Etiology, management, and survival of acute mechanical bowel obstruction: Five-year results of a training and research hospital in Turkey

BACKGROUND: Acute mechanical bowel obstruction (AMBO) is still a major surgical problem for emergency departments. The aim of this study was to evaluate AMBO in terms of etiology, management, and survival.
METHODS: Data of the age, sex, etiology, management, and survival of patients who were hospitalized for bowel obstruction between January 2014 and December 2018 were evaluated retrospectively. Adhesions, tumors, hernias and peritoneal carcinomatosis were evaluated in detail.
RESULTS: A total of 735 patients were included in the study. The obstruction was located in the small bowel (AMSBO) in 60% and in the large bowel (AMLBO) in 40%. The mean patient age was 59.9±16.02 years and 52.9% of the patients were male. Adhesion, tumor, and hernia were the most common etiologies of the overall AMBO group (43.3%, 26.2%, and 6%, respectively). The most common etiology for AMSBO was an adhesion (69.3%), while it was a tumor for AMLBO cases (61.6%). The most common management of AMBO patients was a conservative approach (53.2%; adhesions: 76.7%). Surgical palliation was performed in 24.9% (peritoneal carcinomatosis: 65.7%), and resection was performed in 21.9% (volvulus: 61.9%). The mortality rate in the group was 8.6%. The most common etiology was colorectal surgery (51.4%) for adhesions, colorectal cancer (93.8%) for tumors, and incisional hernia (47.7%) in cases of hernia-related AMBO.
CONCLUSION: Adhesions, tumors, and hernias are the most common etiologies of AMBO. The incidence of femoral/inguinal hernia have decreased while that of incisional hernia has increased, and it was further observed that peritoneal carcinomatosis has now become as common as hernia as a cause.

Mekanik baðýrsak týkanýklýðýnýn etiyoloji, yönetimi ve saðkalýmý: Türkiye’deki bir eðitim ve araþtýrma hastanesinin beþ yýllýk sonuçlarý

AMAÇ: Akut mekanik baðýrsak týkanýklýðý (AMBT) acil servisler için halen ciddi bir cerrahi problemdir. AMBT’nin etiyoloji, yönetimi ve sað kalýmý açýsýndan deðerlendirmeyi amaçlamaktayýz.
GEREÇ VE YÖNTEM: Ocak 2014 ile Aralýk 2018 tarihleri arasýnda baðýrsak týkanýklýðý için yatýrýlmýþ hastalar geriye dönük incelendi. Yaþ, cinsiyet, etiyoloji, yönetim ve sað kalým AMBT açýsýndan geriye dönük deðerlendirildi. Adezyonlar, tümörler, herniler ve peritoneal karsinomatoza daha detaylý deðerlendirildi.
BULGULAR: Çalýþmaya 735 hasta dâhil edildi. %60’ý ince baðýrsak %40’ý kalýn baðýrsak týkanýklýðýydý. Yaþ ortalamasý 59.9±16.02 yýldý. %52.9’u erkek, %47.1’i kadýndý. AMBT’nin en sýk nedeni adezyonlar, tümörler ve hernilerdi (sýrasýyla, %43.3, %26.2 ve %6). Ýnce baðýrsak için en sýk neden adezyon (%69.3), kalýn baðýrsaklar için ise tümörlerdi (%61.6). AMBT’nin en sýk yönetimi konservatif yaklaþýmdý (%53.2), cerrahi palyasyon %24.9 ve rezeksiyon %21.9 oranýnda uygulanmýþtý. Konservatif yaklaþým en sýk adezyonlarda (%76.7), cerrahi palyasyon peritoneal karsinomatozada (%65.7), ve rezeksiyon ise volvulusta (%61.9) uygulanmýþtý. Mortalite oraný %8.6 bulundu. Adezyon için kolorektal cerrahi (%51.4), tümör için splenik fleksura distal (%71.3) yerleþimli kolorektal kanserler (%93.8) ve herniler için ise sýklýkla gastrointestinal cerrahi (%57.1) sonrasý geliþen insizyonel herni (%47.7) en sýk nedenlerdi.
TARTIÞMA: Adezyon, tümör ve herniler AMBT’nin sýrasýyla en sýk nedenleridir. En sýk yönetim þekli konservatif yaklaþýmdýr ve çoðunlukla adezyonlar için uygulanýr. Femoral ve inguinal herni sýklýðý azalýrken insizyonel herni sýklýðý artmakta, peritoneal karsinomatoza son yýllarda herni kadar sýk gözlenmektedir.