Postoperative non-adhesive mechanical intestinal obstruction: a review of seven cases

Postoperative mechanical intestinal obstruction results commonly from adhesions and less often from other pathologies. Establishing the cause of obstruction in the latter category is usually delayed as attention is often focused on the former. Delayed diagnosis and expedient surgical treatment may lead to bowel infarction.

Consecutive patients presenting with features of postoperative mechanical intestinal obstruction seen at Jos University Teaching Hospital over a 2 year period between February 2000 and December 2002 were the subject of the study.

Seven (20.6 percent) of 34 patients presenting with postoperative mechanical bowel obstruction had pathologies other than adhesions as the underlying cause of obstruction. There were three females and four males with age ranging from 17 to 45 years. All patients presented with features consistent with bowel obstruction. There were no features at the initial setting to suggest non-adhesions as the underlying cause of obstruction. However, three patients had clues that suggested non-adhesions were responsible for the postoperative obstruction. These patients had diagnoses of recurrent sigmoid volvulus, anastomotic colon cancer and a large bowel cancer. They had early surgery and definitive treatment.

Non-adhesive postoperative mechanical bowel obstruction is a rare life-threatening surgical emergency. A high index of suspicion based on the patient's history and response to conservative management is required to achieve early diagnosis so that surgical treatment can be rapidly instituted.