Surgery for acute abdominal conditions in intellectually-disabled adults

Area of Science:

• Surgical gastroenterology
• Intellectual disability research
• Patient management

Background:

• Intellectually-disabled patients present unique challenges in diagnosing acute abdominal conditions due to communication barriers and altered responses.
• These challenges can lead to delayed diagnosis, increased complications, and adverse outcomes in perioperative management.

Purpose of the Study:

• To present surgical experiences with acute abdominal conditions in intellectually-disabled patients.
• To highlight management difficulties and propose solutions for improved patient care.

Main Methods:

• A 5-year prospective descriptive study of consecutive intellectually-disabled adults undergoing surgery for acute abdominal conditions.
• Data collected included demographics, clinical presentation, diagnostic methods, operative findings, morbidity, and mortality.

Main Results:

• The study included 22 patients (19 male, 3 female) with a mean age of 28.3 years.
• Common presentations were anorexia, vomiting, and abdominal distension; 36.4% had a history of pica.
• Frequent conditions included intestinal obstruction, appendicitis, and volvulus, with postoperative morbidity at 33% and mortality at 23%.

Conclusions:

• Intellectually-disabled patients require specialized clinical expertise for acute abdominal conditions.
• High clinical suspicion for conditions like anorexia, vomiting, and abdominal distension is essential.
• Intensive perioperative care and early surgical intervention are recommended to mitigate high morbidity and mortality rates.