Acute intestinal obstruction is one of the most frequently encountered surgical emergencies in routine clinical practice. It refers to a partial or complete interruption of the normal passage of intestinal contents and, if not addressed promptly, may rapidly progress to bowel ischemia, perforation, sepsis, and death [1]. Despite improvements in diagnostic modalities, perioperative care, and surgical techniques, acute intestinal obstruction continues to be associated with substantial morbidity and mortality worldwide [2]. The disease burden is particularly high in developing countries, where delayed presentation and limited access to timely surgical care remain significant challenges [3]. The clinical presentation of acute intestinal obstruction is often characteristic but not uniform. Common symptoms include abdominal pain, vomiting, abdominal distension, and constipation, although the severity and combination of these features vary depending on the level, cause, and duration of obstruction [4,5]. Abdominal pain is typically colicky in the early stages due to increased peristaltic activity, while persistent pain may indicate strangulation or ischemia. Vomiting is more prominent in proximal obstruction, whereas abdominal distension is usually marked in distal obstruction [6]. Such variability can complicate early diagnosis and underscores the importance of careful clinical evaluation. Postoperative adhesions are consistently reported as the most common cause of acute intestinal obstruction, accounting for a significant proportion of cases worldwide [7]. Adhesive obstruction is particularly frequent in patients with a history of previous abdominal surgery and represents a growing clinical problem due to the increasing number of operative procedures performed globally [8]. Hernias continue to be an important cause in regions where elective repair is delayed. Other etiological factors include malignancy, volvulus, strictures, intussusception, and fecal impaction, with their relative frequencies varying according to geographical location, age distribution, dietary habits, and healthcare infrastructure [9,10]. Accurate and timely diagnosis is essential for guiding appropriate management and preventing complications. While clinical examination remains the cornerstone of initial assessment, radiological imaging plays a pivotal role in confirming the diagnosis, identifying the level and cause of obstruction, and detecting complications [11]. Plain abdominal radiographs are commonly used as an initial investigation, while ultrasonography and computed tomography have become indispensable diagnostic tools in modern surgical practice [12]. Computed tomography, in particular, provides valuable information regarding bowel viability, the presence of strangulation, and associated intra-abdominal pathology, thereby assisting in decision-making between conservative and surgical management [13]. Management of acute intestinal obstruction requires an individualized approach based on etiology, clinical severity, and patient-related factors. Selected patients, especially those with adhesive obstruction without signs of ischemia or peritonitis, may be managed conservatively with nasogastric decompression, intravenous fluids, and close monitoring [14]. However, a significant proportion of patients ultimately require surgical intervention, particularly in cases of complete obstruction, strangulation, malignancy, or failure of conservative treatment [15]. Surgical procedures may include adhesiolysis, hernia repair, bowel resection with primary anastomosis, or stoma formation depending on intraoperative findings [16]. Postoperative outcomes are influenced by several factors, including age, comorbidities, duration of symptoms before presentation, and the presence of bowel ischemia or perforation at the time of surgery [17]. Delayed presentation and intervention have been consistently associated with higher rates of postoperative complications such as wound infection, sepsis, prolonged hospital stay, and increased mortality [18]. Recurrent obstruction, particularly following adhesive disease, further adds to long-term morbidity and healthcare burden [19]. Given the wide variation in etiological patterns, clinical presentation, and outcomes reported across different regions, institution-specific studies remain essential for understanding local disease trends and optimizing management protocols [20]. Outcome analysis also provides valuable insight into prognostic factors and highlights opportunities for early diagnosis and timely intervention. The present study was undertaken to analyse the clinical presentation, etiological profile, management strategies, and outcomes of patients presenting with acute intestinal obstruction at a tertiary care centre. By correlating clinical findings with operative details and postoperative outcomes, this study aims to contribute meaningful evidence to existing literature and support improved patient care and surgical decision-making

Study Design and Study Setting This research was conducted as a prospective observational study aimed at evaluating the clinical presentation, management practices, and outcomes of patients with acute intestinal obstruction. The study was carried out in the Department of General Surgery at Government Medical College and General Hospital, Jagtial, Telangana. The duration of the study was 18 months, spanning from January 2024 to June 2025. The hospital functions as a tertiary care referral centre catering to both urban and rural populations of the region, thereby providing a diverse patient profile. Study Population and Sample Size All consecutive patients admitted with a provisional diagnosis of acute intestinal obstruction during the study period were assessed for eligibility. Patients were enrolled after confirmation of diagnosis and obtaining informed consent. Both male and female adult patients were included. The sample size was determined by the number of eligible cases presenting during the study period, ensuring a real-world representation of disease burden without selective sampling. Inclusion Criteria Patients presenting with clinical features suggestive of acute intestinal obstruction, including abdominal pain, vomiting, abdominal distension, and constipation, were included in the study. The diagnosis was supported by radiological evidence on erect abdominal radiograph, ultrasonography, or contrast enhanced computed tomography. Patients who consented to participate were enrolled. Exclusion Criteria Patients with paralytic ileus, pseudo-obstruction, postoperative ileus, chronic or subacute intestinal obstruction, and those with abdominal symptoms due to non-obstructive causes were excluded. Pediatric patients were not included. Patients who declined consent or were unfit for evaluation due to terminal illness were also excluded. Clinical Assessment and Data Collection A detailed clinical history was obtained from each patient at admission. Information regarding age, gender, duration and progression of symptoms, previous abdominal surgeries, history of hernia, comorbid conditions such as diabetes or hypertension, and relevant drug history was recorded. A comprehensive physical examination was performed with emphasis on abdominal findings including distension, tenderness, guarding, bowel sounds, visible peristalsis, and palpable masses. Examination of hernial sites was routinely undertaken. Vital parameters were documented at presentation and monitored regularly throughout the hospital stay. All clinical data were recorded in a structured proforma designed specifically for this study to ensure uniformity and completeness of data collection. Laboratory Investigations Baseline laboratory investigations were performed for all patients at admission. These included complete blood count to assess for anemia or leukocytosis, renal function tests and serum electrolytes to evaluate dehydration and electrolyte imbalance, and random blood glucose levels. Additional investigations such as liver function tests, coagulation profile, and arterial blood gas analysis were performed when clinically indicated, particularly in patients with suspected sepsis or metabolic derangements. Radiological Evaluation Radiological assessment played a key role in confirming the diagnosis and guiding management. An erect abdominal radiograph was obtained as the initial imaging modality to identify air-fluid levels and dilated bowel loops. Ultrasonography of the abdomen was performed in selected cases to assess bowel dilatation, free fluid, and associated pathology. Contrast enhanced computed tomography of the abdomen was advised in cases where the diagnosis was uncertain or when complications such as strangulation, ischemia, or perforation were suspected. Computed tomography findings were used to determine the level and cause of obstruction and to aid in deciding the timing and nature of surgical intervention. Management Strategy Initial management focused on prompt resuscitation and stabilization. All patients were kept nil per oral and underwent nasogastric tube decompression. Intravenous fluids were administered to correct dehydration, and electrolyte imbalances were addressed appropriately. Broad spectrum intravenous antibiotics were initiated as per institutional protocol. Patients were closely observed for clinical improvement or deterioration through repeated abdominal examinations and monitoring of vital signs and urine output. Conservative management was continued in patients who were hemodynamically stable and showed no clinical or radiological evidence of strangulation or peritonitis. Failure to improve within a reasonable period or worsening of clinical status prompted surgical intervention. Emergency surgery was undertaken in patients presenting with signs of bowel ischemia, perforation, generalized peritonitis, or complete obstruction. The type of surgical procedure was determined by intraoperative findings. Procedures performed included adhesiolysis, bowel resection with primary anastomosis, stoma formation, hernia repair, and appendicectomy where appropriate. All operative details were documented carefully. Postoperative Care and Follow Up Postoperative care was provided according to standard surgical protocols. Patients were monitored for return of bowel function, wound healing, and development of postoperative complications. Complications such as surgical site infection, anastomotic leak, respiratory infection, and sepsis were recorded. Patients were followed up until discharge or death, and the duration of hospital stay was documented. Outcome Measures Primary outcome measures included mode of management, postoperative complications, duration of hospital stay, and mortality. Secondary outcomes included correlation between clinical presentation, etiology, and treatment outcome. Statistical Analysis Collected data were entered into Microsoft Excel and analyzed using Statistical Package for the Social Sciences software. Continuous variables were expressed as mean with standard deviation or median with interquartile range depending on data distribution. Categorical variables were presented as frequencies and percentages. Associations between variables were assessed using Chi square test or Fisher’s exact test where appropriate. A p value less than 0.05 was considered statistically significant. Ethical Considerations The study protocol was reviewed and approved by the Institutional Ethics Committee of Government Medical College, Jagtial. Written informed consent was obtained from all participants or their legally authorized representatives prior to enrolment. Confidentiality of patient information was maintained throughout the study, and all procedures adhered to ethical standards and institutional guidelines.

Study Population and Demographic Profile During the 18-month study period from 2024 to 2025, a total of 120 patients diagnosed with acute intestinal obstruction were included in the analysis. The study population comprised 78 males (65.0%) and 42 females (35.0%), with a male to female ratio of 1.9:1. The age of patients ranged from 18 to 78 years, with a mean age of 46.3 ± 14.8 years. The highest incidence was observed in the 41–60 year age group, accounting for 38.3% of cases. There was a statistically significant association between increasing age and the need for surgical intervention (Chi square = 9.72, p = 0.021) (Table 1). Table 1: Age and Gender Distribution of Study Population Age group (years) Male Female Total (%) 18–30 12 8 20 (16.7) 31–40 16 10 26 (21.7) 41–60 32 14 46 (38.3) >60 18 10 28 (23.3) Total 78 42 120 (100) Clinical Presentation Abdominal pain was the most frequent presenting symptom and was reported by 112 patients (93.3%). This was followed by vomiting in 102 patients (85.0%), abdominal distension in 96 patients (80.0%), and constipation in 90 patients (75.0%). Fever was noted in 28 patients (23.3%), predominantly among those with strangulation or perforation (Table 2). Patients presenting with all four classical symptoms had a significantly higher likelihood of requiring emergency surgery (Chi square = 11.84, p = 0.008). Table 2: Presenting Symptoms of Acute Intestinal Obstruction Symptom Number (%) Abdominal pain 112 (93.3) Vomiting 102 (85.0) Abdominal distension 96 (80.0) Constipation 90 (75.0) Fever 28 (23.3) Etiological Distribution Postoperative adhesions were identified as the most common cause of obstruction, accounting for 48 cases (40.0%). Hernias were the second most common cause, observed in 30 patients (25.0%). Malignancy accounted for 18 cases (15.0%), while volvulus and strictures were responsible for 12 cases (10.0%) each (Table 3; Figure 1). A significant association was observed between etiology and age group, with malignancy being more common in patients aged above 60 years (Chi square = 14.26, p = 0.004). Table 3: Etiology of Acute Intestinal Obstruction Etiology Number (%) Adhesions 48 (40.0) Hernias 30 (25.0) Malignancy 18 (15.0) Volvulus 12 (10.0) Strictures 12 (10.0) Total 120 (100) Radiological Findings Erect abdominal radiographs demonstrated multiple air-fluid levels in 104 patients (86.7%). Ultrasonography identified dilated bowel loops and free fluid in 68 patients (56.7%). Contrast enhanced computed tomography was performed in 72 patients (60.0%) and successfully identified the level and cause of obstruction in 66 cases (91.7%) (Table 4). CT findings suggestive of bowel ischemia were significantly associated with postoperative complications (Chi square = 10.92, p = 0.001). Table 4: Radiological Findings in Patients with Acute Intestinal Obstruction (n = 120) Radiological modality Key findings Number of patients (%) Erect abdominal radiograph Multiple air-fluid levels 104 (86.7) Ultrasonography abdomen Dilated bowel loops with or without free fluid 68 (56.7) Contrast enhanced computed tomography (CECT) Identification of level and cause of obstruction 66 / 72 (91.7) CECT findings suggestive of bowel ischemia Association with postoperative complications Chi square = 10.92, p = 0.001 Management Pattern Conservative management was successful in 36 patients (30.0%), predominantly in cases of adhesive obstruction without signs of ischemia. Surgical intervention was required in 84 patients (70.0%) (Table 5; Figure 2). The need for surgery was significantly higher among patients presenting after 48 hours of symptom onset (Chi square = 13.64, p < 0.001). Table 5: Management Modality Management approach Number (%) Conservative 36 (30.0) Surgical 84 (70.0) Surgical Procedures Performed Among surgically managed patients, primary closure with omental patch or adhesiolysis was the most frequently performed procedure (48 patients, 40.0%). Resection with anastomosis was required in 36 patients (30.0%), particularly in malignancy and gangrenous bowel. Stoma formation was performed in 24 patients (20.0%), while appendicectomy alone was sufficient in 12 patients (10.0%) (Table 6). The choice of surgical procedure was significantly influenced by the degree of peritoneal contamination (Chi square = 12.68, p = 0.005). Table 6: Surgical Procedures Performed Procedure Number (%) Adhesiolysis / primary closure 48 (40.0) Resection with anastomosis 36 (30.0) Stoma formation 24 (20.0) Appendicectomy 12 (10.0) Postoperative Complications Postoperative complications were observed in 24 patients (20.0%). Surgical site infection was the most common complication (12 patients, 10.0%), followed by sepsis (6 patients, 5.0%), anastomotic leak (4 patients, 3.3%), and respiratory complications (2 patients, 1.7%) (Table 7). Patients with bowel ischemia at surgery had a significantly higher complication rate (Chi square = 15.08, p < 0.001). Table 7: Postoperative Complications Complication Number (%) Surgical site infection 12 (10.0) Sepsis 6 (5.0) Anastomotic leak 4 (3.3) Respiratory complications 2 (1.7) Duration of Hospital Stay The length of hospital stay varied considerably among patients, reflecting differences in disease severity, mode of management, and the presence of complications. The overall mean duration of hospital stay was 8.6 ± 3.4 days. Patients who were successfully managed with conservative treatment had a noticeably shorter hospital stay, with a mean duration of 6.2 ± 2.1 days. In contrast, patients who required surgical intervention stayed longer in the hospital, with an average duration of 9.8 ± 3.6 days. This difference was found to be statistically significant (p < 0.001), highlighting the additional recovery time associated with operative management (Table 8). Shorter hospital stay among conservatively treated patients can be attributed to early clinical improvement, absence of surgical wounds, and lower risk of postoperative complications. On the other hand, surgically managed patients often required prolonged hospitalization due to preoperative resuscitation, postoperative monitoring, delayed return of bowel function, and management of associated complications such as wound infection or sepsis. Patients who underwent bowel resection or stoma formation tended to have longer hospital stays compared to those who underwent simpler procedures like adhesiolysis. These findings emphasize the importance of early diagnosis and timely intervention, as delayed presentation often necessitates surgery and contributes to prolonged hospitalization and increased healthcare utilization. Table 8: Comparison of Duration of Hospital Stay by Mode of Management Management type Mean hospital stay (days) p value Conservative 6.2 ± 2.1 <0.001 Surgical 9.8 ± 3.6 Mortality Analysis In the present study, an overall mortality rate of 8.3 percent was observed, with 10 patients succumbing during the course of hospitalization. Mortality was not uniformly distributed across the study population and was significantly influenced by several clinical factors. Patients who presented late, particularly those arriving more than 72 hours after the onset of symptoms, had a markedly higher risk of death. Delayed presentation often resulted in advanced disease with bowel ischemia, perforation, or generalized peritonitis, which adversely affected outcomes. The presence of bowel ischemia at the time of surgery was strongly associated with increased mortality, as ischemic bowel is frequently accompanied by sepsis, metabolic derangements, and multi-organ dysfunction. Elderly patients, especially those aged above 60 years, also demonstrated a higher mortality rate, likely due to reduced physiological reserve and the presence of comorbid conditions such as diabetes, hypertension, and cardiovascular disease. Statistical analysis confirmed a significant association between these risk factors and mortality (Chi square = 16.42, p < 0.001). These findings underscore the critical role of early recognition, prompt referral, and timely surgical intervention in reducing mortality in acute intestinal obstruction. Improved awareness at the primary care level and early imaging can help prevent delays in treatment and improve survival, particularly among high-risk patient groups.

Acute intestinal obstruction continues to represent a major surgical emergency, demanding timely diagnosis and appropriate intervention to prevent serious complications. The present study provides a comprehensive analysis of the clinical presentation, etiological profile, management strategies, and outcomes of patients presenting with acute intestinal obstruction at a tertiary care centre. The findings highlight important trends that are consistent with existing literature while also reflecting region-specific characteristics. In the present study, acute intestinal obstruction was more commonly observed in middle-aged and elderly patients, with a clear male predominance. Similar demographic trends have been reported in several earlier studies, suggesting a higher exposure of males to risk factors such as previous abdominal surgeries, hernias, and occupational strain [1,3,4]. Increasing age was significantly associated with the need for surgical intervention and adverse outcomes, which may be attributed to reduced physiological reserve and higher prevalence of comorbidities among older individuals [17,18]. Abdominal pain was the most frequent presenting symptom, followed by vomiting, abdominal distension, and constipation. This classical symptom complex has been consistently described as the hallmark of acute intestinal obstruction [4,5]. However, not all patients presented with the complete symptom triad, particularly in early stages or partial obstruction. Patients presenting with all four symptoms were more likely to require emergency surgery, reinforcing the importance of comprehensive clinical assessment in identifying severe disease. Postoperative adhesions emerged as the most common cause of obstruction in the present study. This finding aligns with global trends that identify adhesions as the leading etiology of small bowel obstruction, particularly in patients with prior abdominal surgeries [7,8]. The rising incidence of adhesive obstruction reflects the increasing number of abdominal procedures being performed worldwide [24]. Hernias were the second most common cause, highlighting the continued burden of untreated or delayed hernia repair in resource-limited settings. Malignancy-related obstruction was predominantly observed in older patients, consistent with previous studies reporting age-related variation in etiological patterns [9,10]. Radiological evaluation played a critical role in diagnosis and management planning. Erect abdominal radiographs were useful as an initial screening tool, demonstrating air-fluid levels in the majority of patients. However, contrast enhanced computed tomography showed superior diagnostic accuracy in identifying the level and cause of obstruction and in detecting complications such as bowel ischemia. Several authors have emphasized the pivotal role of computed tomography in early decision-making, particularly in distinguishing simple obstruction from strangulation [11–13]. In the present study, CT findings suggestive of bowel ischemia were significantly associated with postoperative complications, underscoring the prognostic value of advanced imaging. Management strategies were tailored according to clinical severity and radiological findings. Conservative management was successful in a subset of patients, particularly those with adhesive obstruction and no signs of ischemia or peritonitis. Similar success rates for non-operative management have been reported in earlier studies, provided that patients are carefully selected and closely monitored [14,15]. Nonetheless, a majority of patients required surgical intervention, especially those presenting late or with complete obstruction. Delay in presentation beyond 48 to 72 hours was strongly associated with increased surgical requirement and poorer outcomes, a finding that has been widely documented in the literature [18,21]. Among surgically managed patients, adhesiolysis and primary procedures were most frequently performed, while bowel resection with anastomosis or stoma formation was required in cases with compromised bowel viability or malignancy. The choice of surgical procedure was significantly influenced by the degree of peritoneal contamination, which mirrors findings from other outcome-based studies [16,19]. Patients undergoing bowel resection and stoma formation experienced longer hospital stays and higher complication rates, reflecting the severity of underlying pathology. Postoperative complications were observed in one fifth of patients, with surgical site infection being the most common. The incidence of complications was higher among patients with bowel ischemia and delayed presentation. These observations are consistent with previous reports that identify ischemia, perforation, and sepsis as major determinants of postoperative morbidity [17,18]. Early diagnosis and intervention remain crucial in reducing complication rates. The mean duration of hospital stay was significantly longer in surgically managed patients compared to those treated conservatively. Prolonged hospitalization in surgical patients can be attributed to preoperative resuscitation, postoperative recovery, delayed return of bowel function, and management of complications. Similar trends have been reported in population-based studies evaluating the economic and healthcare burden of intestinal obstruction [24]. The overall mortality rate observed in the present study was comparable to rates reported in other tertiary care centre-based studies [10,18]. Mortality was significantly higher among elderly patients, those presenting after 72 hours, and those with bowel ischemia. These findings reinforce the well-established association between delayed intervention and poor outcomes in acute intestinal obstruction [21–23]. Improving early recognition at the primary care level and ensuring timely referral may help reduce mortality, particularly in high-risk groups. Overall, the findings of this study emphasize that acute intestinal obstruction remains a complex surgical condition influenced by multiple patient- and disease-related factors. While advancements in imaging and perioperative care have improved diagnostic accuracy and outcomes, delayed presentation continues to be a major contributor to morbidity and mortality. Institution-specific data such as those presented in this study are essential for understanding local disease patterns and for refining management protocols.

Acute intestinal obstruction remains a significant surgical emergency with considerable implications for patient morbidity and mortality. The present study highlights that postoperative adhesions continue to be the leading cause, followed by hernias and malignancy. Classical symptoms such as abdominal pain, vomiting, distension, and constipation remain key indicators for early diagnosis, although their absence does not exclude severe disease. Timely radiological evaluation, particularly with contrast enhanced computed tomography, plays a crucial role in identifying the level and cause of obstruction and in detecting complications such as bowel ischemia. Early presentation and prompt intervention were associated with favourable outcomes, whereas delayed presentation was strongly linked to increased need for surgery, prolonged hospital stay, postoperative complications, and mortality. Conservative management was effective in carefully selected patients, while surgical intervention was essential in advanced or complicated cases. Overall, the study emphasizes the importance of early clinical recognition, appropriate imaging, and individualized management strategies to improve outcomes in patients with acute intestinal obstruction, especially in resource-limited settings. Conflict of Interest The authors declare that there are no conflicts of interest related to this study. Source of Funding This study did not receive any external funding from public, commercial, or not-for-profit agencies. All investigations and treatments were carried out as part of routine institutional clinical practice. Acknowledgements The authors express their sincere gratitude to all the patients who consented to participate in this study. The authors also acknowledge the support and cooperation of the faculty, residents, nursing staff, and technical personnel of the Department of General Surgery, Government Medical College and General Hospital, Jagtial, Telangana, whose assistance was invaluable in the successful completion of this study. Author Contributions All authors contributed significantly to the conception and design of the study. Data collection, clinical evaluation, patient management, and surgical procedures were carried out by the authors. Data analysis and interpretation were performed collaboratively. The manuscript was drafted, reviewed, and critically revised by all authors, and all authors approved the final version for publication.

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