Assessment of outcome of and factors associated with gangrenous small bowel obstruction 

Assessment of outcome of and factors associated with gangrenous small bowel obstruction | 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 Assessment of outcome of and factors associated with gangrenous small bowel obstruction Fasil Wale, Adnan Abdulkadir, Dumessa Edessa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6674894/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background small bowel obstructions account for 15% of hospital admissions for acute abdominal complaints and up to 30% of these patients will require operative intervention. Ethiopia is one of the countries where intestinal obstruction is a major cause of morbidity and mortality. Objectives To assess outcome and factors associated with gangrenous small bowel obstruction among patients admitted to surgical ward of Hiwot Fana Specialized University Hospital from January 1, 2016-December 31, 2020. Methods A retrospective cross-sectional study was conducted on all patients with gangrenous small bowel obstruction admitted to surgical ward of Hiwot Fana Specialized University Hospital from January1,2016-December 31,2020.For this study, a customized data abstraction form was developed for data capturing from medical records of the patients. The captured data was coded, entered to EpiINFo and exported to statistical package for social sciences software, version 22.0. for analysis. To summarize demographic and clinical characteristics of the patients considered for this study, descriptive statistics such as percent and frequency was employed. All variables with P-value < 0.3, during bi-variable analyses were considered for multivariable logistic regression analyses. Odds ratio along with 95% Confidence interval were estimated to measure the strength of the association. Level of statistical significance was declared at p value less or equal to 0.05 Results A total of 91patiens were included and finally analyzed in this study. From these 52 (57.1%) patients have un favorable surgical outcomes of gangrenous Small bowel obstruction. Of the 52 patients with unfavorable outcome, the most common postoperative complication occurred was anastomotic leak (29.5) followed by surgical site infection (25.5%) and pneumonia (23.6%). A total of 15 postoperative deaths were also documented as unfavorable surgical management outcomes of gangrenous Small bowel obstruction. Three factors including duration of illness before surgery, length of hospital stay after surgery and shock at presentation were significantly associated withthe surgical management outcome of gangrenous Small Bowel Obstruction. Conclusion In this study, the majority of patients had unfavorable surgical management outcomes of gangrenous Small Bowel Obstruction, however the proportion of patients with favorable outcomes was considerable. Thus, designing a strategy that address the factors associated with unfavorable outcomes could be helpful to further increase the likelihood of favorable surgical management outcomes of gangrenous Small Bowel Obstruction. gangrenous small bowel obstruction surgical ward outcome factors associated Ethiopia INTRODUCTION Intestinal obstruction (IO) is defined as obstruction of the passage of the intestine for its contents [ 16 ]. The small intestine consists of the duodenum, jejunum and ileum. It extends from the distal end of the pyloric canal to the ileocaecal valve. Its overall length ranges from three to seven meters in the living adult. The duodenum extends up to the duodeno-jejunal junction and the remaining small intestine is often referred to as the “small bowel” of which proximal two-fifths is jejunum and distal three-fifths is ileum.[ 5 ]. The IO can be classified as dynamic obstruction (mechanical obstruction) or adynamic obstruction (paralytic ileus and pseudo-obstruction) [ 6 ]. If the intramural pressure becomes high enough, micro vascular perfusion to the intestine is impaired, leading to intestinal ischemia, and, ultimately, necrosis. This condition is termed as gangrenous bowel obstruction. Gangrenous small bowel obstruction (SBO) most often result from hernia, adhesions, and mesenteric insufficiency. The classical signs of gangrenous small bowel obstruction are fever, tachycardia, continuous abdominal pain, peritoneal signs, leukocytosis and metabolic acidosis [ 5 ]. Of all IO gangrenous SBO forms an important part of pathologies that necessitate emergency surgical interventions in parts of Asia, including India, Iran and Pakistan [ 13 , 15 ]. In rural Africa, small bowel obstruction accounts for a great proportion of morbidity and mortality [ 13 ] and Ethiopia is one of the countries where intestinal obstruction constitutes a major cause of morbidity and mortality. [ 2 ]. SBO account for 15% of hospital admissions for acute abdominal complaints and up to 30% of these patients will require operative intervention. In the study done at Adama hospital medical college the prevalence of IO was 21.8% among patients admitted with the acute abdomen conditions, and 4.8% among total surgical admission patients. Among these 7.9% had gangrenous SBO. Postoperative adhesions are the etiology of 75% of mechanical SBOs, followed by hernias and neoplasia [ 16 ]. METHODS AND MATERIALS Study Area and Period The study was conducted in HFSUH, Harari region, eastern Ethiopia. HFSUH is one of the oldest hospitals in eastern Ethiopia and has a total of 210 beds and about 250 of health professionals. It is affiliated with the College of Health and Medical Sciences (Haramaya University) since 2014 and is the major referral centre for about five million populations in eastern Ethiopia. During the study period the surgical ward has intensive care unit and two major operation theatres with equipments sharing the same operation theatres with gynecology and surgery department. The hospital, apart from giving daily medical service and referral center, it also serves as a teaching center for students coming from government and private institutions (HFSUH, 2019). The study was conducted in HFSUH surgery ward on patients admitted with gangrenous SBO from November 1, 2020- December 31, 2020. Study Design A retrospective cross-sectional study design was used. Population Source Population The source population for this study was all patients admitted to surgical ward of HFSUH during the data capturing period. Study Population All patients admitted to surgery ward of HFSUH for management of gangrenousSBO was considered as study population. Inclusion and Exclusion Criteria Inclusion criteria All patients diagnosed with gangrenous SBO during the study period and admitted to surgical ward of HFSUH and both male and female patients with complete medical record of required information were included. Exclusion criteria Patients with incomplete medical records Sample Size Determination For sample size determination the required sample size was calculated using a single population proportion formula with the following assumptions: prevalence of injury P = 0.05 [ 16 ], confidence level of 95% and margin of error (d) = 5%. Based on this data, the sample size was calculated as follow: Where; Z = Confidence interval (95% = 1.96) d = Marginal error (5%) P = Prevalence (0.05%) = 72,9904 = 73 So, after adding 10% adjustment to the calculated sample size, the final sample size was determined to be 81 patients. Sampling Technique Since the number of patients diagnosed with gangrenous SBO nears to the sample calculated all of the patients with this assessment during the study period were considered and no sampling technique was needed. Data Collection Method Data collection tools Data was collected using structured data abstraction format. Preliminary data source was log books of surgical ward. Patients’ medical records documented on the respective log books and medical charts was employed for data capturing. The information obtained from the above mentioned sources including sociodemographic data such as sex, age and clinical characteristics involving abdominal pain, vomiting, constipation, abdominal distention, groin swelling, duration of symptoms, previous history of abdominal operation, preoperative diagnosis, initial managements performed, antibiotic initiated, intra-operative findings, Procedure done during operative management,length of hospital stay in days, any post-operative complication, (data collection form attached as annex).In addition, the number of surgical ward admissions during the data capturing period were analyzed in order to determine outcome and associated factors of gangrenous small bowel obstruction. Data collectors Three medical interns were involved in collection of data by prepared check list from patients’ cards and registered log-books as secondary data. One junior resident supervised the daily activity, consistency and completeness of the checklist gave appropriate support during the data collection processes. The principal investigator checked the daily activities of supervisor. Data Collection Procedure Review of medical records were employed to collect data by using pre tested and well-structured data retrieval form from the card as it was diagnosed by physicians. Medical charts with missing data and lacking the required information were excluded. Variables Independent variables Age, sex, residence, duration of illness, cause, intra-operative findings, co morbid illness,time to event, and previous surgery Dependent variables Management outcome (favorable outcome, unfavorable outcome). Operational Definitions Favorable outcome if the patient is discharged alive and does not have any history of postoperative complications after surgery for gangrenous small bowel obstruction [ 16 ]. Unfavorable outcome if the patient dies or has one or more postoperative (after surgery for gangrenous small bowel obstruction) complications like dehiscence, surgical site infection, pneumonia, as documented in the medical charts [ 16 ]. Data Quality Control Before starting the data collection, data collecting format were cross matched (pretested) with available information on records in Jugal Hospital surgical ward; then the study questions were enhanced as necessary. Completeness of the data were cross checked on daily bases, if incomplete data were found, the data were recaptured for its completeness. If still incomplete registers revised to complete missed information, then finally incomplete data were discarded. Data Processing and Analysis The collected data was processed, coded and entered to Epi-INFO and analyzed with computer using SPSS version 22software. Accordingly, socio demographic and clinical characteristics was summarized using descriptive statistics (percent and frequency).In addition, outcome of gangrenous SBO management was also be determined using frequency with percent. Proportion of gangrenous SBO relative to other admission was rated as well. Factors associated with outcomes of gangrenous SBO were identified using bivariable logistics regression analysis. Covariates with the potential for association were adjusted by using multivariable analysis. Significance of associations between the dependent and independent variables were determined by the use of 95% confidence level Ethical Considerations The study protocol was reviewed and approved by the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University, College of Health and Medical Sciences. As this was a retrospective chart review, the need for informed consent was waived by the ethics committee, in accordance with national guidelines and institutional policies. Patient confidentiality was strictly maintained, and no personal identifiers were collected. All procedures were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments. RESULTS Socio demographic characteristics A total of 91 patients who had a history of surgery for gangrenous SBO at the HFSUH were included and finally analyzed in this study. Of the 91 patients, 61(67%) were within 15–40 years, the largest age group. The minimum age of the patients was 10 years and the maximum was 75 years, with mean 32.38 years, median 28years, and standard deviation (SD) ± 16.025 years. The majority of patients were males (84.2%) and 75.8% of them were rural dwellers (Table 1 ) Table 1 Socio demographic characteristics of gangrenous SBO patients (N = 91) at HFSUH, Ethiopia, January 2016-December 31, 2020. Variable Category Frequency % Age ( years) 5–14 15–40 41–60 > 60 9 61 15 6 9.9 67 16.5 6.6 Median age ( years) 28 - - Sex Male Female 75 16 82.4 17.6 Residence Rural Urban 69 22 75.8 24.2 Preoperative clinical characteristics. The findings showed abdominal pain (100%), vomiting (93.4%), abdominal distension (84.6%), and failure to pass abdominal contents, such as feces and/or flatus, (79.1%) were the leading clinical symptoms among patients who presented with Gangrenous SBO at the healthcare facility (Table 2 ). Regarding the duration of illness, 66 (72.5%) of cases were presented longer than 24 hours after the onset of symptoms until the time of operation. The average duration for the symptoms prior to operation was67.3 hours, with a SD of ± 46.089hours. The duration however ranges from 7 to 168 hours among them. This study also showed 15 (16.5%) patients had a previous history of abdominal surgery, and 12.1% of all the gangrenous SBO cases had at least one diagnosed comorbid condition of cardiovascular diseases, lung diseases, and diabetes mellitus (Table 2 ). Table 2 Pre-operative clinical characteristics of gangrenous SBO patients (N = 91) at HFSUH, Ethiopia, January 2016-December 31, 2020. Presenting symptoms Category Frequency % Abdominal pain Yes No 91 0 100 0 Vomiting Yes No 85 6 93.4 6.6 Abdominal distention Yes No 77 14 83.8 15.4 Constipation Yes No 72 19 79.1 20.9 Duration of symptoms 24 hours 25 66 27.5 72.5 Previous abdominal operation Yes No 15 76 16.5 83.5 Co morbid illness Yes No 11 80 12.1 87.9 Concerning the key elements of preoperative care assessed in this study, IV fluid resuscitation was given for all (100%) patients and preoperative therapeutic antibiotics was initiated generally for 84 (92.3%) of the patients, with a combination of ceftriaxone and metronidazole, whereas the rest 7 (7.7%) of all patients did not received therapeutic antibiotics before their operation for gangrenous SBO management.( Table 3 ) Table 3 Pre-operative care of gangrenous SBO patients (N = 91) at HFSUH, Ethiopia,January 2016-December 31, 2020. Variables Category Frequency % IV fluid resuscitation Initiated Not initiated 91 0 100 0 Preoperative antibiotics Initiated Not initiated 84 7 92.3 7.7 Intra and postoperative clinical characteristics Gangrenous small bowel volvulus (GSBV) was the leading specific intraoperative clinical diagnosis of gangrenous SBO, followed by obstructing band, obstructing adhesion, meckels diverticulum and mesenteric ischemia, ilioilial knotting, and intucesseption among others. The commonest specific type of intraoperative procedure done, after a general laparotomy, to treat the patients with gangrenous SBO was resection and anastomosis. Postoperative antibiotics were initiated for all of patients. Regarding the length of hospital stay, 68.1% patients stayed in the hospital for > 7 days after their surgery for gangrenous SBO. The mean, median, and SD of hospital stay in days were founded to be 12.54, 9, and 10.78, respectively, with the minimum of 2 days and the maximum of 66 days. (Table 4 ) Table 4 Intra- and postoperative clinical characteristics of gangrenous small bowel obstruction patients ( N = 91) at HFSUH, Ethiopia. January 2016-December 31, 2020. Variables Category Frequency % Intraoperative Diagnosis GSBV Adhesion Obstructing band Meckels diverticulum Mesenteric ischemia Ilioilial knotting Intucesseption Groin hernia Ilio sigmoid knotting Others* Total 42 8 11 8 6 5 4 3 3 1 91 46.2 8.8 12.1 8.8 6.6 5.5 4.4 3.3 3.3 1.1 100 Intraoperative Procedure Resectionand anastomosis Ileostomy Others** Total 84 4 3 91 92.3 4.4 3.3 100 Length of hospital stay (days) ≤ 7 days > 7 days 29 62 31.9 68 Median length of hospital stay (days) 9 - - Others* unkown cause for gangrenous SBO Others** jejunosomy and the abdomen closed without further intervention Surgical Management Outcome This study shows 39 (42.9%) of 91 patients have favorable surgical management outcomes of Gangrenous SBO which was defined as the absence of all types of postoperative complications, whereas the rest 52 (57.1%) patients have unfavorable outcomes which was defined as the presence of one or more types of postoperative complications(Table 5 ). Furthermore, the overall success rate of the surgery was 83.5%, with 76 patients discharged on improvement, although 15(16.5%) inpatient postoperative deaths were documented, among a total of 91 analyzed cases who were engaged for the surgical management of gangrenous SBO at HFSUH, eastern Ethiopia.(Table 5 ) Factors Associated with unfavorable outcomes of gangrenous SBO From the bivariate binary logistic regression analysis, factors including duration of illness, comorbidity, shock at presentation, and length of hospital stay were associated with the surgical management outcome of Gangrenous SBO. Subsequently, all factors were entered into the multivariable binary logistic regression model. In the multivariable analysis, only three factors such as duration of illness, shock at presentation and length of hospital stays in days were significantly associated with the surgical management outcome of gangrenous SBO (at P < 0.05. The patients seeking healthcare for gangrenous SBO after 24 hours of illness were about five times (AOR = 4.807; 95% CI: 1.201–19.235; P = 0.026) more likely to have unfavorable outcome than those seeking healthcare within 24 hours of illness. The patients those who had no shock at presentation were about 99.1% (AOR = 0.009; 95% CI: 0.000–0.179; P = 0.002) less likely to have unfavorable outcome than those who presented with shock. The patients who stayed in the hospital for > 7 days after surgery were about 47 times (AOR = 47.5 95% CI:5.25–429; P = 0.040) more likely to have unfavorable outcome than those who stayed in the hospital for < 7 days after surgery (Table 6 ). Table 6 Factors associated with the surgical management outcome of Gangrenous SBO at HSUH, Ethiopia,, January 2016-December 31, 2020. Variables (N = 91) Favourable (n) Unfavourable (n) COR (95% CI) AOR, (95% CI) P- value Duration of illness 24hrs 20 19 11 41 1 3.324(1.272–8.688) 1 4.807(1.201–19.235) 0.026 Residence Urban 7 19 1 1 Rural 31 34 0.700(0.26–1.885) 0.512 (0.117–2.247) 0.375 Comorbidity Yes 1 10 1 1 No 38 42 0.111(0.14–0.904) 0.044(0.001–1.65) 0.091 Previous history of abdominal operation Yes 7 6 1.203(0.396–3.658) 1.3(0.437–4.288) 0.702 No 32 46 1 1 Shock at presentation Yes 1 20 1 1 No 32 38 0.042(0.005–0.331) 0.009(0.000-0.179) 0.002 Hospital stay in days ≤ 7 days > 7 days 21 16 9 45 1 8.319(3.008–23.007) 1 47.5(5.2–429) 0.004 Preoperative antibiotics Initiated 37 47 1.968(0.364–10.274) 0.177(0.009–3.445) 0.253 Not initiated 2 5 1 1 DISCUSSION In this study, the majority of patients had unfavorable surgical management outcomes of gangrenous Small Bowel Obstruction. This study also revealed that duration of illness before surgery, shock at presentation and length of hospital study were factors significantly associated with the surgical management outcome of Gangrenous SBO The analyzed data showed that 57.1% of all cases have unfavorable surgical management outcomes of Gangrenous SBO, which was characterized by the presence of the recorded postoperative complications or death at the healthcare facility. The finding on this unfavorable outcome rate is in line with a study conducted in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia 53.1% [ 18 ] but it is higher than the studies from Adama Hospital 44% [ 16 ] and also higher than the findings from other countries, such as 22.3% in Kenya [ 12 ] The possible reason for the difference might be due to delay in the presentation of patients to health care facilities due to lack of awareness about gangrenous SBO and due to delayed referral from referring health facilities [16.,19]. In this study 15 (16.5%) patients died and the finding was higher compared with the study done in India 7.35% [ 17 ] and in Kenya 5.3% [ 12 ].The possible reason for the difference might be due to delay in the presentation of patients to health care facilities that might predispose them to complications like sepsis and septic shock which predisposes for a higher mortality [ 16 ]. The patients who presented in the hospital after 24 hours of duration of illness were about 5 times more likely to have unfavourable surgical management outcome compared with those who presented within 24 hours after the onset of symptoms before surgery. This finding is supported by the research studies conducted in north central Ethiopia (11 times) [ 18 ] and by a research study done in Pakistan (6 times) [ 4 ]. The possible reason for the high rate of unfavourable outcome for patients presenting late was patients might develop hypovolemic shock, sepsis, septic shock and electrolyte disturbance when the time goes on without intervention that negatively affects the outcome of patients who came late [ 16 ] This study also shows that patients who presented without shock to the hospital were 99.1% less likely to have unfavourable outcome than those who presented with shock. It is consistent with other studies conducted in Ethiopia 95.5% [ 16 , 21 ]. This also might show patients with hemodynamic stability maintains end organ perfusion and cellular metabolism that met the cellular demand and enables to keep its function intact that helps to establish better defense to offending stimuli [ 5 ]. This study also shows that patients who stayed in the hospital for more than 7 days after surgery were about 47 times more likely to have unfavourable outcomes when compared with those who stayed for shorter or equal to 7 days after the surgery. It is consistent with other studies conducted in Ethiopia [ 19 ]. This also might be patients with increased morbidity after surgery tends to stay longer in the hospital till they get better than those who get better shortly after surgery and the short length of hospital stay may also decrease the chance of patients to acquire nosocomial infections, such as hospital-acquired pneumonia [ 16 ]. Since the study was conducted in one hospital, it cannot be generalized to all population living in the catchment area because of difference in factors such as socio economic status of the patients, the hospital set up differences and the human power that might affect the outcome of patients. Some important variables that might be associated with outcomes of surgery like economic status of patients, patients awareness about intestinal obstruction and investigation like serum electrolyte were not included in the study because the study was retrospective. CONCLUSION This study provided insight into the surgical management outcome and its factors associated among patients with Gangrenous SBO at a tertiary teaching hospital in eastern Ethiopia. The majority of patients had unfavorable surgical management outcomes of Gangrenous SBO.In this study 15 (16.5%) patients died. Determinant factors including duration of illness before surgery, shock at presentation, and, hospital stay after operation were significantly associated with the surgical management outcome of Gangrenous SBO. Therefore, designing a strategy that address these factors would be helpful to further increase the likelihood of favorable surgical management outcome for the patients attending hospital with Gangrenous SBO. Abbreviations SBO Small Bowel Obstruction GSBO Gangrenous Small Bowel Obstruction HFCSUH Hiwot Fana Comprehensive Specialized University Hospital SPSS Statistical Package for Social Sciences CI Confidence Interval OR Odds Ratio SSI Surgical Site Infection Declarations ACKNOWLEDGMENTS First of all, we would like to thank almighty God for being with us from the beginning of our life. Second, we would like to thank Haramaya University, Collage of Health and Medical Sciences for giving us the chance to carry out this research. Data collectors and respondents are also praised for their unreserved support. Ethics approval and consent to participate Ethical Considerations The study protocol was reviewed and approved by the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University, College of Health and Medical Sciences. As this was a retrospective chart review , the need for informed consent was waived by the ethics committee , in accordance with national guidelines and institutional policies. Patient confidentiality was strictly maintained, and no personal identifiers were collected. All procedures were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions FW collected the data. AA and DE critically revised the manuscript. All authors read and approved the final manuscript. Clinical trial numb er: not applicable. References Adebambo O, Adedapo O, Adedoyin A. 2017. Predictive Factors of Management Outcome In Adult Patients With Mechanical Intestinal Obstruction Niger postgradmedj, 24(4):217–223. Adesunkanmi A, Agbakwuru. 2011.Changing Pattern of Acute Intestinal Obstruction In A Tropical African Population EastAfrMed J., 73(11): 727–31. Adesunkanmi A, Agbakwuru E. 2011. Changing pattern of acute intestinal obstruction in a tropicalAfricanpopulation. 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Surgically Treated Acute Abdomen at Gondar University Hospital, Ethiopia.East And Central African. J Surg. 2007;12(1):55–7. XiamingH.,Guan F, Jie L, Keyu X, Hongqi S, Lei Z. August 2017. Department of General Surgery, The First affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Yohannes M. Molla T.,2017 preparation of intestinal obstruction and associated factors. among patients with non traumatic. acute abdomen admitted to surgical ward of. debrebirhan hospital.,American journal of biomedical and life sciences 54–62. Tables Table 5 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table5.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6674894","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":476411220,"identity":"8f518b94-f00f-4ee5-9d3e-83c1edae5240","order_by":0,"name":"Fasil Wale","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYBAC9gYGhgMPQKwDDMwPPlQwMBgQ0sJzAKg4AaKFzXDGGSK1MEC1MEjzthGjhf34wwOJbTZ5fNfOGBjzzjssb87efIDhR8U23Fp4cgyAWtKKJW/nGDycu+2w4c6eYwmMPWdu49Riz5DDcCBx2+HEDUAtBm+3HWbccCPHgJmxDbcWHv7nD+BaJHjnHLYnrEUiwQCuRZK3AcggrOUNUMu/tMSZt9PKDGccS0/ecOZYwkF8fuHhT3/84cMZm8S+28mbH3yosbbdcLz54IMfFbi1oINmMHmAaPVAUEeK4lEwCkbBKBghAAAfaWflbJiHRAAAAABJRU5ErkJggg==","orcid":"","institution":"Haramaya University","correspondingAuthor":true,"prefix":"","firstName":"Fasil","middleName":"","lastName":"Wale","suffix":""},{"id":476411221,"identity":"f27f6fb0-1170-43b9-aec4-e182f733e364","order_by":1,"name":"Adnan Abdulkadir","email":"","orcid":"","institution":"Haramaya University","correspondingAuthor":false,"prefix":"","firstName":"Adnan","middleName":"","lastName":"Abdulkadir","suffix":""},{"id":476411222,"identity":"8867c6df-a812-48ed-b53a-cb14b48a2c0e","order_by":2,"name":"Dumessa Edessa","email":"","orcid":"","institution":"Haramaya University","correspondingAuthor":false,"prefix":"","firstName":"Dumessa","middleName":"","lastName":"Edessa","suffix":""}],"badges":[],"createdAt":"2025-05-15 17:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6674894/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6674894/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89891607,"identity":"b8d4101e-ca0f-4b51-b4c3-1dbde3ff1645","added_by":"auto","created_at":"2025-08-26 07:39:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1058177,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6674894/v1/b6ada7a7-9b1a-4e42-9504-005c8dcd7463.pdf"},{"id":85548926,"identity":"9f75bb81-1c75-4ea9-a4c1-0d0488b128e9","added_by":"auto","created_at":"2025-06-27 09:20:45","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15597,"visible":true,"origin":"","legend":"","description":"","filename":"Table5.docx","url":"https://assets-eu.researchsquare.com/files/rs-6674894/v1/2ddcd937d2945f51dfc5d9ff.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of outcome of and factors associated with gangrenous small bowel obstruction ","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eIntestinal obstruction (IO) is defined as obstruction of the passage of the intestine for its contents [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The small intestine consists of the duodenum, jejunum and ileum. It extends from the distal end of the pyloric canal to the ileocaecal valve. Its overall length ranges from three to seven meters in the living adult. The duodenum extends up to the duodeno-jejunal junction and the remaining small intestine is often referred to as the \u0026ldquo;small bowel\u0026rdquo; of which proximal two-fifths is jejunum and distal three-fifths is ileum.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe IO can be classified as dynamic obstruction (mechanical obstruction) or adynamic obstruction (paralytic ileus and pseudo-obstruction) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIf the intramural pressure becomes high enough, micro vascular perfusion to the intestine is impaired, leading to intestinal ischemia, and, ultimately, necrosis. This condition is termed as gangrenous bowel obstruction. Gangrenous small bowel obstruction (SBO) most often result from hernia, adhesions, and mesenteric insufficiency. The classical signs of gangrenous small bowel obstruction are fever, tachycardia, continuous abdominal pain, peritoneal signs, leukocytosis and metabolic acidosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOf all IO gangrenous SBO forms an important part of pathologies that necessitate emergency surgical interventions in parts of Asia, including India, Iran and Pakistan [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn rural Africa, small bowel obstruction accounts for a great proportion of morbidity and mortality [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and Ethiopia is one of the countries where intestinal obstruction constitutes a major cause of morbidity and mortality. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSBO account for 15% of hospital admissions for acute abdominal complaints and up to 30% of these patients will require operative intervention. In the study done at Adama hospital medical college the prevalence of IO was 21.8% among patients admitted with the acute abdomen conditions, and 4.8% among total surgical admission patients. Among these 7.9% had gangrenous SBO. Postoperative adhesions are the etiology of 75% of mechanical SBOs, followed by hernias and neoplasia [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area and Period\u003c/h2\u003e \u003cp\u003eThe study was conducted in HFSUH, Harari region, eastern Ethiopia. HFSUH is one of the oldest hospitals in eastern Ethiopia and has a total of 210 beds and about 250 of health professionals. It is affiliated with the College of Health and Medical Sciences (Haramaya University) since 2014 and is the major referral centre for about five million populations in eastern Ethiopia. During the study period the surgical ward has intensive care unit and two major operation theatres with equipments sharing the same operation theatres with gynecology and surgery department. The hospital, apart from giving daily medical service and referral center, it also serves as a teaching center for students coming from government and private institutions (HFSUH, 2019). The study was conducted in HFSUH surgery ward on patients admitted with gangrenous SBO from November 1, 2020- December 31, 2020.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eA retrospective cross-sectional study design was used.\u003c/p\u003e\n\u003ch3\u003ePopulation\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSource Population\u003c/h2\u003e \u003cp\u003eThe source population for this study was all patients admitted to surgical ward of HFSUH during the data capturing period.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eAll patients admitted to surgery ward of HFSUH for management of gangrenousSBO was considered as study population.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and Exclusion Criteria\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eAll patients diagnosed with gangrenous SBO during the study period and admitted to surgical ward of HFSUH and both male and female patients with complete medical record of required information were included.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003ePatients with incomplete medical records\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSample Size Determination\u003c/h2\u003e \u003cp\u003eFor sample size determination the required sample size was calculated using a single population proportion formula with the following assumptions: prevalence of injury P\u0026thinsp;=\u0026thinsp;0.05 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], confidence level of 95% and margin of error (d)\u0026thinsp;=\u0026thinsp;5%. Based on this data, the sample size was calculated as follow:\u003c/p\u003e \u003cp\u003eWhere; Z\u0026thinsp;=\u0026thinsp;Confidence interval (95% = 1.96)\u003c/p\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;Marginal error (5%)\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;Prevalence (0.05%)\u003c/p\u003e \u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1751015089.png\"\u003e\u003c/p\u003e\u003ch2\u003e=\u0026thinsp;72,9904\u003c/h2\u003e \u003ch2\u003e=\u0026thinsp;73\u003c/h2\u003e \u003cp\u003eSo, after adding 10% adjustment to the calculated sample size, the final sample size was determined to be 81 patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSampling Technique\u003c/h2\u003e \u003cp\u003eSince the number of patients diagnosed with gangrenous SBO nears to the sample calculated all of the patients with this assessment during the study period were considered and no sampling technique was needed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Method\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003eData collection tools\u003c/h2\u003e \u003cp\u003eData was collected using structured data abstraction format. Preliminary data source was log books of surgical ward. Patients\u0026rsquo; medical records documented on the respective log books and medical charts was employed for data capturing. The information obtained from the above mentioned sources including sociodemographic data such as sex, age and clinical characteristics involving abdominal pain, vomiting, constipation, abdominal distention, groin swelling, duration of symptoms, previous history of abdominal operation, preoperative diagnosis, initial managements performed, antibiotic initiated, intra-operative findings, Procedure done during operative management,length of hospital stay in days, any post-operative complication, (data collection form attached as annex).In addition, the number of surgical ward admissions during the data capturing period were analyzed in order to determine outcome and associated factors of gangrenous small bowel obstruction.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eData collectors\u003c/h2\u003e \u003cp\u003eThree medical interns were involved in collection of data by prepared check list from patients\u0026rsquo; cards and registered log-books as secondary data. One junior resident supervised the daily activity, consistency and completeness of the checklist gave appropriate support during the data collection processes. The principal investigator checked the daily activities of supervisor.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Procedure\u003c/h2\u003e \u003cp\u003eReview of medical records were employed to collect data by using pre tested and well-structured data retrieval form from the card as it was diagnosed by physicians. Medical charts with missing data and lacking the required information were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003eAge, sex, residence, duration of illness, cause, intra-operative findings, co morbid illness,time to event, and previous surgery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eDependent variables\u003c/h2\u003e \u003cp\u003eManagement outcome (favorable outcome, unfavorable outcome).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eOperational Definitions\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eFavorable outcome\u003c/strong\u003e \u003cp\u003eif the patient is discharged alive and does not have any history of postoperative complications after surgery for gangrenous small bowel obstruction [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eUnfavorable outcome\u003c/strong\u003e \u003cp\u003eif the patient dies or has one or more postoperative (after surgery for gangrenous small bowel obstruction) complications like dehiscence, surgical site infection, pneumonia, as documented in the medical charts [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eData Quality Control\u003c/h2\u003e \u003cp\u003eBefore starting the data collection, data collecting format were cross matched (pretested) with available information on records in Jugal Hospital surgical ward; then the study questions were enhanced as necessary. Completeness of the data were cross checked on daily bases, if incomplete data were found, the data were recaptured for its completeness. If still incomplete registers revised to complete missed information, then finally incomplete data were discarded.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eData Processing and Analysis\u003c/h2\u003e \u003cp\u003eThe collected data was processed, coded and entered to Epi-INFO and analyzed with computer using SPSS version 22software. Accordingly, socio demographic and clinical characteristics was summarized using descriptive statistics (percent and frequency).In addition, outcome of gangrenous SBO management was also be determined using frequency with percent. Proportion of gangrenous SBO relative to other admission was rated as well. Factors associated with outcomes of gangrenous SBO were identified using bivariable logistics regression analysis. Covariates with the potential for association were adjusted by using multivariable analysis. Significance of associations between the dependent and independent variables were determined by the use of 95% confidence level\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e The study protocol was reviewed and approved by the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University, College of Health and Medical Sciences. As this was a retrospective chart review, the need for informed consent was waived by the ethics committee, in accordance with national guidelines and institutional policies. Patient confidentiality was strictly maintained, and no personal identifiers were collected. All procedures were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eSocio demographic characteristics\u003c/h2\u003e \u003cp\u003eA total of 91 patients who had a history of surgery for gangrenous SBO at the HFSUH were included and finally analyzed in this study. Of the 91 patients, 61(67%) were within 15\u0026ndash;40 years, the largest age group. The minimum age of the patients was 10 years and the maximum was 75 years, with mean 32.38 years, median 28years, and standard deviation (SD)\u0026thinsp;\u0026plusmn;\u0026thinsp;16.025 years. The majority of patients were males (84.2%) and 75.8% of them were rural dwellers (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\u003eSocio demographic characteristics of gangrenous SBO patients (N\u0026thinsp;=\u0026thinsp;91) at HFSUH, Ethiopia, January 2016-December 31, 2020.\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=\"left\" 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\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge ( years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;14\u003c/p\u003e \u003cp\u003e15\u0026ndash;40\u003c/p\u003e \u003cp\u003e41\u0026ndash;60\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e61\u003c/p\u003e \u003cp\u003e15\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003cp\u003e67\u003c/p\u003e \u003cp\u003e16.5\u003c/p\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian age ( years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.4\u003c/p\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.8\u003c/p\u003e \u003cp\u003e24.2\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\u003e \u003cb\u003ePreoperative clinical characteristics.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe findings showed abdominal pain (100%), vomiting (93.4%), abdominal distension (84.6%), and failure to pass abdominal contents, such as feces and/or flatus, (79.1%) were the leading clinical symptoms among patients who presented with Gangrenous SBO at the healthcare facility (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e ).\u003c/p\u003e \u003cp\u003eRegarding the duration of illness, 66 (72.5%) of cases were presented longer than 24 hours after the onset of symptoms until the time of operation. The average duration for the symptoms prior to operation was67.3 hours, with a SD of \u0026plusmn;\u0026thinsp;46.089hours. The duration however ranges from 7 to 168 hours among them. This study also showed 15 (16.5%) patients had a previous history of abdominal surgery, and 12.1% of all the gangrenous SBO cases had at least one diagnosed comorbid condition of cardiovascular diseases, lung diseases, and diabetes mellitus (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\u003ePre-operative clinical characteristics of gangrenous SBO patients (N\u0026thinsp;=\u0026thinsp;91) at HFSUH, Ethiopia, January 2016-December 31, 2020.\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\u003ePresenting symptoms\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\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.4\u003c/p\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal distention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.8\u003c/p\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.1\u003c/p\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24 hours\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003cp\u003e72.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious abdominal operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003cp\u003e83.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCo morbid illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003cp\u003e87.9\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\u003eConcerning the key elements of preoperative care assessed in this study, IV fluid resuscitation was given for all (100%) patients and preoperative therapeutic antibiotics was initiated generally for 84 (92.3%) of the patients, with a combination of ceftriaxone and metronidazole, whereas the rest 7 (7.7%) of all patients did not received therapeutic antibiotics before their operation for gangrenous SBO management.( 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\u003ePre-operative care of gangrenous SBO patients (N\u0026thinsp;=\u0026thinsp;91) at HFSUH, Ethiopia,January 2016-December 31, 2020.\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\u003eVariables\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\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV fluid resuscitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInitiated\u003c/p\u003e \u003cp\u003eNot initiated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative antibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInitiated\u003c/p\u003e \u003cp\u003eNot initiated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.3\u003c/p\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eIntra and postoperative clinical characteristics\u003c/h2\u003e \u003cp\u003eGangrenous small bowel volvulus (GSBV) was the leading specific intraoperative clinical diagnosis of gangrenous SBO, followed by obstructing band, obstructing adhesion, meckels diverticulum and mesenteric ischemia, ilioilial knotting, and intucesseption among others. The commonest specific type of intraoperative procedure done, after a general laparotomy, to treat the patients with gangrenous SBO was resection and anastomosis. Postoperative antibiotics were initiated for all of patients. Regarding the length of hospital stay, 68.1% patients stayed in the hospital for \u0026gt;\u0026thinsp;7 days after their surgery for gangrenous SBO. The mean, median, and SD of hospital stay in days were founded to be 12.54, 9, and 10.78, respectively, with the minimum of 2 days and the maximum of 66 days. (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\u003eIntra- and postoperative clinical characteristics of gangrenous small bowel obstruction patients (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;91) at HFSUH, Ethiopia. January 2016-December 31, 2020.\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=\"left\" 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\u003eVariables\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\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative\u003c/p\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGSBV\u003c/p\u003e \u003cp\u003eAdhesion\u003c/p\u003e \u003cp\u003eObstructing band\u003c/p\u003e \u003cp\u003eMeckels diverticulum\u003c/p\u003e \u003cp\u003eMesenteric ischemia\u003c/p\u003e \u003cp\u003eIlioilial knotting\u003c/p\u003e \u003cp\u003eIntucesseption\u003c/p\u003e \u003cp\u003eGroin hernia\u003c/p\u003e \u003cp\u003eIlio sigmoid knotting\u003c/p\u003e \u003cp\u003eOthers*\u003c/p\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.2\u003c/p\u003e \u003cp\u003e8.8\u003c/p\u003e \u003cp\u003e12.1\u003c/p\u003e \u003cp\u003e8.8\u003c/p\u003e \u003cp\u003e6.6\u003c/p\u003e \u003cp\u003e5.5\u003c/p\u003e \u003cp\u003e4.4\u003c/p\u003e \u003cp\u003e3.3\u003c/p\u003e \u003cp\u003e3.3\u003c/p\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative\u003c/p\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResectionand anastomosis\u003c/p\u003e \u003cp\u003eIleostomy\u003c/p\u003e \u003cp\u003eOthers**\u003c/p\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.3\u003c/p\u003e \u003cp\u003e4.4\u003c/p\u003e \u003cp\u003e3.3\u003c/p\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay\u003c/p\u003e \u003cp\u003e(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7 days\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.9\u003c/p\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian length of hospital stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eOthers* unkown cause for gangrenous SBO\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOthers** jejunosomy and the abdomen closed without further intervention\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eSurgical Management Outcome\u003c/h2\u003e \u003cp\u003eThis study shows 39 (42.9%) of 91 patients have favorable surgical management outcomes of Gangrenous SBO which was defined as the absence of all types of postoperative complications, whereas the rest 52 (57.1%) patients have unfavorable outcomes which was defined as the presence of one or more types of postoperative complications(Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, the overall success rate of the surgery was 83.5%, with 76 patients discharged on improvement, although 15(16.5%) inpatient postoperative deaths were documented, among a total of 91 analyzed cases who were engaged for the surgical management of gangrenous SBO at HFSUH, eastern Ethiopia.(Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFactors Associated with unfavorable outcomes of gangrenous SBO\u003c/h3\u003e\n\u003cp\u003eFrom the bivariate binary logistic regression analysis, factors including duration of illness, comorbidity, shock at presentation, and length of hospital stay were associated with the surgical management outcome of Gangrenous SBO. Subsequently, all factors were entered into the multivariable binary logistic regression model. In the multivariable analysis, only three factors such as duration of illness, shock at presentation and length of hospital stays in days were significantly associated with the surgical management outcome of gangrenous SBO (at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eThe patients seeking healthcare for gangrenous SBO after 24 hours of illness were about five times (AOR\u0026thinsp;=\u0026thinsp;4.807; 95% CI: 1.201\u0026ndash;19.235; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026) more likely to have unfavorable outcome than those seeking healthcare within 24 hours of illness. The patients those who had no shock at presentation were about 99.1% (AOR\u0026thinsp;=\u0026thinsp;0.009; 95% CI: 0.000\u0026ndash;0.179; P\u0026thinsp;=\u0026thinsp;0.002) less likely to have unfavorable outcome than those who presented with shock. The patients who stayed in the hospital for \u0026gt;\u0026thinsp;7 days after surgery were about 47 times (AOR\u0026thinsp;=\u0026thinsp;47.5 95% CI:5.25\u0026ndash;429; P\u0026thinsp;=\u0026thinsp;0.040) more likely to have unfavorable outcome than those who stayed in the hospital for \u0026lt;\u0026thinsp;7 days after surgery (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\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\u003eFactors associated with the surgical management outcome of Gangrenous SBO at HSUH, Ethiopia,, January 2016-December 31, 2020.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables (N\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eFavourable (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnfavourable (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAOR, (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP- value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;24 hrs\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;24hrs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e3.324(1.272\u0026ndash;8.688)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e4.807(1.201\u0026ndash;19.235)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.026\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\u003e\u003cb\u003eUrban\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRural\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.700(0.26\u0026ndash;1.885)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.512 (0.117\u0026ndash;2.247)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.111(0.14\u0026ndash;0.904)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.044(0.001\u0026ndash;1.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious history of abdominal operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.203(0.396\u0026ndash;3.658)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.3(0.437\u0026ndash;4.288)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e32\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\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eShock at presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.042(0.005\u0026ndash;0.331)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.009(0.000-0.179)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital stay in days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026le;\u0026thinsp;7 days\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;7 days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e8.319(3.008\u0026ndash;23.007)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e47.5(5.2\u0026ndash;429)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePreoperative antibiotics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eInitiated\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.968(0.364\u0026ndash;10.274)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.177(0.009\u0026ndash;3.445)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNot initiated\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\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\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\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\u003eIn this study, the majority of patients had unfavorable surgical management outcomes of gangrenous Small Bowel Obstruction. This study also revealed that duration of illness before surgery, shock at presentation and length of hospital study were factors significantly associated with the surgical management outcome of Gangrenous SBO\u003c/p\u003e \u003cp\u003eThe analyzed data showed that 57.1% of all cases have unfavorable surgical management outcomes of Gangrenous SBO, which was characterized by the presence of the recorded postoperative complications or death at the healthcare facility. The finding on this unfavorable outcome rate is in line with a study conducted in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia 53.1% [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] but it is higher than the studies from Adama Hospital 44% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and also higher than the findings from other countries, such as 22.3% in Kenya [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] The possible reason for the difference might be due to delay in the presentation of patients to health care facilities due to lack of awareness about gangrenous SBO and due to delayed referral from referring health facilities [16.,19]. In this study 15 (16.5%) patients died and the finding was higher compared with the study done in India 7.35% [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and in Kenya 5.3% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].The possible reason for the difference might be due to delay in the presentation of patients to health care facilities that might predispose them to complications like sepsis and septic shock which predisposes for a higher mortality [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The patients who presented in the hospital after 24 hours of duration of illness were about 5 times more likely to have unfavourable surgical management outcome compared with those who presented within 24 hours after the onset of symptoms before surgery. This finding is supported by the research studies conducted in north central Ethiopia (11 times) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and by a research study done in Pakistan (6 times) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The possible reason for the high rate of unfavourable outcome for patients presenting late was patients might develop hypovolemic shock, sepsis, septic shock and electrolyte disturbance when the time goes on without intervention that negatively affects the outcome of patients who came late [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis study also shows that patients who presented without shock to the hospital were 99.1% less likely to have unfavourable outcome than those who presented with shock. It is consistent with other studies conducted in Ethiopia 95.5% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This also might show patients with hemodynamic stability maintains end organ perfusion and cellular metabolism that met the cellular demand and enables to keep its function intact that helps to establish better defense to offending stimuli [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This study also shows that patients who stayed in the hospital for more than 7 days after surgery were about 47 times more likely to have unfavourable outcomes when compared with those who stayed for shorter or equal to 7 days after the surgery. It is consistent with other studies conducted in Ethiopia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This also might be patients with increased morbidity after surgery tends to stay longer in the hospital till they get better than those who get better shortly after surgery and the short length of hospital stay may also decrease the chance of patients to acquire nosocomial infections, such as hospital-acquired pneumonia [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSince the study was conducted in one hospital, it cannot be generalized to all population living in the catchment area because of difference in factors such as socio economic status of the patients, the hospital set up differences and the human power that might affect the outcome of patients. Some important variables that might be associated with outcomes of surgery like economic status of patients, patients awareness about intestinal obstruction and investigation like serum electrolyte were not included in the study because the study was retrospective.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003e This study provided insight into the surgical management outcome and its factors associated among patients with Gangrenous SBO at a tertiary teaching hospital in eastern Ethiopia. The majority of patients had unfavorable surgical management outcomes of Gangrenous SBO.In this study 15 (16.5%) patients died. Determinant factors including duration of illness before surgery, shock at presentation, and, hospital stay after operation were significantly associated with the surgical management outcome of Gangrenous SBO. Therefore, designing a strategy that address these factors would be helpful to further increase the likelihood of favorable surgical management outcome for the patients attending hospital with Gangrenous SBO.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSBO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSmall Bowel Obstruction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGSBO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGangrenous Small Bowel Obstruction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHFCSUH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHiwot Fana Comprehensive Specialized University Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSSI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSurgical Site Infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst of all, we would like to thank almighty God for being with us from the beginning of our life. Second, we would like to thank Haramaya University, Collage of Health and Medical Sciences for giving us the chance to carry out this research. Data collectors and respondents are also praised for their unreserved support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003eEthical Considerations\u003c/h2\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University, College of Health and Medical Sciences. As this was a \u003cstrong\u003eretrospective chart review\u003c/strong\u003e, the need for informed consent was \u003cstrong\u003ewaived by the ethics committee\u003c/strong\u003e, in accordance with national guidelines and institutional policies. Patient confidentiality was strictly maintained, and no personal identifiers were collected. All procedures were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments.\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\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 the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFW collected the data. AA and DE critically revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial numb\u003c/strong\u003eer: \u0026nbsp;not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdebambo O, Adedapo O, Adedoyin A. 2017. Predictive Factors of Management Outcome In Adult Patients With Mechanical Intestinal Obstruction Niger postgradmedj, 24(4):217\u0026ndash;223.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdesunkanmi A, Agbakwuru. 2011.Changing Pattern of Acute Intestinal Obstruction In A Tropical African Population EastAfrMed J., 73(11): 727\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdesunkanmi A, Agbakwuru E. 2011. Changing pattern of acute intestinal obstruction in a tropicalAfricanpopulation.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmmar S, Hafiz A, Muhammad M, Jonas F, Lodve S, Odd S, Knut S, Asgaut V. 2000 Department of Surgery, Haukeland University Hospital, University of Bergen, Bergen, Norway.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrunicardi F, Dana K, Timothy RDL, ,John G, Jeffrey B, Raphael E. 2015. SchwartzS Princeples of Surgery.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEllis. \u0026amp;Patterson-Brown, 2003.Hamilton andBaileys Emergency Surgery.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHFSUH. 2019. Human Resource Managment.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeremy E, Jonathan G, Philip J, Paul M. Management and Outcomes of Small Bowel Obstruction in Older Adult Patients, A Prospective Cohort Study. Can J Surg. 2014;57(6):379\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKotiso B, \u0026amp;Abdurahman. Pattern of AcuteAbdomenIn Adult Patients. East Cent Afr J Surg. 2007;12(1):47\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMukarugwiro. 2009. Patterns of Intestinal Obstruction at Kibogola Hospital,Rural Hospital In Rwanda. East Cent Afr J Surg(2):103\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNyundo,Rugwizangoga N, Kakande. Outcome of Emergency Abdominal Surgery at Kigali University Teaching Hospital: A Review of 229 Cases. East Cent Afr J Surg. 2013;18(1):31\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhilip B, Betty S, Seno S, Hillary M, Topazian, Russell W. 2015. Pattern Of Adult Intestinal Obstruction at Tenwek Hospital, In South \u0026ndash; Western Kenya.[Pmc Free Article], [April 2018].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuill D, Devlin H, Deham K. Surgical operation rates. A 12 year experiences in Stockton on tees. Ann R CollSurg Engl; 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchool of Nursing. College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaikh M, Dholia K. 2010. Current Spectrum of Acute Intestinal obstruction at CMC Larkana.Medical Channel.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoressa U, Abebe M, Desta H, Netsanet F. 2016. Prevalence, Causes and Management Outcome of Intestinal Obstruction Bmc Surgery, 16(8): 1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSouvik A, Zahid A, Amitabha D, Nilanjan M, \u0026amp;Udipta R. Etiology and Outcome of Acute Intestinal Obstruction: A Review of 367 Patients In Eastern India. Saudi J Gastroenterol. 2010;16(4):285\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTesfamichael G, Addisu T, Mehammed. A.,2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsegaye T, Osman M, Bekele A. Surgically Treated Acute Abdomen at Gondar University Hospital, Ethiopia.East And Central African. J Surg. 2007;12(1):55\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiamingH.,Guan F, Jie L, Keyu X, Hongqi S, Lei Z. August 2017. Department of General Surgery, The First affiliated Hospital of Wenzhou Medical University, Wenzhou, China.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYohannes M. Molla T.,2017 preparation of intestinal obstruction and associated factors.\u003c/span\u003e \u003cspan\u003eamong patients with non traumatic. acute abdomen admitted to surgical ward of.\u003c/span\u003e \u003cspan\u003edebrebirhan hospital.,American journal of biomedical and life sciences 54\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 5 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"gangrenous small bowel obstruction, surgical ward, outcome, factors associated, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-6674894/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6674894/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003esmall bowel obstructions account for 15% of hospital admissions for acute abdominal complaints and up to 30% of these patients will require operative intervention. Ethiopia is one of the countries where intestinal obstruction is a major cause of morbidity and mortality.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo assess outcome and factors associated with gangrenous small bowel obstruction among patients admitted to surgical ward of Hiwot Fana Specialized University Hospital from January 1, 2016-December 31, 2020.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cross-sectional study was conducted on all patients with gangrenous small bowel obstruction admitted to surgical ward of Hiwot Fana Specialized University Hospital from January1,2016-December 31,2020.For this study, a customized data abstraction form was developed for data capturing from medical records of the patients. The captured data was coded, entered to EpiINFo and exported to statistical package for social sciences software, version 22.0. for analysis. To summarize demographic and clinical characteristics of the patients considered for this study, descriptive statistics such as percent and frequency was employed. All variables with P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.3, during bi-variable analyses were considered for multivariable logistic regression analyses. Odds ratio along with 95% Confidence interval were estimated to measure the strength of the association. Level of statistical significance was declared at p value less or equal to 0.05\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 91patiens were included and finally analyzed in this study. From these 52 (57.1%) patients have un favorable surgical outcomes of gangrenous Small bowel obstruction. Of the 52 patients with unfavorable outcome, the most common postoperative complication occurred was anastomotic leak (29.5) followed by surgical site infection (25.5%) and pneumonia (23.6%). A total of 15 postoperative deaths were also documented as unfavorable surgical management outcomes of gangrenous Small bowel obstruction. Three factors including duration of illness before surgery, length of hospital stay after surgery and shock at presentation were significantly associated withthe surgical management outcome of gangrenous Small Bowel Obstruction.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn this study, the majority of patients had unfavorable surgical management outcomes of gangrenous Small Bowel Obstruction, however the proportion of patients with favorable outcomes was considerable. Thus, designing a strategy that address the factors associated with unfavorable outcomes could be helpful to further increase the likelihood of favorable surgical management outcomes of gangrenous Small Bowel Obstruction.\u003c/p\u003e","manuscriptTitle":"Assessment of outcome of and factors associated with gangrenous small bowel obstruction ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-27 09:12:40","doi":"10.21203/rs.3.rs-6674894/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"78786f90-226e-45d9-a0b5-e75b1c4b72bc","owner":[],"postedDate":"June 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-26T07:39:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-27 09:12:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6674894","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6674894","identity":"rs-6674894","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}