ABSTRACT Background: Intra-abdominal adhesions after laparotomy is common surgical problem, it is considered as the main cause of postoperative intestinal obstruction, and also associated with high morbidity and mortality rates. Aim of the work: This study was designed to evaluate postoperative adhesive intestinal obstruction (PAIO) with relation to types of the previously used surgical procedure, Also postoperative period will be correlated in the same study group. Patients and Methods: A retrospective study on total of 438 adult patient were operated on for intestinal obstruction in Prince Sultan Military Medical City, Saudi Arabia (tertiary referral hospital) between January 2006 and December 2014, 259 male (59.1%) and 179 female (40.9%).About399 patient (91.1%) had previous one or more laparotomies as appendectomy (n=182, %=41.6), cholecystectomy (n= 129,%= 29.5), gynecological surgery (n= 25,%= 4.8), right hemi colectomy(n= 18, %=4.1 ), left hemi colectomy (n= 19, %=4.3), total colectomy (n=11, %=2.5), perforated duodenal ulcer(n= 9 %= 2.1) or rectal surgery (n= 6, %= 1.6), 39 patient (8.9%) presented with adhesive intestinal obstruction had no previous abdominal surgical. Conclusion: Post-operative adhesions are the most common causes of intestinal obstruction in surgical patients presenting at our hospital, Previous laparotomy and type of surgery affect largely on occurrence of adhesive intestinal obstruction, also follow up of patients during the first post-operative month can detect and prevent more than 26 % of the post-operative intraabdominal adhesions.
PATIENT AND METHODS This is a retrospective study of all adult patients who were operated for intestinal obstruction due intra-abdominal adhesions either post-operative or spontaneous adhesions at Prince Sultan Military Medical City, Riyadh Saudi Arabia (tertiary hospital) between January 2006 and December 2014. Patients’ medical records were reviewed after obtaining local ethical approval. Secondary data were sourced from the operative registers and from the patients' files in the Records Department. Files with inadequate data were excluded. The diagnosis of adhesive intestinal obstruction carried out by studying the clinical history of previous laparotomy, clinical symptoms of obstruction, such as abdominal pain, distention, vomiting, and constipation; also radiological evidence of IO on plain x-ray of the abdomen; finally all other organic lesions were excluded by radiological contrast study. The abdominal pathology accounted for the initial laparotomy were recorded for all patients as well as the number of previous hospitalizations. The time gap separating the initial laparotomy and the re-admissions was also recorded. The treatment methods achieved by the surgical team either conservative or surgical re-exploration were recorded, as well as the post-operative observation period. All the patient diagnosed to be IO due to intra-abdominal adhesions were confirmed intra-operatively and were reported by the surgical teams. Patients were classified into two main groups, group (A) included the patients who didn’t have previous laparotomy and group (B) included the patients had previous one or more abdominal laparotomy. Data sheet was designed and divided to include patient’s age, gender, causes of the intestinal obstruction, presenting clinical picture, diagnostic imaging and management also included the type of previous operation and the cause and number of previous admissions also the post-operative complications. The data were entered and analyzed using the statistical package for social sciences (SPSS Inc., Chicago, IL, USA), version 16.00. The quantitative data were presented in the form of mean, standard deviation, percentage.
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