TITLE:
Etiologies, Clinical Presentation and Outcome of Adult Patients Presenting with Bowel Obstruction on a Virgin Abdomen
AUTHORS:
Georges Bwelle Motto, Tim Fabrice, Yannick Mahamat Ekani Boukar, El-Alaoui Mounjid Khadija Emmanuella, Joseph Cyrille Chopkeng Ngoumfe, Arthur Essomba
KEYWORDS:
Acute Abdomen, Intestinal Obstructions, Etiologies
JOURNAL NAME:
Surgical Science,
Vol.14 No.3,
March
31,
2023
ABSTRACT: Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of
intestinal obstruction on a virgin abdomen or unhealed abdomen at the central
hospital of Yaoundé in order to better understand the main causes and to better
anticipate and improve the diagnosis, management and the evolution of intestinal
obstruction on a virgin abdomen. Method: The patients were prospectively included from June
2021 to May 2022, these patients were recruited from the digestive and
emergency surgery units of the Yaoundé Central Hospital during the study period
and who met the inclusion criteria, with suspicion of partial or total
intestinal obstruction or those with an intraoperative confirmed diagnosis were
enrolled. Results: We recruited 73 patients including 43 (60.3%) men
and 29 (39.7%) women whose mean age was 42.5 years with extremes ranging from
16 to 70 years. Most of them consulted after 72 hours, i.e. 65.2% of cases due to self-medication or even prior
consultations in the lower level center at the Central Hospital of Yaoundé. The
patients retained for this work presented in majority the symptoms according to
the abdominal pains, the stop of the materials and gases; meteorism and
vomiting. Abdominal wall hernias with incarcerated intestinal loops were the
most common cause of intestinal obstruction in an unscarred abdomen in adults
at 38.4% of cases, followed by digestive tumors 23.3% and adhesions 17.8%.
Exceptionally, a cluster of roundworms was found as the cause of intestinal
obstruction in two of our patients. Complications occurred in 25 patients or 31.5% of cases and were dominated respectively by
nausea and hematoma (36%), local infections (24%) and malaria (24%). Death
occurred in 5 of our patients, or
6.8% of cases, and was mostly caused by hypovolemic shock (40%) and
pulmonary embolism (40%). Conclusion: Intestinal obstructions on the abdomen without
scarring remain the prerogative of young adults and are caused by strangulated
hernias with incarcerated intestinal loops, tumors and adhesions. The rate of
complications remains high and they are dominated by infectious pathology.
Their mortality is clearly improving.