Acute intestinal obstruction represents a very frequent admission to surgical emergencies. The aim of our study was to make a descriptive analysis of the management of acute intestinal obstructions at the level of hospital establishments in Ziguinchor. MaterialsandMethods: This was a retrospective, descriptive, multicenter study from the period of January 1, 2017 to December 31, 2021. Patients over 15 years of age admitted for occlusive syndrome in the two surgical departments of the Ziguinchor regional hospitals were included in the study. Epidemiological, diagnostic, therapeutic and evolutionary data were studied. Results: Acute intestinal occlusions accounted for 8.3% of admissions. A total of 163 patients were enrolled, 61.9% were men, sex ratio of 1.6. The mean age was 48.7 years. The average consultation time was 74.8 hours (3.12 days). The total occlusive syndrome was in 48.5% of the cases. Abdominal pain was present in 87.1%, vomiting in 74.2%, cessation of matter and gas in 60.7% and meteorism in 36.2%. Biological lab tests reported hyperleukocytosis in 28.1% of the cases. Abdominal CT scans were performed in 71.2%, confirming the diagnosis in 90.5% and determining the etiology in 93.1%. The zone of the obstruction in the small bowel was 62.7%, and in the colon in 37.3%. Functional occlusions accounted for 22.7% of cases and mechanical for 77.3%, including 120 cases of strangulation occlusion (95.2%) and 6 cases of obstruction. Etiologies were dominated by adhesions and/or fibrous bands (61.2%). Medical treatment resolved the occlusive syndrome in 9.2% of cases, instrumental treatment in 17.1% and surgical treatment in 77.3%. Adhesiolysis/section of fibrous bands (55.7%), detorsion (14.3%) and resection anastomosis (11.9%) were the most common surgical procedures. Overall morbidity was 11.6%, dominated by surgical site infection (7.14%). The mean resumption of intestinal transit was 2.7 days, and the mean hospital stay was 7.9 days. Overall mortality was 6.7%. Conclusion: Acute intestinal obstruction is a frequent, absolute medical-surgical emergency, with multiple etiologies dominated in our series by adhesions and/or fibrous bands, whose morbi-mortality could be reduced by early and appropriate management before the onset of intestinal necrosis.
References
[1]
Gomis, R., Dieng, M., Diémé, E. and Sall, I. (2021) Occlusions Intestinales aiguës du grêle par brides et/ou adhérences (Oiaba): Aspects étiologiques et thérapeutiques à l’hôpital Principal de Dakar. Journal de Chirurgie, 19, 2775-2780.
[2]
Alaoui, A., Akammar, A., Haloua, M., Alami, B., Boubbou, M. and Maaroufi, M. (2019) Atlas d’imagerie des occlusions intestinales aigues mécaniques de cause inhabituelle et commune. Journal of Dental and Medical Sciences, 18, 76-100.
[3]
Dia, A., Fall, B., Thognon, P., Ndoye, A.K., Sow, M.L. and Diop, A. (1991) Les occlusions intestinales par brides post-opératoires: 79 observations CHU, lin. Chirurgicale, Dakar, Sénégal. Journal de chirurgie, 128, 548-551.
[4]
Engbang, J.P., Beugheum, C.C., Mvele, J.L. and Ngowe, M.N. (2021) Occlusions intestinales aigues: causes, prise en charge et évolution post opératoire dans deux hôpitaux de Douala (Cameroun). Revue de Médecine et de Pharmacie, 11, 1154-1159.
[5]
Agence Nationale de la Statistique et de la Démographie (ANSD) (2023) du Sénégal. Rapport préliminaire sur les données de population Octobre 2023.
[6]
Ooko, P.B., Sirera, B., Saruni, S., Topazian, H.M. and White, R. (2015) Pattern of Adult Intestinal Obstruction at Tenwek Hospital, in South-Western Kenya. Pan African Medical Journal, 20, Article 31. https://doi.org/10.11604/pamj.2015.20.31.5830
[7]
Catena, F., De Simone, B., Coccolini, F., Di Saverio, S., Sartelli, M. and Ansaloni, L. (2019) Bowel Obstruction: A Narrative Review for All Physicians. World Journal of Emergency Surgery, 29, Article No. 20. https://doi.org/10.1186/s13017-019-0240-7
[8]
Adamou, H., Magagi, I.A., Habou, O., Magagi, A., Maazou, H., Adamou, M., et al. (2016) Etiologies et pronostic des occlusions intestinales aigues mécaniques à l’Hôpital National de Zinder: étude transversale sur 171 patients. Pan African Medical Journal, 24, Article 248. https://doi.org/10.11604/pamj.2016.24.248.8372
[9]
Hernandez, M.C., Finnesgard, E.J., Shariq, O.A., Knight, A., Stephens, D., Aho, J.M., Kim, B.D., et al. (2019) Disease Severity and Cost in Adhesive Small Bowel Obstruction. World Journal of Surgery, 43, 3027-3034. https://doi.org/10.1007/s00268-019-05148-y
[10]
Alegbeleye, B.J. (2019) The Current Spectrum of Intestinal Obstruction at a Mission Hospital in Northwestern Cameroon. CPQ Medicine, 5, 1-14.
[11]
Mbengue, A., Ndiaye, A., Maher, S., Schmutz, G., Ranchoup, P., Blum, A., et al. (2016) Imagerie des occlusions intestinales hautes de l’adulte. Feuillets de Radiologie, 56, 265-296. https://doi.org/10.1016/j.frad.2016.04.001
[12]
Perrot, L., Fohlen, A., Alves, A. and Lubrano, J. (2016) Management of the Colonic Volvulus in 2016. Journal of Visceral Surgery, 153, 183-192. https://doi.org/10.1016/j.jviscsurg.2016.03.006
[13]
Jackson, P. and Vigiola Cruz, M. (2018) Intestinal Obstruction: Evaluation and Management. American Family Physician, 98, 362-367.
[14]
Ba, P.A., Diop, B. and Soumah, S.A. (2015) Management of Sigmoid Volvulus in the Tropical Area of Thies (Senegal). Médecine et Santé Tropicales, 25, 316-318. https://doi.org/10.1684/mst.2015.0476
[15]
Abenhaim, H.A., Tulandi, T., Wilchesky, M., Platt, R., Spence, A.R., Czuzoj-Shulman, N. and Suissa, S. (2018) Effect of Cesarean Delivery on Long-Term Risk of Small Bowel Obstruction. Obstetrics & Gynecology, 131, 354-359. https://doi.org/10.1097/AOG.0000000000002440
[16]
Ten Broek, R.P.G., Krielen, P., Di Saverio, S., Coccolini, F., Biffl, W.L., Ansaloni, L., Velmahos, G.C., et al. (2018) Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2017 Update of the Evidence-Based Guidelines from the World Society of Emergency Surgery ASBO Working Group. World Journal of Emergency Surgery, 19, Article No. 24. https://doi.org/10.1186/s13017-018-0185-2
[17]
Chiche, L., Lebreton, G. and Le Pennec, V. (2019) Occlusions intestinales aiguës de l’adulte: Diagnostic. Gastro-entérologie, 14, 1-22.
[18]
Borie, F., Souche, F.-R. and Bertrand, M. (2020) Occlusions intestinales aiguës de l’adulte: Diagnostic. EMC-Gastro-entérologie, 26, 1-23.
[19]
Niang, F.G., Nsria, R.E., Ndong, A., Tendeng, J.N., Diedhiou, M., Diop, A.N. and Konaté, I. (2023) Occlusion intestinale aiguë au centre hospitalier régional de Saint-Louis: corrélations radio-chirurgicales. Journal Africain d’Imagerie Médicale, 15, 185-190.
[20]
Scaglione, M., Galluzzo, M., Santucci, D., Trinci, M., Messina, L., Laccetti, E., Faiella, E. and Zobel, B.B. (2022) Small Bowel Obstruction and Intestinal Ischemia: Emphasizing the Role of MDCT in the Management Decision Process. Abdominal radiology, 47, 1541-1555. https://doi.org/10.1007/s00261-020-02800-3
[21]
Taourel, P., Alili, C., Pages, E., Curros Doyon, F. and Millet, I. (2013) Mechanical Occlusions: Diagnostic Traps and Key Points of the Report. Diagnostic and Interventional Imaging, 94, 805-818. https://doi.org/10.1016/j.diii.2013.03.016
[22]
Podda, M., Khan, M. and Di Saverio, S. (2021) Adhesive Small Bowel Obstruction and the Six w’s: Who, How, Why, When, What, and Where to Diagnose and Operate? Scandinavian Journal of Surgery, 110, 159-169. https://doi.org/10.1177/1457496920982763
[23]
Traoré, D., Sanogo, Z.Z., Bengaly, B., Sissoko, F., Coulibaly, B., Togola, B., et al. (2014) Volvulus du sigmoïde : résultats des approches chirurgicales dans les CHU de Bamako. Journal de Chirurgie Viscérale, 151, 104-108. https://doi.org/10.1016/j.jchirv.2014.01.005
[24]
Seoane, U.A., Saperas, E., O’Callaghan, C.E., Pera, R.M., Raga, G.A., Riu, P.F., Barranco, P.L., et al. (2020) Colonic Stent vs Surgical Resection of the Primary Tumor. Effect on Survival from Stage-IV Obstructive Colorectal Cancer. Revista Espanola De Enfermedades Digestivas, 112, 694-700.
[25]
Cossé, C., Sabbagh, C., Carroni, V., Galmiche, A., Rebibo, L., Regimbeau, J.M. (2017) Impact d’un algorithme basé sur la procalcitonine dans la prise en charge des occlusions grêliques sur brides. Journal de Chirurgie Viscérale, 154, 241-247. https://doi.org/10.1016/j.jchirv.2016.07.009
[26]
Armbrust, R., Chekerov, R., Sander, S., Biebl, M., Chopra, S., Krell, J., et al. (2022) Surgery due to Mechanical Bowel Obstruction in Relapsed Ovarian Cancer: Clinical and Surgical Results of a Bicentric Analysis of 87 Patients. Archives of Gynecology and Obstetrics, 305, 963-968. https://doi.org/10.1007/s00404-021-06237-x
[27]
Cissé, M., Touré, A., Tendeng, J., Seck, M., Thiam, O., Gueye, M., et al. (2015) Apport de la laparoscopie devant les urgences abdominales au CHU à Le Dantec de Dakar, à propos de 144 cas. Le Journal de coelio-chirurgie, 95, 1-4.
[28]
Shu, Q.N.V., Rajiv, J.S., Wei, Y.J., Han Ng, C., Rui, X.G.T., Tan, E. and Seng, C.C. (2021) Controversies of Colonic Stenting in Obstructive Left Colorectal Cancer: A Critical Analysis with Meta-Analysis and Meta-Regression. International Journal of Colorectal Disease, 36, 689-700. https://doi.org/10.1007/s00384-021-03834-9
[29]
Rouibaa, F., Bakkar, M., Seddik, H., Addioui, T., Filali, F.Z., Akka, R., et al. (2013) Intérêt des prothèses métalliques expansives dans la prise en charge de l’occlusion tumorale colique: expérience d’un service hospitalier Marocain. Pan African Medical Journal, 14, Article 68. https://doi.org/10.11604/pamj.2013.14.68.1982
[30]
Baer, C., Menon, R., Bastawrous, S. and Bastawrous, A. (2017) Emergency Presentations of Colorectal Cancer. Surgical Clinics of North America, 97, 529-545. https://doi.org/10.1016/j.suc.2017.01.004
[31]
Mauro, A., Scalvini, D., Borgetto, S., Fugazzola, P., Mazza, S., Perretti, I., Gallotti, A., et al. (2024) Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management. Cancers, 16, Article 821. https://doi.org/10.3390/cancers16040821
[32]
Thacker, C., Lauer, C., Nealon, K., Walker, C. and Factor, M. (2022) Admitting Service and Outcome for Small Bowel Obstruction. The American Surgeon, 88, 643-647. https://doi.org/10.1177/00031348211054065
[33]
Fahim, M., Dijksman, L.M., Derksen, W.J.M., Bloemen, J.G., Biesma, D.H. and Smits, A.B. (2021) Prospective Multicentre Study of a New Bowel Obstruction Treatment in Colorectal Surgery: Reduced Morbidity and Mortality. European Journal of Surgical Oncology, 47, 2414-2420. https://doi.org/10.1016/j.ejso.2021.05.010