestinal obstruction remains one of the commonest surgical emergencies. With hernias being electively repaired and obstructive hernias becoming less common, adhesive obstruction has emerged as the leading cause of intestinal obstruction in the west. This study was designed to analyse any such changes in the pattern of intestinal obstruction in the population of Pondicherry of Tamilnadu of South India.

Data were collected from the compiled case records at JIPMER, Pondicherry, both retrospectively and prospectively from 1984 to 1992 about the clinical aspects of intestinal obstruction and analysed.

There were 572 patients admitted with a diagnosis of intestinal obstruction in this period. Obstructed external hernia occurred in 219 patients and adhesive obstruction in 176 patients. Fourteen percent of the patients with adhesive obstruction had appendicectomy as the index laparotomy in the past. Majority of the patients presented within 10 years of the index laparotomy. Adhesive obstruction was managed mainly by conservative treatment in 109 cases. There were 25 patients with recurrent obstruction; most of them were conservatively managed.

Obstructed external hernias were the commonest cause of intestinal obstruction. Increasing the patient awareness will help to decrease the incidence of obstructed hernias significantly. Adhesive obstruction deserves a conservative approach with judicious application of surgical intervention. A careful approach is required to avoid the increased morbidity and mortality associated with delay in the diagnosis of gangrenous obstructions.