Abstract:
BACKGROUND: Gastrointestinal tract (GIT) is a single long tube about 5–7 meters
long extending from the mouth to the anus, and functions to digest food and provide
nutrients to the body. Gastrointestinal obstruction is a major cause of morbidity and
financial expenditure in hospitals around the world, accounting for almost 15% of
surgical emergency department visits for acute abdomen. However, studies on gut
obstruction are scarce in Ethiopia in general and in Southern Region in particular.
OBJECTIVES: To assess the types, causes, management and treatment outcome of
gastrointestinal obstruction and associated factors with the ultimate management
outcome in Southern Ethiopia.
METHODOLOGY: This is hospital based prospective study for three months from May
01 to August 01, 2018 at three governmental referral hospitals in Southern Ethiopia,
namely Hawassa referral hospital, Yirgalem generalized hospital and Dilla referral
hospital. Patients admitted at the surgical emergency units of the hospitals for acute
abdomen and confirmed diagnosis of gastrointestinal obstruction were recruited as study
participants and followed during the course of their management at the hospitals till
discharge. The data were collected by trained data collectors about the objectives of the
study. The collected data were entered into Epi Data 3.1 version and transported to SPSS
for statistical analysis. Binary logistic regression analysis was conducted to identify
factors associated with the management outcomes of gastrointestinal obstruction at the
study hospitals.
RESULTS: Altogether, a total of 156 patients with confirmed diagnosis of gut
obstruction at the three hospitals were studied. The male to female ratio was 1.6:1. Age
ranged 2 to 80 years, with a mean of 34.1±13.7 years. Large bowel obstruction (LBO),
small bowel and gastric outlet obstructions were the common anatomical types of
obstructions in decreasing order. The chief complaints of the patients at admission were
abdominal pain, vomiting, abdominal distension and constipation. The majority of cases
were managed surgically; resection and anastomosis was the most common intraoperative procedure underwent. The most common pathologies were volvulus and
adhesion. Adhesiolysis was the most common post-operative complication evident in
18(12%) cases. In almost 12% (18 out of 150) of the study population, the treatment
outcome was unfavourable with overall mortality rate of was 2.7% (4/150). The
significant predictors of the outcome were length of time lapse from onset to admission, over 24 hrs [AOR=0.034; 95% CI: 0.004 -0.287; p=0.002] and gangrenous sigmoid
volvulus [AOR=4.01; 95% CI: 1.445-15.118; p=0.010].
CONCLUSION AND RECOMMENDATION: Incidence of gastrointestinal obstruction
in the study areas was relatively high, LBO being the commonest obstruction.
Fortunately, mortality risk from the condition was less than 3.0%. Late admission was the
independent predictor of mortality. Improving health seeking behaviour and public
awareness on the role of timely admission to prompt treatment in reducing death from gut
obstruction is recommended.