Ahmad Khan Ch, Muhammad Azam.
An etiological spectrum of mechanical Intestinal Obstruction: A study at Lahore Garrison.
Pak Armed Forces Med J Jan ;54(1):19-24.

To determine the incidence of etiological spectrum of Mechanical Intestinal Obstruction at Lahore Garrison, the current study was carried out at CMH Lahore during Aug 1999 to Aug 2001. A total of 74 cases admitted with symptoms and signs of mechanical intestinal obstruction with age ranging from new born to age above 70 years were included in the study. A complete history, physical examination, clinical findings, appropriate investigations and operating findings were coined together to reach a final diagnosis. An exact etiological cause was found in each case and their relative incidence was calculated. Patients with obvious peritonitis and those which improved with non-operative measures were excluded from the study. Among the 74 patients presenting with mechanical intestinal obstruction, the most common cause was adhesions and bands (26%), intestinal tuberculosis and malignancy as cause of mechanical intestinal obstruction were almost equal in their incidence i.e. 20% tuberculosis and 19% malignancy. External Hernias leading to intestinal obstruction were found in 13% cases. Volvulus and Intussusception as a cause of mechanical intestinal obstruction were found in 11 % cases, whereas vascular catastrophe like mesenteric thrombosis was seen in 7 % of total admitted cases. Post-operative adhesions and bands are still the commonest cause of mechanical intestinal obstruction. It is stressed that at the first/initial surgery, a thorough peritoneal wash, a perfect hemostasis, respect-full handling of tissues and a meticulous attention to eradicate the effects of primary cause are of paramount importance. Tuberculosis is still very rife and needs early diagnosis with effective drug treatment. Carcinoma is increasing in incidence and all cases presenting with chronic symptoms be thoroughly investigated. Abdominal vascular catastrophes are increasing with increase in cardiovascular diseases and their recognition with modern investigative tools and speedy resuscitation with early intervention is necessary to lower the mortality which is still very high in these patients.

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