Acute Bowel Obstructions of the Elderly in a Low African Country

Background: Acute bowel obstruction is one of the main causes of non-traumatic gastro—intestinal surgical emergencies. When they occur in elderly patients, they seem to induce higher morbi-mortality. The aim of our study was to identify the causes of these bowel obstructions in elderly patients and to expose the results of their surgical management. Patients and Methods: Retrospective and analytical study of patients aged 65 years and over, operated on between January 2013 and December 2019 for acute bowel obstruction at the University Hospital of Bouake. Demographic, diagnostic, therapeutic and evolutionary data were analysed. Results: The study involved 36 men and 23 women (sex ratio = 1.6). The mean age of these patients was 70 ± 4.6 years (65 and 90 years). A history and/or co-morbidities were found in 67.8% of them. Patients were classified as ASA I (20.3%), ASA II (42.4%), ASA III (33.9%) or ASA IV (3.4%). The average consultation time was 5.3 ± 4.1 days (2 days and 28 days). Bowel obstructions were due to colonic volvulus (38.9%), colonic cancer (22%), postoperative adhesions (18.6%), strangulated groin hernia (16.9%) or internal bowel hernia (3.3%). Volvulated or necrotic bowel and resectable cancers were resected followed by immediate anastomosis or stoma. Near upstream stomas were performed for unresectable cancers. A herniorrhaphy for groin hernias and a mesenteric breach suture for internal hernia were performed after bowel disinterment. Adhesions were released. The time to surgery was 22.3 ± 12.4 hours (2 hours and 72 hours). The post-surgery morbidity was 32.2%, marked by parietal suppurations (47.4%). The post-surgery mortality was 16.9%. Hemodynamic or septic shock, ASA score ≥ III, bowel necrosis and ICU stay were the significant risk factors. Conclusion: Acute bowel obstructions in the elderly are dominated by colonic volvulus. The high mortality is related to various factors highlighting the frailty of the elderly. A multidisciplinary management involving the geriatrician could improve the prognosis.

Prospective evaluation of intestinal decompression in treatment of acute bowel obstruction from Crohn’s disease

Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression tube(LT)in treatment of CD with acute intestinal obstruction.Methods:This is a prospective observational study.Comparative analysis was performed in CD patients treated with LT(the LT group)and nasogastric tube(the GT group).The primary outcome was the avoidance of emergent surgery.Additionally,predictive factors for failure of decompression and subsequent surgery were investigated.Results:There were 27 and 42 CD patients treated with LT and GT,respectively,in emergent situations.Twelve(44.4%)patients using LT were managed conservatively without laparotomy,while only nine(21.4%)patients in the GT group were spared from emergent surgery(P<0.05).Both in surgery-free and in surgery patients,the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups(both P<0.01).C-reactive protein decrease after intubation and 48-hour drainage volume>500mL were predictors of unavoidable surgery(both P<0.05).The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group(both P<0.05).No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups(all P>0.05).Conclusions:Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction.The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery.Compared to traditional GT decompression,LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence.

Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome

AIM: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia, necrosis, and perforation. METHODS: This is a prospective observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002. RESULTS: Of the 150 consecutive patients included in the study, 114 (76%) presented with small bowel and 36 (24%) with large bowel obstruction. Absence of passage of flatus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms and physical finding, respectively. Adhesions (64.8%), incarcerated hernias (14.8%), and large bowel cancer (13.4%) were the most frequent causes of obstruction. Eighty-eight patients (58.7%) were treated conservatively and 62 (41.3%) were operated (29 on the first day). Bowel ischemia was found in 21 cases (14%), necrosis in 14 (9.3%), and perforation in 8 (5.3%). Hernias, large bowel cancer, and adhesions were the most frequent causes of bowel ischemia (57.2%, 19.1%, 14.3%), necrosis (42.8%, 21.4%, 21.4%), and perforation (50%, 25%, 25%). A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes. CONCLUSION: Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction, respectively. Adhesions, hernias, and large bowel cancer are the most commoncauses of obstruction, as well as of bowel ischemia, necrosis, and perforation. Although an important proportion of these patients can be nonoperatively treated, a substantial portion requires immediate operation. Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.