Patterns of Small Bowel Volvulus in North - Eastern Ethiopia

Patterns of Small Bowel Volvulus in North - Eastern Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patterns of Small Bowel Volvulus in North - Eastern Ethiopia Yohannes Teshome, Fikru Tadelle, Meron Tadesse, Redwan Yimer, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8454978/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background Small bowel volvulus ( SBV) is a condition where the small bowel loops coil around the axis of its own mesentery which can lead to mechanical intestinal obstruction. It contributes significant number of patients at surgical emergency with small bowel obstruction (SBO) especially in developing countries. The main objective of this study was to assess the clinical and epidemiological status of SBV in North-Eastern Ethiopia. Method The study was conducted at Dessie Comprehensive and Specialized Hospital (DCSH). The study period was on November 2023 G.C. Hospital (facility) based retrospective cross sectional study design was used and data was collected with a standardized structured checklist. Data was collected from medical records of adult patients with discharge diagnosis of small bowel obstruction in a four (4) years period from September 1, 2019 G.C to August 31, 2023 G.C. Cross tabulation analysis was done for factors which contributed for mortality and morbidity of SBV. Result A total of about 162 patient with SBV were included in the study accounting about 37.2% of patients with SBO with annual occurrence rate of about 40.6 patients. The mean age of patients was 47 years. Majority of them (152(93.8%)) were males. The common seasons at presentation were during September - November and March - May. All participants had abdominal pain and vomiting but 159(98.1%) and 143(88.3%) had abdominal distension and constipation respectively. Eighty five (52.5%) of patients with SBV presented within 24hrs of symptom onset and 99(61.1%) had normal CBC result whereas 63(38.9%) of them had leukocytosis. Majority (125(77.1%)) of them were managed with derotation and retrograde milking whereas 12(7.4%) ) were managed with resection and anastomosis and 18(11.1%) undergone band release and derotation. PSBV was seen in 138(85.2%) patients and the remaining 24(14.8%) had SSBV. Conclusion The prevalence of SBV among patients with SBO was 37.2% with 85.2% primary and the remaining 14.8% being secondary type. The annual occurrence rate was about 40.6 patients per year with mean age of 47 years. Small bowel volvulus Small bowel obstruction Dessie Ethiopia Background Volvulus is a mechanical intestinal obstruction resulting from abnormal twisting of a loop of bowel around the axis of its mesentery [ 1 ]. SBV is a condition where the small bowel loops coiled around the axis of its own mesentery [ 2 ]. SBV can be classified as primary or secondary according to the cause. Primary SBV is defined as torsion of a segment of small bowel at the base of the mesentery without any evident underlying cause [ 3 ]. Secondary SBV occurs in the presence of acquired underlying conditions such as post-op adhesion, tumors, pregnancy, diverticular disease and bands [ 4 ]. The most commonly accepted explanation for the initiation of primary small bowel volvulus is the abnormal bowel peristalsis generated due to the sudden overfilling of the empty bowel loop with a large portion of meal after prolong fasting [ 5 ]. No specific symptom, clinical sign, or abnormal laboratory finding clearly identifies both primary and secondary types. A high index of suspicion is required to reach a diagnosis [ 5 , 6 ]. Abdominal pain is the most common presenting feature of small bowel volvulus[ 7 , 8 ]. CT scan is the investigation of choice and a whirl sign is the characteristic finding of bowel volvulus[ 16 ]. Urgent surgical exploration is the treatment of choice to prevent complications due to vascular compromise [ 5 , 9 , 10 ]. The clinical manifestations are due to the narrowing or obliteration of the bowel lumen or cutting off of the blood supply, or both which leads to ischemia finally resulting in gangrene [ 20 , 21 , 22 ]. Common clinical manifestations in order of frequency are central abdominal pain (94 to 100%), nausea or vomiting (83 to 100%), distension (55 to 100%), and constipation (14 to 26%). They may present all together or may occur in any combinations [ 17 , 19 ]. Because of its vague and nonspecific nature, it mimics irritable bowel syndrome, peptic ulcer disease, pancreatic disease, biliary disease, psychiatric disease [ 12 ] and acute appendicitis [ 13 ]. In rural Africa, acute intestinal obstruction accounts a great prevalence of morbidity and mortality [ 14 , 15 ]. Ethiopia is one of the countries where intestinal obstruction constitutes a major cause of morbidity and mortality [ 14 ]. Methods Study area, period and design The study was conducted at Dessie Comprehensive and Specialized Hospital (DCSH), located at Dessie city, Amhara Region, Northeastern Ethiopia. The hospital has catchment area of more than 10 million populations. The hospital gives different inpatient and outpatient services with about 560 staff members including 97 Specialist physicians. The study period was on November 2023. Hospital (facility) based retrospective cross sectional study design was used. Operational Definition Ethiopian seasons - Tsedey (September, October, November), Bega (December, January, February), Bega (March, April, May) and Kiremt (Jun, July, August). Data collection methods and quality control Data was extracted from medical records using structured checklist which was adopted and modified from other similar previous literature and it was prepared in English and administered by trained data collectors after pretest was done. The structured checklist contains each patient’s demography, clinical presentation, duration of illness, and presence of medical co morbidity, season at presentation, history of previous surgery, procedures done, intraoperative findings, postoperative complications and management outcomes. All adult patients above the age of 18 years with a discharge diagnosis of SBO treated at DCSH for 4 years (from September 1, 2019 - August 31, 2023 G.C.) whose medical records are complete and with adequate information in the chart were taken and those charts with incomplete records were not included in the review. Data processing and analysis Data was checked for possible inconsistency, coded and entered directly to SPSS for analysis. Before the data were run through the software for analysis, additional data cleaning was done to look for outliers, missed values, and any inconsistencies. The analysis was described in the form of frequency, percent, mean and median. Variables were cross tabulated with development of SBV and other important outcomes. Ethical considerations Based on declaration of Helsinki developed by The World Medical Association (WMA), Ethical clearance was obtained from Ethical Review Committee of college of medicine and health science at Wollo University. A formal letter was written from the coordinator of department of Surgery to the hospital administrator office for cooperation. The confidentiality and privacy of patient charts was maintained during data collection. Results A total of 436 patient charts with complete data with discharge diagnosis of SBO shown that adhesion contributes 46.8% (204) of SBO whereas SBV accounts 37.2% (162) and hernia, band and small bowel tumors contributes 3% (13), 2.8% (12) and 1.4% (6) respectively(Table 1 ). Table 1 Causes of SBO in DCSH from September 1, 2019 - August 31, 2023, Dessie, Ethiopia, (N = 436) S.N Variables Category Frequency (N) Percentage (%) V.1 Causes of SBO SBV 162 37.2 Adhesion 204 46.8 Small bowel tumors 6 1.4 Hernia 13 3.0 Bands 12 2.8 Others 39 8.9 Among the study participants with SBV, 152(93.8%) were men and 10(6.2%) were women. The age group distribution was 26.5%, 32.7%, 7.8% and 12.9% for age ranges of 16–30, 31–45, 46–60 and > 60 years of age(Table 2 ). Regarding residency, 153(94.4%) lives in rural areas and 9(5.6%) resides in urban areas. 151(93.2%) were farmers and the remaining 2(1.2%) and 9(5.6%) were government employees and merchants respectively(Table 2 ). Table 2 Socio-demographic factors of patients with SBV in DCSH from September 1, 2019 - August 31, 2023, Dessie, Ethiopia, (N = 162) Variable Category Frequency (N) Percentage (%) Sex Male 152 93.8 Female 10 6.2 Age in years 16–30 43 26.5 31–45 53 32.7 46–60 45 27.8 > 60 21 12.9 Residence Rural 153 94.4 Urban 9 5.6 Occupation Farmer 151 93.2 Government Employee 2 1.2 Merchant 9 5.6 Other 0 0 Religion Christian 51 31.5 Muslim 111 68.5 Season Tsedey 55 33.9 Bega 25 15.4 Belg 53 32.7 Kiremt 29 17.9 Out of 162 patients with SBV, 14(8.6%) had comorbidities like hypertension, DM, asthma and cardiac disease whereas 13(8.1%) had previous abdominal surgery(Table 3 ). All (100%) patients had variable degree of abdominal pain and vomiting but 159(98.1%) and 143(88.3%) had abdominal distension and constipation(Table 3 ). Majority of them (85(52.5%)) presented within 24hrs of symptom onset and the remaining 20(12.3%) and 57(35.2%) came to the hospital within a range of 24-48hrs and after 48hrs respectively(Table 3 ). 99(61.1%) of them had normal CBC result whereas 63(38.9%) of them had leukocytosis(Table 3 ). Table 3 Clinical features of patients with SBV in DCSH from September 1, 2019 - August 31, 2023, Dessie, Ethiopia, (N = 162) Variable Category Frequency (N) Percentage (%) Abdominal pain and vomiting Yes 162 100 Abdominal distension Yes 159 98.1 No 2 1.9 Constipation Yes 143 88.3 No 19 11.7 Low blood pressure Yes 5 3.1 No 157 96.9 Tachycardia Yes 100 61.7 No 62 38.3 Fever Yes 3 1.9 No 159 98.1 Abdominal tenderness Yes 6 3.7 No 156 96.3 Bowel sound Normal 95 58.6 Hyperactive 65 40.1 Hypoactive 2 1.2 Visible peristalisis Yes 118 72.8 No 44 27.2 Hypertympanic percussion Yes 158 97.5 No 4 2.5 Duration of illness 48 hrs 57 35.2 CBC result Normal 99 61.1 Leucocytosis 63 38.9 Most of those patients (125(77.1%)) with SBV were managed with derotation and retrograde milking and 12(7.4%) were managed with resection and anastomosis and the remaining 18(11.1%) undergone band release and derotation. 7(4.3%) patients refused surgery(Table 4 ). Table 4 Interventions done for patients with SBV in DCSH from September 1, 2019 - August 31, 2023, Dessie, Ethiopia, (N = 162) Variable Frequency (N) Percentage %) Derotation and retrograde milking 125 77.1 Resection and anastomosis 12 7.4 Band release and derotation 18 11.1 Refused surgery 7 4.3 125(77.2%) of patients with SBV improved without complication and discharged and 28(17.3%) of them developed complications but treated and improved(Table 5 ). About 2(1.2%) of them died in the hospital after intervention and 7(1.6%) with suspected SBV left against medical advice from the emergency room(Table 5 ). Out of those who developed complications, 4(2.5%), 2(1.2%) and 22(13.6%) had SSI, anastomotic leak and paralytic ileus respectively. (Table 5 ). Table 5 Treatment outcome and complications of patients with SBV in DCSH from September 1, 2019 - August 31, 2023, Dessie, Ethiopia, (N = 162) Variable Category Type of SBV Primary SBV (N) Frequency(%) Secondary SBV (N) Frequency (%) Patient outcome Improved without complication 108 66.7 17 10.5 Improved with complication 21 12.9 7 4.3 Died 2 1.2 0 0 Left against medical advice 7 4.3 0 0 Type of complication SSI 2 1.2 2 1.2 Anastomotic leak 2 1.2 0 0 Short bowel syndrome 0 0 0 0 Paralytic ileus 17 10.5 5 3.1 Others 0 0 0 0 Discussion Based on this study, SBV contributes about 37.2% of SBO. The prevalence of small bowel volvulus varies considerably in different parts of the world [ 4 ]. In the United States,Canada, and Western Europe, small bowel volvulus does not represent a health problem of the same magnitude as it is in some African and Asian States where the disease seems to be more common. E.g, a study conducted in Boston, USA showed prevalence of SBV among SBO to be only 4% [ 6 ]. This might be due to commonality of high fiber diet and relatively longer acquired bowel related to these bulk agents in patients of developing countries when compared to developed ones. Studies conducted in Debre Tabor Hospital (North central Ethiopia), Bahir Dar Tibebe Ghion Hospital (North Western Ethiopia), Adama general hospital (Central Ethiopia) and Hossana hospital (Southern Ethiopia) shown a result of 59%, 25%, 30.3% and 51.6% with mean of 41.5% which has acceptable similarity with the current study [ 23 , 26 , 14 , 4 ](Table 6 ). The mean age of occurrence is about 47 years which has proximity with the findings mentioned in Ethiopia, Iran and china [ 23 , 27 , 11 ] (Table 6 ). The age ranges from 16- 80yrs and occurrence is found to decrease with increasing age. The study in Boston shown a mean age of 67 years whereas it is 34 and 37 yrs in Uganda and India respectively [ 6 , 30 , 28 ] (Table 6 ). These differences are basically dependent on the type of SBV where secondary type is more common in older patients and in developed countries where abdominal surgeries are more common unlike the developing world [ 6 ]. The current study shows significant male preponderance of about 152(93.8%) which parallels with most other local and international literature except the study conducted in Boston which shown slight male predominance of 1: 1.2 male to female ratio (6). The exact cause of less association on females is not clearly explained except some anatomic factors like wider pelvis especially in black women and lax abdominal wall muscles more prominent in parous women which are supposed to be protective for females by creating a capacious abdomen providing adequate space for bowel movement and if at all spontaneous detortion before significant twist happens [ 23 ]. Table 6 Summary of reviewed literature Authors Yohannes T. (Current study) Atalel F. M. Demssie Roggo Duke Gulati Vaez-Zadeh De Souza Xiaohang Li Study place Dessie, Ethiopia Debre Tabor, Ethiopia Hossana, Ethiopia Boston, USA Afghanistan India Iran Uganda Shenyang China Study Period Sep 1,2019 -Aug 31, 2023 Jan1,2016-Dec31, 2019 June 1992 -May 1996 1980–1990 1970–1971 1966–1971 1962–1967 1962–1964 January 2001 to Decem ber 2015 Duration of study 4 years 4 years 4 years 10 years 13 months 6 years 5 years 2 years 15yrs No of patients 162 148 98 35 26 54 41 12 31 Annual occurrence 40.5 37 24.5 3.5 24 9 8.2 6 2.06 Male to female ratio 15.2 : 1 5.4 : 1 8.8 : 1 1 : 1.2 --- 12.5 : 1 9.25 : 1 3 : 1 1.06 : 1 Mean age (years) 47 41.14 34.1 67 37 42 34 47.7 Primary SBV (%) 85.2 100 94.9 14 100 70 80 100 41.9 Secondary SBV (%) 14.8 0 5.1 86 0 30 20 0 58.1 Gangrenous SSBV (%) 7.4 16.9 28.7 46 -- 15 -- 17 48.4 Overall mortality (%) 1.2 3.4 13.3 9 15 26 15 33 9.7 Rural residents are significantly affected by SBV with a rate of 94.4% in our study which coincides with studies conducted in Debre Tabor and Hossana, Ethiopia [ 23 , 4 ]. These could be related to the heavy activities and common practice of ingesting large amount of bulky food at a time. The common seasons at presentation are from September to November and March to May accounting about 33.9% and 32.7% respectively. These seasonal variations are also observations by Agegnehu and Demissie M from Ethiopia, Duke from Afghanistan and Veaz-Zadeh from Iran [ 24 , 4 , 29 , 27 ] (Table 6 ). These are months of fasting for both Muslims (Ramadan) and Christians at when large amount of fibrous diet may be taken after prolonged fasting causing a bulky bolus of food entering the proximal jejunum making it to fall down into pelvis and causing empty distal bowel to rise into a right upper quadrant. Rapid emptying of the stomach makes the distal bowel to spread across the left upper quadrant. As this distal loop is filled up again, it would fall into left lower quadrant completing 360 0 twists [ 23 , 25 ]. Based on the type of SBV, primary type accounted about 85.2% while secondary SBV takes 14.8%. This has slight similarity with figures obtained from Iran (PSBV- 80% and SSBV − 20%), and India (PSBV- 70% and SSBV − 30%)(29,30). But it is completely opposite to the same study of Boston which shows 14% PSBV and 86% SSBV [ 6 ]. This could possibly be due to high abdominal surgery rates in the United States predisposing patients for development of fibrous band around which the small bowel volvulates. In Afghanistan and Uganda, all patients with SBV has the primary type [ 29 , 30 ]. This could be due to the same reason of high fiber diet which is more common in developing countries predisposing to primary SBV. We found no patient with previous abdominal surgery developing primary SBV but about 13(54.2%) of the 24 patients with secondary SBV had it. In our study, 85(52.5%) of patients with SBV presented within 24hours of symptom onset. This is opposite to the finding by Demissie M from Hossana, Ethiopia which shows only 20.4% presenting within 24hours and 79.6% of them presented after 24 hours [ 4 ]. This is relatively an old study (1992–1996) and the recent early presentation could be due to increase in communal health seeking behavior and high index of suspicion and early detection by clinicians. Conclusion Small bowel volvulus is an important and common emergency surgical encounter with prevalence of 37.2% among patients with SBO. The mean age of occurrence is 47 years more common in rural residents during the months of September through November and March through May. Most of our patients undergone operative exploration and successfully treated with low morbidity and mortality. Abbreviations CBC: Complete blood count; CT: Computerized Tomography; DCSH: Dessie Comprehensive and specialized hospital; DM: Diabetes Mellitus; G.C: Gregorian Calender; MRN: Medical record number; N: Number; PSBV: Primary small bowel volvulus; SBO: Small bowel obsruction; SBV: Small bowel volvulus; SSBV: Secondary small bowel volvulus; SSI: Surgical site infection; USA: United States of America; WMA: World Medical Association Declarations Acknowledgements Not applicable. Authors ’ contributions Conceptualization: YT,MT. Data collection and Methodology development: YT,FT,RY,AS. Software: YT. Data analysis: YT,FT,MT. Manuscript Draft: YT,AF,MT,AS. Manuscript review and editing; YT,AF,RY,AS,SA. All authors have read and approved the manuscript. Funding No funding given for this study Availability of data and materials The datasets used and/or analyzed during the current study are available from corresponding authors on reasonable request. Ethical approval and consent to participate Based on declaration of Helsinki developed by The World Medical Association (WMA), Ethical Review Committee of Wollo University approved the ethical issue of this study and official permission to undertake the study was obtained from Dessie Comprehensive and Specialized Hospital. The confidentiality and privacy of patients was maintained during data collection. The data was collected retrospectively from medical charts and consent from patients was not needed. Consent for publication Not applicable Competing interests Authors declare that they have no competing interests. References Purcell LN, Reiss R, Mabedi C, Gallaher J, Maine R, Charles A. HHS Public Access. 2021;44(7):2087–93. Kapadia MR. Volvulus of the Small Bowel and Colon. Clin Colon Rectal Surg September. 2019;12(1):040–5. Li X, Zhang J, Li B, Yi D, Zhang C, Sun N, et al. 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14:12:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":801181,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8454978/v1/0bfbdb5e-a831-4201-9599-3a2ed471baee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patterns of Small Bowel Volvulus in North - Eastern Ethiopia","fulltext":[{"header":"Background","content":"\u003cp\u003eVolvulus is a mechanical intestinal obstruction resulting from abnormal twisting of a loop of bowel around the axis of its mesentery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. SBV is a condition where the small bowel loops coiled around the axis of its own mesentery [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. SBV can be classified as primary or secondary according to the cause. Primary SBV is defined as torsion of a segment of small bowel at the base of the mesentery without any evident underlying cause [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Secondary SBV occurs in the presence of acquired underlying conditions such as post-op adhesion, tumors, pregnancy, diverticular disease and bands [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most commonly accepted explanation for the initiation of primary small bowel volvulus is the abnormal bowel peristalsis generated due to the sudden overfilling of the empty bowel loop with a large portion of meal after prolong fasting [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. No specific symptom, clinical sign, or abnormal laboratory finding clearly identifies both primary and secondary types. A high index of suspicion is required to reach a diagnosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Abdominal pain is the most common presenting feature of small bowel volvulus[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. CT scan is the investigation of choice and a whirl sign is the characteristic finding of bowel volvulus[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Urgent surgical exploration is the treatment of choice to prevent complications due to vascular compromise [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe clinical manifestations are due to the narrowing or obliteration of the bowel lumen or cutting off of the blood supply, or both which leads to ischemia finally resulting in gangrene [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Common clinical manifestations in order of frequency are central abdominal pain (94 to 100%), nausea or vomiting (83 to 100%), distension (55 to 100%), and constipation (14 to 26%). They may present all together or may occur in any combinations [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Because of its vague and nonspecific nature, it mimics irritable bowel syndrome, peptic ulcer disease, pancreatic disease, biliary disease, psychiatric disease [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and acute appendicitis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In rural Africa, acute intestinal obstruction accounts a great prevalence of morbidity and mortality [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Ethiopia is one of the countries where intestinal obstruction constitutes a major cause of morbidity and mortality [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area, period and design\u003c/h2\u003e \u003cp\u003eThe study was conducted at Dessie Comprehensive and Specialized Hospital (DCSH), located at Dessie city, Amhara Region, Northeastern Ethiopia. The hospital has catchment area of more than 10\u0026nbsp;million populations. The hospital gives different inpatient and outpatient services with about 560 staff members including 97 Specialist physicians. The study period was on November 2023. Hospital (facility) based retrospective cross sectional study design was used.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOperational Definition\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eEthiopian seasons\u003c/strong\u003e \u003cp\u003e- Tsedey (September, October, November), Bega (December, January, February), Bega (March, April, May) and Kiremt (Jun, July, August).\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eData collection methods and quality control\u003c/h3\u003e\n\u003cp\u003eData was extracted from medical records using structured checklist which was adopted and modified from other similar previous literature and it was prepared in English and administered by trained data collectors after pretest was done. The structured checklist contains each patient\u0026rsquo;s demography, clinical presentation, duration of illness, and presence of medical co morbidity, season at presentation, history of previous surgery, procedures done, intraoperative findings, postoperative complications and management outcomes. All adult patients above the age of 18 years with a discharge diagnosis of SBO treated at DCSH for 4 years (from September 1, 2019 - August 31, 2023 G.C.) whose medical records are complete and with adequate information in the chart were taken and those charts with incomplete records were not included in the review.\u003c/p\u003e\n\u003ch3\u003eData processing and analysis\u003c/h3\u003e\n\u003cp\u003eData was checked for possible inconsistency, coded and entered directly to SPSS for analysis. Before the data were run through the software for analysis, additional data cleaning was done to look for outliers, missed values, and any inconsistencies. The analysis was described in the form of frequency, percent, mean and median. Variables were cross tabulated with development of SBV and other important outcomes.\u003c/p\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e Based on declaration of Helsinki developed by The World Medical Association (WMA), Ethical clearance was obtained from Ethical Review Committee of college of medicine and health science at Wollo University. A formal letter was written from the coordinator of department of Surgery to the hospital administrator office for cooperation. The confidentiality and privacy of patient charts was maintained during data collection.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 436 patient charts with complete data with discharge diagnosis of SBO shown that adhesion contributes 46.8% (204) of SBO whereas SBV accounts 37.2% (162) and hernia, band and small bowel tumors contributes 3% (13), 2.8% (12) and 1.4% (6) respectively(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCauses of SBO in DCSH from September 1, 2019 - August 31, 2023, Dessie, Ethiopia, (N\u0026thinsp;=\u0026thinsp;436)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS.N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrequency (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eV.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eCauses of SBO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSBV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e162\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdhesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSmall bowel tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the study participants with SBV, 152(93.8%) were men and 10(6.2%) were women. The age group distribution was 26.5%, 32.7%, 7.8% and 12.9% for age ranges of 16\u0026ndash;30, 31\u0026ndash;45, 46\u0026ndash;60 and \u0026gt;\u0026thinsp;60 years of age(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Regarding residency, 153(94.4%) lives in rural areas and 9(5.6%) resides in urban areas. 151(93.2%) were farmers and the remaining 2(1.2%) and 9(5.6%) were government employees and merchants respectively(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic factors of patients with SBV in DCSH from September 1, 2019 - August 31, 2023, Dessie, Ethiopia, (N\u0026thinsp;=\u0026thinsp;162)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment Employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSeason\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTsedey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBega\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKiremt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOut of 162 patients with SBV, 14(8.6%) had comorbidities like hypertension, DM, asthma and cardiac disease whereas 13(8.1%) had previous abdominal surgery(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). All (100%) patients had variable degree of abdominal pain and vomiting but 159(98.1%) and 143(88.3%) had abdominal distension and constipation(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Majority of them (85(52.5%)) presented within 24hrs of symptom onset and the remaining 20(12.3%) and 57(35.2%) came to the hospital within a range of 24-48hrs and after 48hrs respectively(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). 99(61.1%) of them had normal CBC result whereas 63(38.9%) of them had leukocytosis(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical features of patients with SBV in DCSH from September 1, 2019 - August 31, 2023, Dessie, Ethiopia, (N\u0026thinsp;=\u0026thinsp;162)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal pain and vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAbdominal distension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLow blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTachycardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAbdominal tenderness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBowel sound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHyperactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypoactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVisible peristalisis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHypertympanic percussion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDuration of illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24 hrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u0026ndash;48 hrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;48 hrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCBC result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeucocytosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMost of those patients (125(77.1%)) with SBV were managed with derotation and retrograde milking and 12(7.4%) were managed with resection and anastomosis and the remaining 18(11.1%) undergone band release and derotation. 7(4.3%) patients refused surgery(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterventions done for patients with SBV in DCSH from September 1, 2019 - August 31, 2023, Dessie, Ethiopia, (N\u0026thinsp;=\u0026thinsp;162)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDerotation and retrograde milking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResection and anastomosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBand release and derotation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRefused surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e125(77.2%) of patients with SBV improved without complication and discharged and 28(17.3%) of them developed complications but treated and improved(Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). About 2(1.2%) of them died in the hospital after intervention and 7(1.6%) with suspected SBV left against medical advice from the emergency room(Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Out of those who developed complications, 4(2.5%), 2(1.2%) and 22(13.6%) had SSI, anastomotic leak and paralytic ileus respectively. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTreatment outcome and complications of patients with SBV in DCSH from September 1, 2019 - August 31, 2023, Dessie, Ethiopia, (N\u0026thinsp;=\u0026thinsp;162)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eType of SBV\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimary SBV (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrequency(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003cp\u003eSBV (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePatient outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImproved without complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImproved with complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft against medical advice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eType of complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnastomotic leak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShort bowel syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParalytic ileus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBased on this study, SBV contributes about 37.2% of SBO. The prevalence of small bowel volvulus varies considerably in different parts of the world [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In the United States,Canada, and Western Europe, small bowel volvulus does not represent a health problem of the same magnitude as it is in some African and Asian States where the disease seems to be more common. E.g, a study conducted in Boston, USA showed prevalence of SBV among SBO to be only 4% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This might be due to commonality of high fiber diet and relatively longer acquired bowel related to these bulk agents in patients of developing countries when compared to developed ones. Studies conducted in Debre Tabor Hospital (North central Ethiopia), Bahir Dar Tibebe Ghion Hospital (North Western Ethiopia), Adama general hospital (Central Ethiopia) and Hossana hospital (Southern Ethiopia) shown a result of 59%, 25%, 30.3% and 51.6% with mean of 41.5% which has acceptable similarity with the current study [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e](Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe mean age of occurrence is about 47 years which has proximity with the findings mentioned in Ethiopia, Iran and china [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The age ranges from 16- 80yrs and occurrence is found to decrease with increasing age. The study in Boston shown a mean age of 67 years whereas it is 34 and 37 yrs in Uganda and India respectively [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). These differences are basically dependent on the type of SBV where secondary type is more common in older patients and in developed countries where abdominal surgeries are more common unlike the developing world [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe current study shows significant male preponderance of about 152(93.8%) which parallels with most other local and international literature except the study conducted in Boston which shown slight male predominance of 1: 1.2 male to female ratio (6). The exact cause of less association on females is not clearly explained except some anatomic factors like wider pelvis especially in black women and lax abdominal wall muscles more prominent in parous women which are supposed to be protective for females by creating a capacious abdomen providing adequate space for bowel movement and if at all spontaneous detortion before significant twist happens [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of reviewed literature\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYohannes T.\u003c/p\u003e \u003cp\u003e(Current study)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAtalel F.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM. Demssie\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRoggo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDuke\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGulati\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVaez-Zadeh\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDe Souza\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eXiaohang Li\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDessie, Ethiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDebre Tabor, Ethiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHossana, Ethiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBoston, USA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAfghanistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eShenyang\u003c/p\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy Period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSep 1,2019 -Aug 31, 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJan1,2016-Dec31, 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJune 1992 -May 1996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1980\u0026ndash;1990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1970\u0026ndash;1971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1966\u0026ndash;1971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1962\u0026ndash;1967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1962\u0026ndash;1964\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eJanuary 2001 to Decem\u003c/p\u003e \u003cp\u003eber 2015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e15yrs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnnual occurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale to female ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.2 : 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4 : 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.8 : 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 : 1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.5 : 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.25 : 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 : 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.06 : 1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e47.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary SBV (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e41.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary SBV (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e58.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGangrenous SSBV (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e48.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall mortality (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRural residents are significantly affected by SBV with a rate of 94.4% in our study which coincides with studies conducted in Debre Tabor and Hossana, Ethiopia [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These could be related to the heavy activities and common practice of ingesting large amount of bulky food at a time. The common seasons at presentation are from September to November and March to May accounting about 33.9% and 32.7% respectively. These seasonal variations are also observations by Agegnehu and Demissie M from Ethiopia, Duke from Afghanistan and Veaz-Zadeh from Iran [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). These are months of fasting for both Muslims (Ramadan) and Christians at when large amount of fibrous diet may be taken after prolonged fasting causing a bulky bolus of food entering the proximal jejunum making it to fall down into pelvis and causing empty distal bowel to rise into a right upper quadrant. Rapid emptying of the stomach makes the distal bowel to spread across the left upper quadrant. As this distal loop is filled up again, it would fall into left lower quadrant completing 360\u003csup\u003e0\u003c/sup\u003e twists [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on the type of SBV, primary type accounted about 85.2% while secondary SBV takes 14.8%. This has slight similarity with figures obtained from Iran (PSBV- 80% and SSBV \u0026minus;\u0026thinsp;20%), and India (PSBV- 70% and SSBV \u0026minus;\u0026thinsp;30%)(29,30). But it is completely opposite to the same study of Boston which shows 14% PSBV and 86% SSBV [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This could possibly be due to high abdominal surgery rates in the United States predisposing patients for development of fibrous band around which the small bowel volvulates. In Afghanistan and Uganda, all patients with SBV has the primary type [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This could be due to the same reason of high fiber diet which is more common in developing countries predisposing to primary SBV.\u003c/p\u003e \u003cp\u003eWe found no patient with previous abdominal surgery developing primary SBV but about 13(54.2%) of the 24 patients with secondary SBV had it. In our study, 85(52.5%) of patients with SBV presented within 24hours of symptom onset. This is opposite to the finding by Demissie M from Hossana, Ethiopia which shows only 20.4% presenting within 24hours and 79.6% of them presented after 24 hours [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This is relatively an old study (1992\u0026ndash;1996) and the recent early presentation could be due to increase in communal health seeking behavior and high index of suspicion and early detection by clinicians.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSmall bowel volvulus is an important and common emergency surgical encounter with prevalence of 37.2% among patients with SBO. The mean age of occurrence is 47 years more common in rural residents during the months of September through November and March through May. Most of our patients undergone operative exploration and successfully treated with low morbidity and mortality.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eCBC: Complete blood count; CT: Computerized Tomography; DCSH: Dessie Comprehensive and specialized hospital; DM: Diabetes Mellitus; G.C: Gregorian Calender; MRN: Medical record number; N: Number; PSBV: Primary small bowel volvulus; SBO: Small bowel obsruction; SBV: Small bowel volvulus; SSBV: Secondary small bowel volvulus; SSI: Surgical site infection; USA: United States of America; WMA: World Medical Association\u0026nbsp;\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo; \u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: YT,MT. Data collection and Methodology development: YT,FT,RY,AS. Software: YT. Data analysis: YT,FT,MT. Manuscript Draft: YT,AF,MT,AS. Manuscript review and editing; YT,AF,RY,AS,SA. All authors have read and approved the manuscript.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding given for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from\u003c/p\u003e\n\u003cp\u003ecorresponding authors on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on declaration of Helsinki developed by The World Medical Association (WMA), Ethical Review Committee of Wollo University approved the ethical issue of this study and official permission to undertake the study was obtained from Dessie Comprehensive and Specialized Hospital. The confidentiality and privacy of patients was maintained during data collection. The data was collected retrospectively from medical charts and consent from patients was not needed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePurcell LN, Reiss R, Mabedi C, Gallaher J, Maine R, Charles A. HHS Public Access. 2021;44(7):2087\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKapadia MR. Volvulus of the Small Bowel and Colon. Clin Colon Rectal Surg September. 2019;12(1):040\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi X, Zhang J, Li B, Yi D, Zhang C, Sun N, et al. Diagnosis, treatment and prognosis of small bowel volvulus in adults: A monocentric summary of a rare small intestinal obstruction. PLoS One September. 2019;12(4):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemissie M. Small intestinal volvulus in Southern Ethiopia. East Afr Med J. 2001;78(4):208\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShyam DC, Shyam RC. Small Bowel Volvulus In Adult: A Review Of Literature. Eur J Med Heal Sci. 2020;2(3):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoggo A, Ottinger LW. Acute small bowel volvulus in adults: A sporadic form of strangulating intestinal obstruction. Ann Surg. 1992;216(2):135\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen X, Guan W, Cao K, Wang H, Du J. 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J Curr Surg. 2012;2(3):110\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi CH, Chen CH, Chou JW. Intestinal obstruction caused by small bowel volvulus. Am J Med. 2011;124(11):e3\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWright A, Chong S, Willatt J. ScienceDirect Small bowel volvulus around caesarian section scar adhesions. Radiol Case Reports [Internet]. September 12, 2019;12(3):504\u0026ndash;7. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.radcr.September\u003c/span\u003e\u003cspan address=\"10.1016/j.radcr.September\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e 12, 2019.04.022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurke EP, Saeed M, Mahmood M, Hayes C, Salama M, Ahmed I. Case Report Whirl Sign and Midgut Volvulus: An Unusual Cause of an Acute Abdomen in an Adult Patient. 2019;2019(Fig. 1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoressa U, Mamo A, Hiko D, Fentahun N. Prevalence, causes and management outcome of intestinal obstruction in Adama Hospital, Ethiopia. BMC Surg [Internet]. 2016;16(1):1\u0026ndash;8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1186/s12893-016-0150-5\u003c/span\u003e\u003cspan address=\"10.1186/s12893-016-0150-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuill DS, Devlin HB, Plant JA, Denham KR, McNay RA, Morris D. Surgical operation rates: A twelve year experience in Stockton on Tees. Ann R Coll Surg Engl. 1983;65(4):248\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsang CLN, Joseph CT, De Robles MSB, Putnis S. Primary Small Bowel Volvulus: An Unusual Cause of Small Bowel Obstruction. Cureus. 2019;11(12):9\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIslam S, Hosein D, Dan D, Naraynsingh V. Volvulus of ileum: a rare cause of small bowel obstruction. 2016;2\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlein J, Baxstrom K, Donnelly S, Feasel P, Koles P. A Fatal Twist: Volvulus of the Small Intestine in a 46-Year-Old Woman. Case Rep Med. 2015;2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrinda MAA, Manjunath S, Balasubramanya KS, Nanjaiah B. An unusual case of small bowel volvulus. J Clin Diagn Res. 2015;9(11):PD08\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapadimitriou G, Marinis A, Papakonstantinou A. Primary Midgut Volvulus in Adults: Report of Two Cases and Review of the Literature. J Gastrointest Surg. 2011;15(10):1889\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValsdottir E, Marks JH. Volvulus: small bowel and colon. Clin Colon Rectal Surg. 2008;21(02):091\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatial T, Chaddha S, Rathore N, Thakur V. Small Bowel Volvulus: A Case Report. September 12, 2019;9(5):9\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAwedew AF, Belay WB, Amsalu BT, Yalewu DZ. Small bowel volvulus (SBV) in Northcentral Ethiopia. BMC Surg. 2020;20(1):4\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBayeh AB, Abegaz BA. Seasonality of Primary Small Bowel Volvulus and Its Variations Based on Sex and Place of Residence, North Western Ethiopia. Cureus. 2022;14(7).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndersen DK. Maingot's Abdominal Operations. Ann Surg. 1986;1(5):607. \u0026amp; 2\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeyene EG, Tarekegn TK, Lebelo RH, Minase MM, Mekonnen RA, Teshome ES. Associated Factors and Management Outcome Intestinal Obstruction Among Prevalence, Associated Factors and Management Outcome Intestinal Obstruction Among Acute Abdomen in Tibebe Ghion Specialized Hospital, Bahr Dar, Ethiopia, 2021. September 11, 2023;(April).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVaez-Zadeh K, Dutz W, Nowrooz-Zadeh M. Volvulus of the small intestine in adults: a study of predisposing factors. Ann Surg. 1969;169(2):265.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGulati SM, Grover NK, Tagore NK, Taneja OP. Volvulus of the small intestine in India. Am J Surg. 1973;126(5):661\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuke JH, Yar MS. Primary small bowel volvulus: cause and management. Arch Surg. 1977;112(6):685\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Souza LJ. Volvulus of the small bowel. Br Med J. 1976;1(6017):1055\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Small bowel volvulus, Small bowel obstruction, Dessie, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-8454978/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8454978/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSmall bowel volvulus \u003cb\u003e(\u003c/b\u003eSBV) is a condition where the small bowel loops coil around the axis of its own mesentery which can lead to mechanical intestinal obstruction. It contributes significant number of patients at surgical emergency with small bowel obstruction (SBO) especially in developing countries. The main objective of this study was to assess the clinical and epidemiological status of SBV in North-Eastern Ethiopia.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThe study was conducted at Dessie Comprehensive and Specialized Hospital (DCSH). The study period was on November 2023 G.C. Hospital (facility) based retrospective cross sectional study design was used and data was collected with a standardized structured checklist. Data was collected from medical records of adult patients with discharge diagnosis of small bowel obstruction in a four (4) years period from September 1, 2019 G.C to August 31, 2023 G.C. Cross tabulation analysis was done for factors which contributed for mortality and morbidity of SBV.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eA total of about 162 patient with SBV were included in the study accounting about 37.2% of patients with SBO with annual occurrence rate of about 40.6 patients. The mean age of patients was 47 years. Majority of them (152(93.8%)) were males. The common seasons at presentation were during September - November and March - May. All participants had abdominal pain and vomiting but 159(98.1%) and 143(88.3%) had abdominal distension and constipation respectively. Eighty five (52.5%) of patients with SBV presented within 24hrs of symptom onset and 99(61.1%) had normal CBC result whereas 63(38.9%) of them had leukocytosis. Majority (125(77.1%)) of them were managed with derotation and retrograde milking whereas 12(7.4%) ) were managed with resection and anastomosis and 18(11.1%) undergone band release and derotation. PSBV was seen in 138(85.2%) patients and the remaining 24(14.8%) had SSBV.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe prevalence of SBV among patients with SBO was 37.2% with 85.2% primary and the remaining 14.8% being secondary type. The annual occurrence rate was about 40.6 patients per year with mean age of 47 years.\u003c/p\u003e","manuscriptTitle":"Patterns of Small Bowel Volvulus in North - Eastern Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-06 09:43:26","doi":"10.21203/rs.3.rs-8454978/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-03T07:26:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-26T23:14:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-22T20:25:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155916990615143610114757587901974424810","date":"2026-02-19T22:11:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12527787490322985712085837306545587692","date":"2026-02-19T20:04:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78897670715236449363569897070810338244","date":"2026-02-18T23:26:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-05T11:08:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277518216793716506922443735729430538808","date":"2026-02-01T12:22:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90939245296663524351110636012176947072","date":"2026-02-01T10:22:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-26T11:09:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90976141542489437945227269835222448496","date":"2026-01-23T11:32:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156860964409934132748770363112755728840","date":"2026-01-23T07:28:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-23T03:18:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-02T12:19:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-29T05:14:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T05:13:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-12-26T11:31:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"95e1400d-375d-41cc-b9ff-dadada59b5b0","owner":[],"postedDate":"January 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T13:23:12+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-06 09:43:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8454978","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8454978","identity":"rs-8454978","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}