Etiology, Clinical Manifestations, and Imaging Evaluation of Intestinal Obstruction in Adults at Tertiary Hospital in Mogadishu, Somalia: A Retrospective Study.

Etiology, Clinical Manifestations, and Imaging Evaluation of Intestinal Obstruction in Adults at Tertiary Hospital in Mogadishu, Somalia: A Retrospective Study. | 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 Etiology, Clinical Manifestations, and Imaging Evaluation of Intestinal Obstruction in Adults at Tertiary Hospital in Mogadishu, Somalia: A Retrospective Study. Abdihamid Mohamed Ali, Yahye Garad Mohamed, Abdulkadir Nor Mohamed, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2046756/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 : Intestinal obstruction is a potential surgical emergency condition with a high rate of morbidity and mortality. The most prevalent causes of intestinal obstruction in adults are adhesions, which are followed by incarcerated hernias and tumors. Methods: A three-year retrospective data study of adult patients treated with IO at the Mogadishu Somalia Turkey training and research hospital in Mogadishu, Somalia, between June 1, 2019, and June 1, 2022. Results: A majority (67%) of our study were male showing the male predominance of the disease with a male-to-female ratio of 2:1. The patients demonstrated a variety of signs and symptoms, but the most prominent manifestations were nausea and vomiting (93.2%), abdominal distension (90.2%), and failure to feces /flatus (70.8%). The majority of the patient 98(95.1%) with intestinal obstruction was treated under operative management, whereas conservative management (i.e., nasogastric tube decompression, intravenous antibiotics, and intravenous fluid resuscitation) was applied in 4.9% of cases. surgical site infections were the main cause of their postoperative complications, According to the patient's hospital stays, the majority of patient (52%) hospitalizations lasted between 8 and 14 days. the overall mortality rate in this study was 5(4.9%), Discussion: Intestinal obstruction is one of the most common life-threatening emergencies all over the world presenting as acute abdomen and requiring surgical admission and management, Surgeons should keep up their aggressive approach to the elective treatment of all abdominal hernias and prompt surgical intervention in patients who have acute mechanical intestinal obstruction caused by incarcerated hernias. According to Mr. Hamilton Bailey, The sun should not rise and set on an unresolved case of intestinal obstruction The mortality rate related to intestinal obstruction was associated with the late presentation of the disease. Conclusion: Small bowel obstruction is more frequent than large bowel obstruction in this study, fibrous adhesion and incarcerated hernia were the leading causes of small bowel obstruction. Adhesiolysis and resection of non-viable. Bowel resection and anastomosis were the most frequent intraoperative procedures. More research utilizing prospective study designs is recommended. Intestinal Obstruction Strangulation Morbidity Mortality Colon Cancer Figures Figure 1 Background Acute intestinal obstruction, a common surgical emergency, is the interruption of the forward passage of intestinal contents anywhere from the mouth to the anal canal. It often manifests as a variety of clinical symptoms depending on the level of obstruction.[ 1 ] It is a potential surgical emergency condition with a high rate of morbidity and mortality[ 2 ]. The term "emergency operation" refers to those procedures that must be carried out urgently within 24 hours of a patient's admission or within 24 hours of the emergence of a particular complication.[ 3 ] It is one of the most prevalent acute abdominal disorders that necessitate admission for emergency surgery and is frequently associated with high mortality of 3–30% worldwide. [ 4 ] According to previously published research, 12% of patients with primary conservative treatment will experience a repeat Intestinal Obstruction, and 8 to 32% of patients with adhesion bowel obstruction will require surgery.[ 5 ] Early detection and surgical treatment reduce disproportionate death, Mechanical intestinal obstruction (IO) is among the pathologies that call for urgent surgical procedures, in many parts of the world. [ 6 ] The most prevalent causes of intestinal obstruction in adults are adhesions, which are followed by incarcerated hernias and tumors, In Africans, Hernias and volvulus are the most common causes of intestinal obstruction, in childhood intussusceptions and adhesion. [ 7 , 8 ] Our current study aims to explore the Etiology, Clinical Manifestations, and Imaging Evaluation of Intestinal Obstruction in Adults at Tertiary Hospital in Mogadishu Somalia. Material And Methods Study design and period A three-year retrospective data study of adult patients treated with IO at the Mogadishu Somalia Turkey training and research hospital in Mogadishu, Somalia, between June 1, 2019, and June 1, 2022. Study setting and population Mogadishu Somalia Turkey, RecepTayyipErdogan Training and Research Hospital is one of the country's primary referral hospitals, located in the capital city of Mogadishu. It has a bed capacity of 250, 7 operating rooms, 28 intensive care unit beds, 300 dialysis beds with 28 machines, and a radiology department with diagnostic facilities (digital x-rays, ultrasounds, CT scanner, 1 Siemens 1.5 tesla MRI, and fluoroscopy) capable of performing many interventional procedures, including ultrasound-guided and CT guided percutaneous drainage, and it serves patients from all over the country. It also functions as a consultant and teaching hospital, with residency programs in 19 different fields. The study population includes all IO patients admitted to Mogadishu's RecepTayyipErdogan Training and Research Hospital in the last three years. The following types of patients were included: individuals whose IO was treated conservatively or surgically. Pediatric cases and patients whose records were either incomplete (missing critical information on causes and management) or lost were excluded from the study. Data collection methods The data were collected using standardized checklists. A checklist in English was created to collect critical information such as age, sex, clinical presentation, laboratory data, previous operation history, etiology, site of obstruction/pathology, radiological findings, surgical methods, complications, and hospital stay. The data was collected by both radiology and general surgery team. Data processing, statistical analysis, interpretation, and presentation The data was cleaned and coded before being imported to SPSS version 27 for analysis. Descriptive statistics were used, and the results were presented in the form of frequency tables, percentages, and graphs. Ethics approval The approval was obtained from the Mogadishu Somali Turkish Training and Research Hospital research advisory and ethical committee (MSTH/10896) and this study was performed in accordance with the tenets of the declaration of Helsinki. Results Demographic characteristics and clinical presentation of intestinal obstruction In our study, 103 adult patients who had been admitted to the general surgery department for intestinal obstruction were reviewed, Two-thirds of the patients were in the younger age group (< 60 years), and only one-third (32%) were more than 60 years old. A majority (67%) of our study were male showing the male predominance of the disease with a male-to-female ratio of 2:1. The patients demonstrated a variety of signs and symptoms, but the most prominent manifestations were nausea and vomiting (93.2%), abdominal distention (90.2%), failure to feces /flatus (70.8%), leukocytosis (44.7%), and uremia (10.7%). See in Table1 . Our study reveals that 24 (23.3%) had a previous history of abdominal surgery. According to the categories of intestinal obstruction cases, non-oncological causes accounted for 79 patients (76.6%) with intestinal obstruction, while the oncological causes contributed to 27 patients (26.2%). Related to the level of obstruction site, Small bowel obstruction was identified in the vast majority of 71(68.9 %) of the patients whereas large bowel obstruction was attributed to 32(31.2%) of the patients. Fibrous adhesions and obstructed hernia were the two most common non-oncological causes of intestinal obstruction, while colon cancer was the leading cause of oncological reasons. The majority of the patient 98(95.1%) with intestinal obstruction was treated under operative management. whereas conservative management (i.e., nasogastric tube decompression, intravenous antibiotics, and intravenous fluid resuscitation) were applied in 4.9 % of cases. See In Table 2 . Our study reveals that 24 (23.3%) had previously undergone abdominal surgery. And the non-oncological causes accounted for 79 patients (76.6%) with intestinal obstruction, while the oncological causes contributed to 27 patients (26.2%). Fibrous adhesions and obstructed hernia were the two most common non-oncological causes of intestinal obstruction, while colon cancer was the leading cause of oncological reasons. Small bowel obstruction was identified inthe vast majority of 71(68.9 %) of the patients whereas large bowel obstruction was attributed to 32(31.2%) of the patients. Radiological evaluation of intestinal obstruction Our study found that the most common radiological findings were the presence of a distinct transition point (92.2%):, where the bowel caliber changes from normal to abnormal, and Proximal dilatation/Distal collapse (98%). A mesenteric fat stranding (18.4%) was also identified in our study, which was more common in patients with necrosis or perforations (such as appendiceal perforation and ischemic bowel perforation). Several dilated, U- or C-shaped fluid-filled dilated bowel loops (18.4%) were found in closed loop obstructions caused by adhesions or abdominal hernias.When there was volvulus, the mesentery twisted (Whirlpool sign ) (6.8%), and when there was intussusception, the Target sign (3.9%) appeared. see in figure 1. Pneumoperitoneum (11.7%), and bowel ischemia (5.8%) were the most common intestinal obstruction complications seen radiologically. See In Table 3 . Management outcome of intestinal obstruction Table 4 As most small bowel obstruction was found to be secondary to fibrous adhesion and obstructed hernia, as, the majority of surgical procedures used to treat these patients involved intraoperativeadhesiolysis and resection of non-viable bowel. 17 of these patients (16.5%) had surgical site infections, which were the main cause of their postoperative complications were early post-operative ileus and intra-abdominal abscess accounts 7.7% and 5.8 % respectively, and leak from anastomosis was documented in 4 patients (3.8%). The overall mortality rate in this study was 5(4.9%), among a total of 103 evaluated cases that underwent operative management. Discussion Intestinal obstruction is one of the most common life-threatening emergencies all over the world presenting as acute abdomen and requiring surgical admission and management [9] In this study, the vast majority of patients—71(68.9%)—were found to have a small intestinal obstruction, whereas 32(31.2%) were revealed to have a large bowel obstruction. Comparative results were noted in studies done in Ethiopia,Nigeria, and India. [10, 11, 12] The two leading non-oncological etiologies of intestinal obstruction were fibrous adhesions and obstructed hernias followed by Bowel Volvulus 8(7.7%), Many African nations still exhibit this trend, particularly in the rural areas.[13,14]while colon cancer was the most frequent oncological cause [15] Additionally, incarcerated hernias were the second most frequent cause of intestinal ischemia, necrosis, and perforation. The fact that intestinal ischemia was treatable in half of our patients where the obstruction was caused by incarcerated hernias justifies doing surgery immediately on these patients. Since 11.7 % of all cases of intestinal obstruction are still caused by abdominal hernias [16, 17, 18] Surgeons should keep up their aggressive approach to the elective treatment of all abdominal hernias and prompt surgical intervention in patients who have acute mechanical intestinal obstruction caused by incarcerated hernias. According to Mr. Hamilton Bailey ‘The sun should not rise and set on an unresolved case of intestinal obstruction [19] A significant number of our patients managed surgical intervention and a substantial number required emergency surgery. Similar findings were found in these studies. [20, 21] in controversy where most of the patients were successfully treated non-operatively. [22,23] Surgical site infection was the most common postoperative complication, occurring in 17 of these patients (16.5%). A similar result of 20.8% was found in research conducted in Nigeria. [24] This could be explained by the operational findings of intestinal perforation, peritonitis, and bowel gangrene. In our study, the mortality rate related to intestinal obstruction was 4.9%, and the mortality rate associated with the late presentation was reported in a study done in Rwanda where the overall mortality rate was 6.7%.[25] Limitations Due to the retrospective nature of this study's design and the potential for missing data in the patient's medical records,The findings are difficult to compare because there were no similar published data from the country. Being a hospital-based, single-center study with small sample size and the findings may not accurately represent the disease's state in the general population. However, our findings provide insight into the scope of intestinal obstruction in the country. Further prospective and multicenter research involving patients from other regions are required. Conclusion In conclusion, small bowel obstruction is more frequent than large bowel obstruction in this study, fibrous adhesion and incarcerated hernia were the leading causes of small and colon cancer in large bowel obstruction, laparotomy was the most common method of treating intestinal obstructions. Adhesiolysis and resection of non-viable Bowel resection and anastomosis were the most frequent intraoperative procedures. The most frequent postoperative complication among these patients was surgical site infection, before the intestine becomes gangrenous, surgeons should establish a prompt diagnosis and implement the proper interventions. To generalize to the entire population and overcome the limitations of secondary data in present retrospective research, more research utilizing prospective study designs is recommended. Abbreviations IO Intestinal Obstruction CT Computed Tomography SPSS Statistical Package for the Social Sciences Declarations Ethical approval and consent to participate Ethical approval for the study was obtained from the Hospital Ethical Committee (MSTH/10896) and this study was performed in accordance with the tenets of the declaration of Helsinki, Informed consent was obtained from all participants. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available in Mogadishu Somali Turkey, RecepTayyipErdogan Training and Research Hospital information system. Data are, however, allowed to the authors upon reasonable request and with permission of the education and research committee. Competing interests The authors declare no competing interests. Funding No funding was received for conducting this study. Author contributions All authors contributed significantly to the work that has been published, whether it be in the concept design, study design, implementation, data collection, analysis, and interpretation, or in all of these areas. They have also all participated in writing, revising, or critically evaluating the article. Authors gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work. Acknowledgments None. Author Details 1. Department of General Surgery, Mogadishu Somali Turkey RecepTayyipErdoğan Training and Research Hospital, Mogadishu, Somalia. 2. Department of Radiology, Mogadishu Somali Turkey RecepTayyipErdoğan Training and Research Hospital, Mogadishu, Somalia. 3. Department of General Directorate of Public Hospitals, Ministry of Health, Republic of Turkiye, Ankara, Turkiye. References Nakanwagi, A.M., Kijjambu, S.C., Ongom, P. et al. Outcomes of management of intestinal obstruction at an urban tertiary hospital in sub Saharan Africa: a cross-sectional study. BMC Surg 21, 408 (2021). Cirocchi R, Abraha I, Farinella E, Montedori A, Sciannameo F. Laparoscopic versus open surgery in small bowel obstruction. Cochrane Database Syst Rev. 2010;17(2):751–5 Shaikh MS, Dholia KR. Current Spectrumof Acute Intestinalobstructionat CMC Larkana. Medical Channel. 2010;16(2):74–8. Tsegaye, S, Osman, M, Bekele, A. Surgically treated acute abdomen at Gondar University Hospital, Ethiopia. East Central African J Surg2007; 12(1): 53–57. Quill DS, Devlin HB, Deham KR. Surgical operation rates. A 12 year experiences in Stockton on tees. Ann R CollSurg Engl. 2007;65(7):248–53. Girma, Hailemichael, et al. "Management outcome and its associated factors among surgically treated intestinal obstruction cases in Dilla University Referral Hospital, Southern Ethiopia. A cross-sectional study." International Journal of Surgery Open 33 (2021): 100351 R.P.H. Meier, W.O. deSaussure, L.A. Orci, E.M. Gutzwiller, P. Morel, F. Ris, et al. Clinical outcome in acute small bowel obstruction after surgical or conservative management World J Surg, 38 (12) (2014), pp. 3082-3088 . S. Asad, H. Khan, I.A. Khan, S. Ali, S. Ghaffar, Z. urRehmanAetiological factors in mechanical intestinal obstruction J Ayub Med Coll Abbottabad, 23 (3) (2011), pp. 26-27 C.M. Townsend, R.D. Beauchamp, B.M. Evers, K.L. Mattox Sabiston textbook of surgery E-book: the biological basis of modern surgical practice (20 ed.), Elsevier Health Sciences (2017) Girma, Hailemichael, et al. "Management outcome and its associated factors among surgically treated intestinal obstruction cases in Dilla University Referral Hospital, Southern Ethiopia. A cross-sectional study." International Journal of Surgery Open 33 (2021): 100351. Lawal, Oladejo O., Olaniyi S. Olayinka, and John O. Bankole. "Spectrum of causes of intestinal obstruction in adult Nigerian patients." South African Journal of Surgery 43.2 (2005): 34-36. Souvik, Adhikari, et al. "Etiology and outcome of acute intestinal obstruction: A review of 367 patients in Eastern India." Saudi journal of gastroenterology: official journal of the Saudi Gastroenterology Association 16.4 (2010): 285. Markogiannakis, Haridimos, et al. "Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome." World journal of gastroenterology: WJG 13.3 (2007): 432. Wysocki A, Krzywoń J. Causes of intestinal obstruction. PrzeglLek. 2001;58:507–508. Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007 Jan 21;13(3):432-7. doi: 10.3748/wjg.v13.i3.432. Ihedioha U, Alani A, Modak P, Chong P, O'Dwyer PJ. Hernias are the most common cause of strangulation in patients presenting with small bowel obstruction. Hernia. 2006;10:338–340. Mohamed AY, al-Ghaithi A, Langevin JM, NassarAH.Causes and management of intestinal obstruction in a Saudi Arabian hospital.J R CollSurgEdinb. 1997;42:21–23. Foster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg. 2006;203:170–176. Triadafilopoulos, George, PrithviLegha, and Charles Lombard. "Sun Should Not Rise and Set on a Case of Acute Intestinal Obstruction." Digestive Diseases and Sciences 63.1 (2018): 27-31. Kuremu RT, Jumbi G. Adhesive intestinal obstruction. East Afr Med J. 2006;83:333–336. McEntee G, Pender D, Mulvin D, McCullough M, Naeeder S, Farah S, Badurdeen MS, Ferraro V, Cham C, Gillham N. Current spectrum of intestinal obstruction. Br J Surg. 1987;74:976–980. Williams SB, Greenspon J, Young HA, Orkin BA. Small bowel obstruction: conservative vs. surgical management. Dis Colon Rectum. 2005;48:1140–1146. Tamijmarane A, Chandra S, Smile SR. Clinical aspects of adhesive intestinal obstruction. Trop Gastroenterol. 2000;21:141–143. Ogundoyin, O. O., et al. "Pattern and outcome of childhood intestinal obstruction at a tertiary hospital in Nigeria." African health sciences 9.3 (2009). Ntakiyiruta, Georges, and BéataMukarugwiro. "The pattern of intestinal obstruction at Kibogola Hospital, a Rural Hospital in Rwanda." East and central African journal of surgery 14.2 (2009): 103-108. Tables Table 1 Socio-demographic characteristics, Clinical presentation and laboratory data among intestinal obstruction cases Variables Frequency (n=103) Percent % Age 18- 25 25 24.3% 26-35 13 12.6% 36-45 20 19.4% 46-60 12 11.7% > 60 33 32.0% Sex Male 69 67.0% Female 34 33.0% Clinical presentation and laboratory data Nausea & vomiting 96 93.2% Constipation / Obstipation 73 70.8% Abdominal distension 93 90.2% Leukocytosis 46 44.7% Uremia 11 10.7% Table 2 Risk factors, etiology, management, and site of pathology among intestinal obstruction cases Variables Frequency (n=103) Percent % History of previous operation Yes 24 23.3% No 79 76.7% Site of obstruction Large bowel 32 31.1% Small bowel 71 68.9% Etiology Non- Oncological 76 73.8% Oncological 27 26.2% Oncological Colon cancer 18 17.5% Rectal cancer 3 2.9% Small bowel cancer 6 5.8% Non- Oncological Fibrous adhesions 34 33.0% Abdominal hernia 12 11.7% Inflammation/infection (IBD, TB, E gastroenteritis) 2 1.9% Intussusception 4 3.9% Small Bowel Volvulus 3 2.9% Large Bowel Volvulus 5 4.9% Diverticulitis 3 2.9% Bowel ischemia (Closed loop) 3 2.9% Necrosis and perforation 10 9.7% Duodenal stricture 8 7.8% Abscess 2 1.9% Other (bezoars, gallstone ileus, SMA S) 1 1.0% Management Non operative management 5 4.9% Operative management 98 95.1% Table 3 Procedures for the evaluation, Radiological finding and associated complications among intestinal obstruction cases Variable Frequency (n=103) Percent % Procedures for the evaluation X-ray 99 96.1 % Ultrasound 28 27.1% CT scan 90 87.3% Radiological finding Proximal dilatation/Distal collapse 101 98.1% Transition point 95 92.2.0% Surrounding mesenteric fat stranding 19 18.4% U-shaped or C-shaped-loop 19 18.4% Twisting of the mesentery (whirlpool sign) 7 6.8% Target sign 4 3.9% Pneumoperitoneum 12 11.7% Bowel ischemia 6 5.8% Table 4 Operative procedures and complications among intestinalobstruction cases Variable Frequency (n=103) Percent % Operative procedures Appendectomy 8 7.8% Loop colostomy 5 4.9% Lysis of adhesions 32 31.1% Lysis of adhesions + resection 7 6.8% Lysis of adhesions + enterostomy 7 6.8% Hernia repair 6 5.8% Hernia repair + resection 4 3.9% Resection + anastomosis 22 21.4% Enterotomy repair 8 7.8% Resection + Enterostomy 34 33.0% Abscess drainage 6 5.8% Complications Iatrogenic bowelinjury 6 5.8% Surgical site infections 17 16.5% Early period ileus 8 7.7% Leakage from anastomosis 4 3.9% Intra-abdominal abscess 6 5.8% Incisional hernia 3 2.9% Evisceration 4 3.8% Mortality 5 4.9% Hospital stay 1-7 days 40 38.8% 8-14 days 54 52.4% > 14 days 9 8.7% Additional Declarations No competing interests reported. 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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-2046756","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":142680655,"identity":"46830184-2a86-4314-a4b0-e52c80167571","order_by":0,"name":"Abdihamid Mohamed Ali","email":"data:image/png;base64,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","orcid":"","institution":"Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Abdihamid","middleName":"Mohamed","lastName":"Ali","suffix":""},{"id":142680658,"identity":"5bf3b56a-14f9-41ee-b39c-2c0aa520bd0b","order_by":1,"name":"Yahye Garad Mohamed","email":"","orcid":"","institution":"Department of Radiology, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yahye","middleName":"Garad","lastName":"Mohamed","suffix":""},{"id":142680661,"identity":"1fd457c9-3421-4bf5-af5a-805a0f662e19","order_by":2,"name":"Abdulkadir Nor Mohamed","email":"","orcid":"","institution":"Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abdulkadir","middleName":"Nor","lastName":"Mohamed","suffix":""},{"id":142680664,"identity":"84a1d644-ee7b-4797-ba3f-4052d6143fae","order_by":3,"name":"Ilkay Güler","email":"","orcid":"","institution":"Department of General Directorate of Public Hospitals ,Republic of Turkiye, Ministry of Health, , Ankara, Turkiye.","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ilkay","middleName":"","lastName":"Güler","suffix":""}],"badges":[],"createdAt":"2022-09-08 21:44:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2046756/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2046756/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":27640079,"identity":"c7624c2b-c36f-4445-8e98-cd2da4c20962","added_by":"auto","created_at":"2022-10-11 19:21:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":342322,"visible":true,"origin":"","legend":"\u003cp\u003eAxial contrast-enhanced abdominal CT demonstrating intestinal obstruction due to (A) Perforated appendicitis, (B) Fibrous adhesion in a patient with a previous history of operation, (C) Incarcerated diaphragmatic hernia, (D) Incarcerated umbilical hernia, (E) Incarcerated inguinal hernia, (F) Strangulated inguinal hernia, (G) Intussusception with typical target sign, (H) Mid gut volvulus with typical whirlpool sign, (I) closed loop obstruction with non-enhancing bowel loops indicating bowel ischemia, (J) Diverticulitis showing a long segment of diffuse sigmoid wall thickening and mesenteric fat stranding, (K) Rectal cancer (L) Sigmoid Colon Cancer.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-2046756/v1/067f05f8ab7f1097281ba5e8.png"},{"id":28529587,"identity":"187d0408-7890-4824-825b-06b08ec7a412","added_by":"auto","created_at":"2022-11-01 18:59:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":762329,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2046756/v1/1883a1f5-6925-4da8-ba97-f682a0a7b4db.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Etiology, Clinical Manifestations, and Imaging Evaluation of Intestinal Obstruction in Adults at Tertiary Hospital in Mogadishu, Somalia: A Retrospective Study.","fulltext":[{"header":"Background","content":"\u003cp\u003eAcute intestinal obstruction, a common surgical emergency, is the interruption of the forward passage of intestinal contents anywhere from the mouth to the anal canal. It often manifests as a variety of clinical symptoms depending on the level of obstruction.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] It is a potential surgical emergency condition with a high rate of morbidity and mortality[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The term \"emergency operation\" refers to those procedures that must be carried out urgently within 24 hours of a patient's admission or within 24 hours of the emergence of a particular complication.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIt is one of the most prevalent acute abdominal disorders that necessitate admission for emergency surgery and is frequently associated with high mortality of 3\u0026ndash;30% worldwide. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAccording to previously published research, 12% of patients with primary conservative treatment will experience a repeat Intestinal Obstruction, and 8 to 32% of patients with adhesion bowel obstruction will require surgery.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eEarly detection and surgical treatment reduce disproportionate death, Mechanical intestinal obstruction (IO) is among the pathologies that call for urgent surgical procedures, in many parts of the world. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe most prevalent causes of intestinal obstruction in adults are adhesions, which are followed by incarcerated hernias and tumors,\u003c/p\u003e \u003cp\u003eIn Africans, Hernias and volvulus are the most common causes of intestinal obstruction, in childhood intussusceptions and adhesion. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOur current study aims to explore the Etiology, Clinical Manifestations, and Imaging Evaluation of Intestinal Obstruction in Adults at Tertiary Hospital in Mogadishu Somalia.\u003c/p\u003e"},{"header":"Material And Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA three-year retrospective data study of adult patients treated with IO at the Mogadishu Somalia Turkey training and research hospital in Mogadishu, Somalia, between June 1, 2019, and June 1, 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy setting and\u0026nbsp;population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMogadishu Somalia Turkey,\u0026nbsp;RecepTayyipErdogan\u0026nbsp;Training and Research Hospital is one of the country\u0026apos;s primary referral hospitals, located in the capital city of Mogadishu. It has a bed capacity of 250, 7 operating rooms, 28 intensive care unit beds, 300 dialysis beds with 28 machines, and a radiology department with diagnostic facilities (digital x-rays, ultrasounds, CT scanner, 1 Siemens 1.5 tesla MRI, and fluoroscopy) capable of performing many interventional procedures, including ultrasound-guided and CT guided percutaneous drainage, and it serves patients from all over the country. It also functions as a consultant and teaching hospital, with residency programs in 19 different fields.\u003c/p\u003e\n\u003cp\u003eThe study population includes all IO patients admitted to Mogadishu\u0026apos;s RecepTayyipErdogan Training and Research Hospital in the last three years.\u003c/p\u003e\n\u003cp\u003eThe following types of patients were included: individuals whose IO was treated conservatively or surgically.\u003c/p\u003e\n\u003cp\u003ePediatric cases and patients whose records were either incomplete (missing critical information on causes and management) or lost were excluded from the study.\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were collected using standardized checklists. A checklist in English was created to collect critical information such as age, sex, clinical presentation, laboratory data, previous operation history, etiology, site of obstruction/pathology, radiological findings, surgical methods, complications, and hospital stay. The data was collected by both radiology and general surgery team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing, statistical analysis, interpretation, and presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data was cleaned and coded before being imported to SPSS version 27 for analysis. Descriptive statistics were used, and the results were presented in the form of frequency tables, percentages, and graphs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe approval was obtained from the Mogadishu Somali Turkish Training and Research Hospital research advisory and ethical committee (MSTH/10896) and this study was performed in accordance with the tenets of the declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic characteristics and clinical presentation of intestinal obstruction \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, 103 adult patients who had been admitted to the general surgery department for intestinal obstruction were reviewed,\u0026nbsp;Two-thirds\u0026nbsp;of the patients were in the younger age group (\u0026lt; 60 years), and only\u0026nbsp;one-third\u0026nbsp;(32%)\u0026nbsp;were\u0026nbsp;more than 60 years old. A majority (67%) of our study\u0026nbsp;were\u0026nbsp;male showing the male predominance of the disease with a male-to-female ratio of 2:1. The patients demonstrated a variety of signs and symptoms, but the most prominent manifestations were nausea and vomiting (93.2%), abdominal distention (90.2%), failure to feces /flatus (70.8%), leukocytosis (44.7%), and uremia (10.7%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSee in Table1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eOur study reveals that 24 (23.3%) had a previous history of abdominal surgery.\u003c/p\u003e\n\u003cp\u003eAccording to the categories of intestinal obstruction cases, non-oncological causes accounted for 79 patients (76.6%) with intestinal obstruction, while the oncological causes contributed to 27 patients (26.2%).\u003c/p\u003e\n\u003cp\u003eRelated to the level of obstruction site, Small bowel obstruction was identified in the vast majority of 71(68.9 %) of the patients whereas large bowel obstruction was attributed to 32(31.2%) of the patients.\u003c/p\u003e\n\u003cp\u003eFibrous adhesions and obstructed hernia were the two most common non-oncological causes of intestinal obstruction, while colon cancer was the leading cause of oncological reasons.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe majority of the patient 98(95.1%) with intestinal obstruction was treated\u0026nbsp;under operative management. whereas conservative management (i.e., nasogastric tube decompression, intravenous antibiotics, and intravenous fluid resuscitation) were applied in 4.9 % of cases. See In\u003cstrong\u003e\u0026nbsp;Table 2\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Our study reveals that 24 (23.3%) had previously undergone abdominal surgery.\u003c/p\u003e\n\u003cp\u003eAnd the non-oncological causes accounted for 79 patients (76.6%) with intestinal obstruction, while the oncological causes contributed\u0026nbsp;to\u0026nbsp;27 patients (26.2%).\u003c/p\u003e\n\u003cp\u003eFibrous adhesions and obstructed hernia were the two most common non-oncological causes of intestinal obstruction, while colon cancer was the leading cause of oncological reasons. Small bowel obstruction was identified\u0026nbsp;inthe vast majority\u0026nbsp;of 71(68.9 %) of the patients whereas large bowel obstruction\u0026nbsp;was attributed\u0026nbsp;to 32(31.2%) of the patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRadiological evaluation of intestinal obstruction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study found that the most common radiological findings were the presence of a distinct transition point (92.2%):, where the bowel caliber changes from normal to abnormal,\u0026nbsp;and Proximal dilatation/Distal collapse (98%).\u003c/p\u003e\n\u003cp\u003eA mesenteric fat stranding (18.4%) was also identified in our study, which was more common in patients with necrosis or perforations (such as appendiceal perforation and ischemic bowel perforation). Several dilated, U- or C-shaped fluid-filled dilated bowel loops (18.4%) were found in closed loop obstructions caused by adhesions or abdominal hernias.When there was volvulus, the mesentery twisted (Whirlpool sign ) (6.8%), and when there was intussusception, the Target sign (3.9%) appeared.\u003cstrong\u003esee in figure 1.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePneumoperitoneum (11.7%), and bowel ischemia (5.8%) were the most common intestinal obstruction complications seen radiologically.\u003cstrong\u003eSee In\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Table 3\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eManagement outcome of intestinal obstruction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs most small bowel obstruction was found to be secondary to fibrous adhesion and obstructed hernia, as, the majority of surgical procedures used to treat these patients involved intraoperativeadhesiolysis and resection of non-viable bowel. 17 of these patients (16.5%) had surgical site infections, which were the main cause of their postoperative complications were early post-operative ileus and intra-abdominal abscess accounts 7.7% and 5.8 % respectively, and leak from anastomosis was documented in 4 patients (3.8%). The overall mortality rate in this study was 5(4.9%), among a total of 103 evaluated cases that underwent operative management.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIntestinal obstruction is one of the\u0026nbsp;most common life-threatening emergencies all over the world presenting as acute abdomen and requiring surgical admission and management [9]\u003c/p\u003e\n\u003cp\u003eIn this study, the vast majority of patients\u0026mdash;71(68.9%)\u0026mdash;were found to have\u0026nbsp;a small intestinal obstruction, whereas 32(31.2%) were revealed to have\u0026nbsp;a large bowel obstruction. Comparative results were noted in studies done in Ethiopia,Nigeria, and India. [10, 11, 12]\u003c/p\u003e\n\u003cp\u003eThe two leading non-oncological etiologies of intestinal obstruction were fibrous adhesions and obstructed hernias followed by Bowel Volvulus 8(7.7%), Many African nations still exhibit this trend, particularly in the rural areas.[13,14]while colon cancer was the most frequent oncological cause [15]\u003c/p\u003e\n\u003cp\u003eAdditionally, incarcerated hernias were the second most frequent cause of intestinal ischemia, necrosis, and perforation. \u0026nbsp;The fact that intestinal ischemia was treatable in half of our patients where\u0026nbsp;the obstruction was caused by incarcerated hernias justifies doing surgery immediately on these patients. Since 11.7 % of all cases of intestinal obstruction are still caused by abdominal hernias [16, 17, 18]\u003c/p\u003e\n\u003cp\u003eSurgeons should keep up their aggressive approach to\u0026nbsp;the elective treatment of all abdominal hernias and prompt surgical intervention in patients who have acute mechanical intestinal obstruction caused by incarcerated hernias. According to Mr. Hamilton Bailey \u0026lsquo;The sun should not rise and set on an unresolved case of intestinal\u0026nbsp;obstruction\u0026nbsp;[19]\u003c/p\u003e\n\u003cp\u003eA significant number of our patients managed surgical intervention and a substantial number required emergency surgery. Similar findings were found in these studies. [20, 21] in controversy where most of the patients\u0026nbsp;were\u0026nbsp;successfully treated non-operatively. [22,23]\u003c/p\u003e\n\u003cp\u003eSurgical site infection was the most common postoperative complication, occurring in 17 of these patients (16.5%). A similar result of 20.8% was found in research conducted in Nigeria. [24] This could be explained by the operational findings of intestinal perforation, peritonitis, and bowel gangrene.\u003c/p\u003e\n\u003cp\u003eIn our study, the mortality rate related to intestinal obstruction was 4.9%, and the mortality rate associated with the late presentation was reported in a study done in Rwanda where the overall mortality rate was\u0026nbsp;6.7%.[25]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the retrospective nature of this study\u0026apos;s design and the potential for missing data in the patient\u0026apos;s medical records,The\u0026nbsp;findings\u0026nbsp;are\u0026nbsp;difficult\u0026nbsp;to\u0026nbsp;compare\u0026nbsp;because\u0026nbsp;there\u0026nbsp;were\u0026nbsp;no\u0026nbsp;similar\u0026nbsp;published\u0026nbsp;data\u0026nbsp;from\u0026nbsp;the\u0026nbsp;country.\u003c/p\u003e\n\u003cp\u003eBeing a hospital-based, single-center study with small sample size and the findings may not accurately represent the disease\u0026apos;s state in the general population. However, our findings provide insight into the scope of intestinal obstruction in the country. Further prospective and multicenter research involving patients from other regions are required.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, small bowel obstruction is more frequent than large bowel obstruction in this study, fibrous adhesion and incarcerated hernia were the leading causes of small and colon cancer in large bowel obstruction, laparotomy was the most common method of treating intestinal obstructions. Adhesiolysis and resection of non-viable Bowel resection and anastomosis were the most frequent intraoperative procedures. The most frequent postoperative complication among these patients was surgical site infection, before the intestine becomes gangrenous, surgeons should establish a prompt diagnosis and implement the proper interventions.\u003c/p\u003e \u003cp\u003eTo generalize to the entire population and overcome the limitations of secondary data in present retrospective research, more research utilizing prospective study designs is recommended.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eIO\u003c/strong\u003e\u0026nbsp; \u0026nbsp; Intestinal Obstruction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCT\u003c/strong\u003e\u0026nbsp; \u0026nbsp;Computed Tomography\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPSS\u003c/strong\u003e Statistical Package for the Social Sciences\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was obtained from the Hospital Ethical Committee (MSTH/10896) and\u0026nbsp;this study was performed in accordance with the tenets of the declaration of Helsinki, Informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\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\u003e\u0026nbsp;The data that support the findings of this study are available in Mogadishu Somali Turkey, RecepTayyipErdogan Training and Research Hospital information system. Data are, however, allowed to the authors upon reasonable request and with permission of the education and research committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;No funding was received for conducting this study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed significantly to the work that has been published, whether it be in the concept design, study design, implementation, data collection, analysis, and interpretation, or in all of these areas. They have also all participated in writing, revising, or critically evaluating the article.\u003c/p\u003e\n\u003cp\u003eAuthors gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Department of General Surgery, Mogadishu Somali Turkey RecepTayyipErdoğan Training and Research Hospital, Mogadishu, Somalia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Department of Radiology, Mogadishu Somali Turkey RecepTayyipErdoğan Training and Research Hospital, Mogadishu, Somalia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. Department of General Directorate of Public Hospitals, Ministry of Health, Republic of \u0026nbsp;Turkiye, Ankara, Turkiye.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNakanwagi, A.M., Kijjambu, S.C., Ongom, P. \u003cem\u003eet al.\u003c/em\u003e Outcomes of management of intestinal obstruction at an urban tertiary hospital in sub Saharan Africa: a cross-sectional study. \u003cem\u003eBMC Surg\u003c/em\u003e 21, 408 (2021).\u003c/li\u003e\n\u003cli\u003eCirocchi R, Abraha I, Farinella E, Montedori A, Sciannameo F. Laparoscopic versus open surgery in small bowel obstruction. Cochrane Database Syst Rev. 2010;17(2):751\u0026ndash;5\u003c/li\u003e\n\u003cli\u003eShaikh MS, Dholia KR. Current Spectrumof Acute Intestinalobstructionat CMC Larkana. Medical Channel. 2010;16(2):74\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eTsegaye, S, Osman, M, Bekele, A. Surgically treated acute abdomen at Gondar University Hospital, Ethiopia. East Central African J Surg2007; 12(1): 53\u0026ndash;57.\u003c/li\u003e\n\u003cli\u003eQuill DS, Devlin HB, Deham KR. Surgical operation rates. A 12 year experiences in Stockton on tees. Ann R CollSurg Engl. 2007;65(7):248\u0026ndash;53.\u003c/li\u003e\n\u003cli\u003eGirma, Hailemichael, et al. \u0026quot;Management outcome and its associated factors among surgically treated intestinal obstruction cases in Dilla University Referral Hospital, Southern Ethiopia. A cross-sectional study.\u0026quot;\u003cem\u003eInternational Journal of Surgery Open\u003c/em\u003e 33 (2021): 100351\u003c/li\u003e\n\u003cli\u003eR.P.H. Meier, W.O. deSaussure, L.A. Orci, E.M. Gutzwiller, P. Morel, F. Ris, \u003cem\u003eet al. \u003c/em\u003eClinical outcome in acute small bowel obstruction after surgical or conservative management World J Surg, 38 (12) (2014), pp. 3082-3088\u003c/li\u003e\n\u003cli\u003e. S. Asad, H. Khan, I.A. Khan, S. Ali, S. Ghaffar, Z. urRehmanAetiological factors in mechanical intestinal obstruction J Ayub Med Coll Abbottabad, 23 (3) (2011), pp. 26-27\u003c/li\u003e\n\u003cli\u003eC.M. Townsend, R.D. Beauchamp, B.M. Evers, K.L. Mattox Sabiston textbook of surgery E-book: the biological basis of modern surgical practice (20 ed.), Elsevier Health Sciences (2017)\u003c/li\u003e\n\u003cli\u003eGirma, Hailemichael, et al. \u0026quot;Management outcome and its associated factors among surgically treated intestinal obstruction cases in Dilla University Referral Hospital, Southern Ethiopia. A cross-sectional study.\u0026quot;\u003cem\u003eInternational Journal of Surgery Open\u003c/em\u003e 33 (2021): 100351.\u003c/li\u003e\n\u003cli\u003eLawal, Oladejo O., Olaniyi S. Olayinka, and John O. Bankole. \u0026quot;Spectrum of causes of intestinal obstruction in adult Nigerian patients.\u0026quot;\u003cem\u003eSouth African Journal of Surgery\u003c/em\u003e 43.2 (2005): 34-36.\u003c/li\u003e\n\u003cli\u003eSouvik, Adhikari, et al. \u0026quot;Etiology and outcome of acute intestinal obstruction: A review of 367 patients in Eastern India.\u0026quot; \u003cem\u003eSaudi journal of gastroenterology: official journal of the Saudi Gastroenterology Association\u003c/em\u003e 16.4 (2010): 285.\u003c/li\u003e\n\u003cli\u003eMarkogiannakis, Haridimos, et al. \u0026quot;Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome.\u0026quot; \u003cem\u003eWorld journal of gastroenterology: WJG\u003c/em\u003e 13.3 (2007): 432.\u003c/li\u003e\n\u003cli\u003eWysocki A, Krzywoń J. Causes of intestinal obstruction. PrzeglLek. 2001;58:507\u0026ndash;508.\u003c/li\u003e\n\u003cli\u003eMarkogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007 Jan 21;13(3):432-7. doi: 10.3748/wjg.v13.i3.432. \u003c/li\u003e\n\u003cli\u003eIhedioha U, Alani A, Modak P, Chong P, O\u0026apos;Dwyer PJ. Hernias are the most common cause of strangulation in patients presenting with small bowel obstruction. Hernia. 2006;10:338\u0026ndash;340. \u003c/li\u003e\n\u003cli\u003eMohamed AY, al-Ghaithi A, Langevin JM, NassarAH.Causes and management of intestinal obstruction in a Saudi Arabian hospital.J R CollSurgEdinb. 1997;42:21\u0026ndash;23.\u003c/li\u003e\n\u003cli\u003eFoster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg. 2006;203:170\u0026ndash;176.\u003c/li\u003e\n\u003cli\u003eTriadafilopoulos, George, PrithviLegha, and Charles Lombard. \u0026quot;Sun Should Not Rise and Set on a Case of Acute Intestinal Obstruction.\u0026quot; \u003cem\u003eDigestive Diseases and Sciences\u003c/em\u003e 63.1 (2018): 27-31.\u003c/li\u003e\n\u003cli\u003eKuremu RT, Jumbi G. Adhesive intestinal obstruction. East Afr Med J. 2006;83:333\u0026ndash;336.\u003c/li\u003e\n\u003cli\u003eMcEntee G, Pender D, Mulvin D, McCullough M, Naeeder S, Farah S, Badurdeen MS, Ferraro V, Cham C, Gillham N. Current spectrum of intestinal obstruction. Br J Surg. 1987;74:976\u0026ndash;980. \u003c/li\u003e\n\u003cli\u003eWilliams SB, Greenspon J, Young HA, Orkin BA. Small bowel obstruction: conservative vs. surgical management. Dis Colon Rectum. 2005;48:1140\u0026ndash;1146. \u003c/li\u003e\n\u003cli\u003eTamijmarane A, Chandra S, Smile SR. Clinical aspects of adhesive intestinal obstruction. Trop Gastroenterol. 2000;21:141\u0026ndash;143.\u003c/li\u003e\n\u003cli\u003eOgundoyin, O. O., et al. \u0026quot;Pattern and outcome of childhood intestinal obstruction at a tertiary hospital in Nigeria.\u0026quot; \u003cem\u003eAfrican health sciences\u003c/em\u003e 9.3 (2009).\u003c/li\u003e\n\u003cli\u003eNtakiyiruta, Georges, and B\u0026eacute;ataMukarugwiro. \u0026quot;The pattern of intestinal obstruction at Kibogola Hospital, a Rural Hospital in Rwanda.\u0026quot; \u003cem\u003eEast and central African journal of surgery\u003c/em\u003e 14.2 (2009): 103-108.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" width=\"100%\"\u003e\n \u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003c/p\u003e\n \u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSocio-demographic characteristics, Clinical presentation and laboratory data among intestinal obstruction cases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"50%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" width=\"25%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e18- 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e24.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e26-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e12.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e36-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e19.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e46-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e11.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;\u003c/strong\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e32.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"25%\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e67.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e33.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" width=\"25%\"\u003e\n \u003cp\u003eClinical presentation and laboratory data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eNausea \u0026amp; vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e93.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eConstipation / Obstipation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e70.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eAbdominal distension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e90.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eLeukocytosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e44.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eUremia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e10.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" width=\"100%\"\u003e\n \u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003c/p\u003e\n \u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eRisk factors, etiology, management, and site of pathology among intestinal obstruction cases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"69.11764705882354%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.522875816993464%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.359477124183007%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"24.50980392156863%\"\u003e\n \u003cp\u003eHistory of previous operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.522875816993464%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.359477124183007%\"\u003e\n \u003cp\u003e23.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e76.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"24.50980392156863%\"\u003e\n \u003cp\u003eSite of obstruction\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eLarge bowel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.522875816993464%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.359477124183007%\"\u003e\n \u003cp\u003e31.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eSmall bowel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e68.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"24.50980392156863%\"\u003e\n \u003cp\u003eEtiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eNon- Oncological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.522875816993464%\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.359477124183007%\"\u003e\n \u003cp\u003e73.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eOncological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e26.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"24.50980392156863%\"\u003e\n \u003cp\u003eOncological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eColon cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.522875816993464%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.359477124183007%\"\u003e\n \u003cp\u003e17.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eRectal cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eSmall bowel cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e5.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" width=\"24.50980392156863%\"\u003e\n \u003cp\u003eNon- Oncological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eFibrous adhesions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.522875816993464%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.359477124183007%\"\u003e\n \u003cp\u003e33.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eAbdominal hernia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e11.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eInflammation/infection (IBD, TB, E gastroenteritis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e1.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eIntussusception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e3.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eSmall Bowel Volvulus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eLarge Bowel Volvulus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e4.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eDiverticulitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eBowel ischemia (Closed loop)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eNecrosis and perforation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e9.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eDuodenal stricture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e7.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eAbscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e1.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eOther (bezoars, gallstone ileus, SMA S)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e1.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"24.50980392156863%\"\u003e\n \u003cp\u003eManagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eNon operative management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.522875816993464%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.359477124183007%\"\u003e\n \u003cp\u003e4.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.09090909090909%\"\u003e\n \u003cp\u003eOperative management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.562770562770563%\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.346320346320347%\"\u003e\n \u003cp\u003e95.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable align=\"left\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" width=\"100%\"\u003e\n \u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003c/p\u003e\n \u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003eProcedures for the evaluation, Radiological finding and associated complications among intestinal obstruction cases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"52.743362831858406%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.530973451327434%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.72566371681416%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"20.884955752212388%\"\u003e\n \u003cp\u003eProcedures for the evaluation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.858407079646017%\"\u003e\n \u003cp\u003eX-ray\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.530973451327434%\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.72566371681416%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;96.1 \u0026nbsp; \u0026nbsp; %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.26845637583892%\"\u003e\n \u003cp\u003eUltrasound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.950782997762865%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.78076062639821%\"\u003e\n \u003cp\u003e27.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.26845637583892%\"\u003e\n \u003cp\u003eCT scan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.950782997762865%\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.78076062639821%\"\u003e\n \u003cp\u003e87.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" width=\"20.884955752212388%\"\u003e\n \u003cp\u003eRadiological finding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.858407079646017%\"\u003e\n \u003cp\u003eProximal dilatation/Distal collapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.530973451327434%\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.72566371681416%\"\u003e\n \u003cp\u003e98.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.26845637583892%\"\u003e\n \u003cp\u003eTransition point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.950782997762865%\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.78076062639821%\"\u003e\n \u003cp\u003e92.2.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.26845637583892%\"\u003e\n \u003cp\u003eSurrounding mesenteric fat stranding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.950782997762865%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.78076062639821%\"\u003e\n \u003cp\u003e18.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.26845637583892%\"\u003e\n \u003cp\u003eU-shaped or C-shaped-loop\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.950782997762865%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.78076062639821%\"\u003e\n \u003cp\u003e18.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.26845637583892%\"\u003e\n \u003cp\u003eTwisting of the mesentery (whirlpool sign)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.950782997762865%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.78076062639821%\"\u003e\n \u003cp\u003e6.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.26845637583892%\"\u003e\n \u003cp\u003eTarget sign\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.950782997762865%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.78076062639821%\"\u003e\n \u003cp\u003e3.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.26845637583892%\"\u003e\n \u003cp\u003ePneumoperitoneum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.950782997762865%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.78076062639821%\"\u003e\n \u003cp\u003e11.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.26845637583892%\"\u003e\n \u003cp\u003e\u003cem\u003eBowel ischemia\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.950782997762865%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.78076062639821%\"\u003e\n \u003cp\u003e5.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" width=\"100%\"\u003e\n \u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e\u003c/p\u003e\n \u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003e\u003c/strong\u003eOperative procedures and complications among intestinalobstruction cases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"69.89247311827957%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.025089605734767%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.082437275985663%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"11\" width=\"22.40143369175627%\"\u003e\n \u003cp\u003eOperative procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.4910394265233%\"\u003e\n \u003cp\u003eAppendectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.025089605734767%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.082437275985663%\"\u003e\n \u003cp\u003e7.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eLoop colostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e4.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eLysis of adhesions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e31.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eLysis of adhesions + resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e6.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eLysis of adhesions + enterostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e6.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eHernia repair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e5.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eHernia repair + resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e3.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eResection + anastomosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e21.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eEnterotomy repair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e7.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eResection + Enterostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e33.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eAbscess drainage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e5.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" width=\"22.40143369175627%\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.4910394265233%\"\u003e\n \u003cp\u003eIatrogenic bowelinjury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.025089605734767%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.082437275985663%\"\u003e\n \u003cp\u003e5.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eSurgical site infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e16.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eEarly period ileus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e7.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eLeakage from anastomosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e3.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eIntra-abdominal abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e5.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eIncisional hernia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eEvisceration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e3.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003eMortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.939953810623557%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.859122401847575%\"\u003e\n \u003cp\u003e4.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"22.40143369175627%\"\u003e\n \u003cp\u003eHospital stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.4910394265233%\"\u003e\n \u003cp\u003e1-7 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.025089605734767%\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.082437275985663%\"\u003e\n \u003cp\u003e38.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003e8-14 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.939953810623557%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.859122401847575%\"\u003e\n \u003cp\u003e52.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.20092378752887%\"\u003e\n \u003cp\u003e\u0026gt; 14 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.939953810623557%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.859122401847575%\"\u003e\n \u003cp\u003e8.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\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":"Intestinal Obstruction, Strangulation, Morbidity, Mortality, Colon Cancer","lastPublishedDoi":"10.21203/rs.3.rs-2046756/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2046756/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Intestinal obstruction is a potential surgical emergency condition with a high rate of morbidity and mortality. The most prevalent causes of intestinal obstruction in adults are adhesions, which are followed by incarcerated hernias and tumors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A three-year retrospective data study of adult patients treated with IO at the Mogadishu Somalia Turkey training and research hospital in Mogadishu, Somalia, between June 1, 2019, and June 1, 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A majority (67%) of our study were male showing the male predominance of the disease with a male-to-female ratio of 2:1. The patients demonstrated a variety of signs and symptoms, but the most prominent manifestations were nausea and vomiting (93.2%), abdominal distension (90.2%), and failure to feces /flatus (70.8%). The majority of the patient 98(95.1%) with intestinal obstruction was treated under operative management, whereas conservative management (i.e., nasogastric tube decompression, intravenous antibiotics, and intravenous fluid resuscitation) was applied in 4.9% of cases. surgical site infections were the main cause of their postoperative complications, According to the patient's hospital stays, the majority of patient (52%) hospitalizations lasted between 8 and 14 days. the overall mortality rate in this study was 5(4.9%),\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion: \u003c/strong\u003eIntestinal obstruction is one of the most common life-threatening emergencies all over the world presenting as acute abdomen and requiring surgical admission and management, Surgeons should keep up their aggressive approach to the elective treatment of all abdominal hernias and prompt surgical intervention in patients who have acute mechanical intestinal obstruction caused by incarcerated hernias. According to Mr. Hamilton Bailey, The sun should not rise and set on an unresolved case of intestinal obstruction\u003c/p\u003e\n\u003cp\u003eThe mortality rate related to intestinal obstruction was associated with the late presentation of the disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Small bowel obstruction is more frequent than large bowel obstruction in this study, fibrous adhesion and incarcerated hernia were the leading causes of small bowel obstruction. Adhesiolysis and resection of non-viable. Bowel resection and anastomosis were the most frequent intraoperative procedures. More research utilizing prospective study designs is recommended.\u003c/p\u003e","manuscriptTitle":"Etiology, Clinical Manifestations, and Imaging Evaluation of Intestinal Obstruction in Adults at Tertiary Hospital in Mogadishu, Somalia: A Retrospective Study.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-10-11 19:21:01","doi":"10.21203/rs.3.rs-2046756/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":"8984c36c-76ff-4558-aad4-14483a7b021f","owner":[],"postedDate":"October 11th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-26T06:47:18+00:00","versionOfRecord":[],"versionCreatedAt":"2022-10-11 19:21:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2046756","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2046756","identity":"rs-2046756","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}