CHANGING PATTERN OF ACUTE INTESTINAL-OBSTRUCTION IN A TROPICAL AFRICAN POPULATION

A study of one hundred and fortytwo patients with acute intestinal obs truction over a period of ten years (January 1985 - December 1994) at Wesley Guild Hospital was undertaken to determine the pattern and outc ome of this problem in a tropical African population, There was a prep onderance of males over females; ratio 1.7:1. Mean age was 33 years an d over half of the patients were aged between two and 30 years, There was a second peak age incidence among elderly patients between 50 - 80 years, Abdominal pain, vomiting and constipation were common symptoms , while abdominal distension and tenderness were common clinical findi ngs, Intraperitoneal adhesions were responsible in 41.5%; there was as sociated intestinal volvulus in 25.4% of the cases of intraperitoneal adhesions, In 16.9%, strangulated external hernia was responsible for acute intestinal obstruction, Small intestinal volvulus was encountere d in 20 cases (14,1%) and associated with adhesion in 75% of the cases , Intussusception occurred in 14.1% of cases of which 70% Of the patie nts were below the age of 15 years, In 15 (10.6%) patients, there were volvulus of the sigmoid colon, with 80% (12 patients) having gangreno us bowel segments, Ascaris were responsible in 3.5% of the patients an d large bowel tumour in 2.8%, Other rare causes were internal hernia a nd ileal pseudo obstruction, Adhesiolysis and intestinal resection wer e the commonest operative procedures, Common complications were wound infection in 16.2%, postoperative fever in 10.6% and chest infection i n 9.1%. A mortality rate of 8.4% was recorded.