Obstruction of the bowel is a commonly encountered problem in gastrointestinal surgery all over the world1. It is the most frequent disorder affecting the small bowel and could complicate any form of abdominal procedure including laparoscopic approach2,3.Despite advances in surgery, bowel obstruction remains a difficult problem with significant morbidity and mortality due to disrupted gastrointestinal flow4. Consequently, Intestinal obstruction is associated with considerable clinical burdens, major financial expenditure, frequent emergency room visits and economic loss from time spent away from duties5.Intestinal obstruction is a symptom complex of a disease with diverse aetiologies of wide geographical variations worldwide. The resultant pattern of intestinal obstruction is dependent upon several factors including environmental, cultural, dietary, demographic factors, variations in the level of sophistication of the local medical services as well as individuals’ anatomic differences6. In the last century, significant changes in aetiological factors of intestinal obstruction have occurred from changes in epidemiologic and environment factors, health services provision and education.The aetiology of bowel obstruction has been varied with small intestinal obstruction caused by adhesions in 60%, strangulated hernia in 20%, malignancy in 5% and volvulus in 5%.6 Small bowel obstruction (SBO) is more common and a challenging clinical problem. Large bowel obstruction (LBO) is most often the result of colorectal malignancies and the lesions usually arise in the sigmoid or recto-sigmoid area7.Considering the aetiological factors and by controlling the risk factors for bowel obstruction, are important to decrease in morbidity and mortality2. Better understanding of pathophysiology, improvement in diagnostic technique, fluid and electrolyte management8. Early diagnosis of obstruction and skillful operative management and intensive postoperative treatment carries a better result.

AIM

To determine the clinical presentation, identify the etiologies, and evaluate the management and outcomes of acute bowel obstruction.

The study was undertaken following approval from the institutional ethical committee, and informed consent was obtained from all participating patients. Data were collected from patients admitted to the Department of Surgery at RNT Medical College and its attached MBGH Hospital, Udaipur, who presented with a clinical diagnosis of intestinal obstruction. Inclusion criteria comprised all patients aged over 12 years presenting with features of acute intestinal obstruction. Exclusion criteria included pediatric patients below 12 years of age, those unwilling to participate, and patients with postoperative, uraemic, or post-spinal ileus.

TABLE 1: SHOWING THE AGE AND SEX DISTRIBUTION OF THE CASES

There were 37 male and 23 female in present study cases. The male and females ratio is 1.6: 1.

Graph1.: PRESENTING SYMPTOMS AND SIGNS

In the present study, the most common clinical features observed were abdominal pain (53 cases), constipation (52), vomiting (51), and abnormal bowel sounds (41). Other findings included tenderness or rigidity (40 cases), abdominal distension (32), visible peristalsis (15), and palpable mass (5).

TABLE 2: ETIOLOGY OF INTESTINAL OBSTRUCTION

In this study, the most common cause of intestinal obstruction was adhesions and bands, accounting for 22 cases (36.7%), followed by hernia and malignancy with 10 cases each (16.7%). Other causes included tuberculosis (13.3%), volvulus (11.7%), intussusception (3.3%), and acute mesenteric ischemia (1.7%).

Graph 2: Types of operation

Out of the 60 patients, 55 underwent surgery, with resection and anastomosis performed in 12 cases, including adhesion, stricture, malignancy, and volvulus. Other surgical procedures included adhesiolysis in 22 cases, anatomical hernia repair in 10 cases, derotation of sigmoid volvulus in 1 case, and resection with double barrel colostomy in 2 cases, along with 4 cases of resection and anastomosis for sigmoid volvulus.

Table 3: Postoperative complications

In the study, postoperative complications included wound infection in 8 patients (13.7%), wound dehiscence in 3 patients (5.0%), respiratory infection in 4 patients (6.7%), and septicemia in 5 patients (8.3%).

Table 4 : Association of etiology with postoperative complications

The study showed that out of the total 60 patients, postoperative complications were present in varying frequencies based on the etiology of intestinal obstruction. Adhesions and bands had 5 cases with complications, hernia had 2, malignancy had 5, tuberculosis had 4, volvulus had 3, and acute mesenteric ischemia had 1, while intussusception had no postoperative complications.

Table 5: Follow up status

Follow-up complications included wound infection in 3 patients at one week, fever in 3 patients at one week and 1 patient at two weeks, and respiratory infection in 4 patients at one week and 1 patient at two weeks, with no cases of septicemia, enterocutaneous fistula, prolonged ileus, recurrence, or death reported during the follow-up period

Study was planned for one year after approval of institutional ethical committee. Keeping in view of the availability and feasibility of the participants, a non-random convenient sampling technique was used. So consecutively patients/ eligible participants were considered for the study.

Though intestinal obstruction occurs in all age groups, here the youngest patient was 17 years and oldest patient was 80 years. In this study, 15% belongs to 50-60 years age group &51.7% belongs to 30-60 years age group. Studies by Gill Eggleston⁹ has reported 17% of cases in the age group of 50-60 years and 60% of the cases of intestinal obstruction occur in the age group of 30-60 years. Their studies almost correlate with the present study.However, studies reported by Harban Singh¹⁰ and C. S. Ramachandran¹¹ says that the maximum number of cases occur in the age group of 21-40 years, of these the etiological factors were obstructed hernia. The possible etiological shift is towards adhesions and then hernia, which are decreasing from the earlier twentieth century commonest cause of intestinal obstruction due to awareness and early treatment for hernia.

In present study, there are 37 male and 23 females. Male and female are nearly in equal ratio. Among previous studies, Budharajaet al¹² and Harban Singh et al¹⁰, reported 4: 1 and Shakeed¹³ found equal incidence.

In the present study, the most common presenting symptoms of acute intestinal obstruction were abdominal pain (88.3%), constipation (86.7%), vomiting (85%), and abdominal distension (53.3%). When compared with previous studies, Souvik Adhikari et al.¹⁴ reported abdominal pain in 72%, vomiting in 91%, distension in 66%, and constipation in 64% of cases. Similarly, Jahangir-Sarwar Khan et al.¹⁵ observed abdominal pain in 100%, vomiting in 92%, distension in 97%, and constipation in 97% of patients.

In the present study, the most common cause of acute intestinal obstruction was adhesions (36.7%), followed by hernia (16.7%), malignancy (16.7%), tuberculosis (13.3%), volvulus (11.7%), intussusception (3.3%), and mesenteric vascular thrombosis (1.7%). These findings were compared with various earlier studies. Saravanan PS (2016)¹⁶ in reported adhesions as the cause in 32%. Hernia was the second most frequent cause in several studies, with reported rates of  26% (Saravanan PS). Intussusception was observed in up to 18% in earlier studies but was less common in the present study (3.3%). Tuberculosis accounted for 13.3% in the present study, higher than the 3–9% reported in earlier literature. Malignancy as a cause was seen in 16.7% of current cases, higher than earlier reports which ranged from 3.4% to 10%. Volvulus was found in 11.7% of present cases, with earlier studies showing a wide range from 1% to 25%. Mesenteric vascular thrombosis was noted in 1.7% of cases in this study, a cause not commonly reported in the previous studies.

Most of the cases of our study (out of 60, 55 cases) underwent surgery. Most common operation performed was Adhesiolysis 36.7% followed by Resection and anastomosis 21.7%, Stoma formation (Ileostomy/colostomy) 16.7%, Hernia repair in 15%, Reduction of Intussusception in 1.7%, 8.3 % cases managed conservatively. Postoperatively IV fluids and nasogastric decompression and antibiotics were given till the good bowel movements appeared.

In our study we had mortality rate of 8.3%. The decrease in overall mortality is due to better understanding of pathophysiology of obstruction, improvement inresuscitative and supportive treatment, aggressive surgical therapy in combination with improved technique in anaesthesia.The mortality in intestinal obstruction is high in individuals who develop strangulation and gangrene of the bowel, those present beyond 72 hours and in those are having pre-existing associated diseases and elderly people, though early treatment can reduce the mortality, advanced age and associated metabolic, cardiopulmonary diseases, still leads to high rate of mortality. In the present study conducted in 2023, the mortality rate among patients with intestinal obstruction was 8.3%, which is comparatively lower than many previously reported studies. Sufian and Matsumoto (1975)¹⁷ reported an even higher mortality of 19.0% in 171 cases. C.S. Ramachandran (1982)¹¹ documented a mortality rate of 12.7% in a larger cohort of 417 patients. In more recent findings, Cheadle et al. (1998)¹⁸ reported a mortality of 9.0% among 300 cases. These comparisons highlight an encouraging trend of improved outcomes over time, possibly due to advancements in diagnostic techniques, timely surgical intervention, and better perioperative care.

Intestinal obstruction continues to be a significant surgical emergency, often presenting late with complications that pose considerable challenges for management. Patients typically require prompt and vigorous correction of fluid and electrolyte imbalances, which can be severe and life-threatening. An accurate diagnosis is best achieved through a combination of clinical evaluation, radiological imaging, and intraoperative findings. Postoperative adhesions remain the most common cause of obstruction, especially with the increasing number of abdominal and pelvic surgeries. Mechanical obstruction lacks a specific biochemical marker to distinguish between simple and complicated cases, making the diagnosis of strangulation particularly difficult. Most patients with intestinal obstruction ultimately require surgical intervention, and early operation is crucial to prevent the development of peritonitis, systemic sepsis, and multi-organ failure.

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