A study of management of large bowel obstruction in a tertiary care centre
Author(s): Dr. TA Vasu
Abstract:Background and Objectives: The challenges in managing this condition are distinguishing colonic obstruction from ileus and ruling out non surgical causes and determining the best surgical management. The morbidity and mortality often are related to the surgical procedure used to relieve the colonic obstruction and, in the long term, to the underlying disease that caused the obstruction. Large bowel obstruction is still a life threatening condition in spite of advances in surgical treatment and critically ill patients care. This study is intended to throw light upon the clinical features and surgical management of large bowel obstruction. Objectives of the study: To study the effectiveness of early identification and surgical intervention in case of large bowel obstruction. Methods: The present study was a prospective study, conducted on 30 inpatients with clinical features suggestive of large bowel obstruction at Victoria and Bowring and Lady Curzon Hospital attached to Bangalore Medical College and Research Institute, Bangalore. A thorough history was taken and examination was done as per proforma after admission. Results: Resection and anastomosis were done in 22 cases, derotation of volvulus and sigmoidopexy in 4 cases, emergency colostomy in 2 cases and abdomino perineal resection in 2 cases. The postoperative complications included wound infection (13.33%), respiratory tract infection (6.66%) and anastomotic leak (3.33%). Overall mortality of this study was 3.33%.The result obtained in this study was comparable with various other studies. Conclusion: Large bowel obstruction remains an important surgical emergency in the surgical field. Success in the treatment of LBO depends largely upon early diagnosis, skilful management and treating the pathological effects of the obstruction just as much as the cause itself. Erect x-ray abdomen is valuable XI investigation in the diagnosis of acute intestinal obstruction. Malignancy and volvulus are the common causes of LBO in our setup. Earlier the presentation, better the outcome was found. It can be concluded that early operations for dynamic LBO is mandatory to avoid the development of peritonitis and systemic sepsis associated with it.