Publication:

Etiological patterns, clinical outcomes and management of acute intestinal obstruction: a prospective study from a tertiary care center

Background Acute intestinal obstruction represents one of the most prevalent surgical emergencies worldwide, significantly impacting healthcare systems and patient outcomes. This study aimed to comprehensively analyze the causes, clinical presentations, management approaches and outcomes of acute intestinal obstruction in a tertiary care setting in Maharashtra, India.

Methods A prospective observational study was conducted over twelve months (2022-23) at Shri Bhausaheb Hire Government Medical College and Hospital, Dhule. Eighty-two consecutive patients with acute intestinal obstruction were enrolled after informed consent. Comprehensive clinical evaluation, laboratory investigations, imaging studies and surgical findings were systematically recorded. Primary outcomes included etiology identification, management approach (conservative versus surgical) and in-hospital mortality. Secondary outcomes comprised postoperative complications and hospital length of stay.

Results The cohort comprised 82 patients with mean age of 48.7±22.3 years and slight male predominance (51.2%). Age distribution showed bimodal pattern with peaks in middle-aged adults (41-50 years, 26.8%) and elderly patients (71-80 years, 17.1%). Adhesions emerged as the predominant cause (35.4%), followed by obstructed hernia (15.9%), malignancy (8.5%) and tuberculous stricture (7.3%). Conservative management succeeded in 24 patients (29.3%), while 58 patients (70.7%) required surgical intervention. Postoperative complications occurred in 29.3%, with septicemia most common (8.5%). Overall mortality was 8.5%, exclusively in the surgical group. Mean hospital stay was 12.3 days.

Conclusions This study demonstrates significant epidemiological transition with adhesions becoming the predominant cause of acute intestinal obstruction, replacing historically dominant obstructed hernias in developing countries. Early diagnosis, appropriate management selection and timely intervention remain critical determinants of outcome. The substantial morbidity and mortality emphasize the need for enhanced preventive strategies and optimized perioperative care protocols.