A Prospective Study of Strangulation in Acute Intestinal Obstruction (Code-T0274)

Introduction: Acute intestinal obstruction is a critical surgical emergency with significant morbidity and mortality. Identifying strangulation in patients with mechanical bowel obstruction is crucial for early intervention and improved outcomes. Distinguishing between simple and strangulated obstruction remains a clinical challenge, necessitating comprehensive evaluation using clinical, biochemical, and radiological parameters.

Aims and Objectives:

To identify the various factors related to strangulation in acute intestinal obstruction.

1. To identify the incidence of strangulation in acute intestinal obstruction among the patients presenting to GGH, Kakinada.
2. To identify various clinical, radiological and biochemical parameters to predict the risk of strangulation in acute intestinal obstruction.
3. To assess the diagnostic accuracy of available scores in literature for predicting strangulation in acute intestinal obstruction.

Methods: A prospective study was conducted on 50 patients presenting with acute intestinal obstruction at Government General Hospital, Kakinada, between June 2022 and June 2024. All patients underwent clinical assessment, imaging, and surgical intervention where necessary. Preoperative parameters were analyzed for their ability to predict strangulation, and postoperative outcomes were evaluated.

Results: Strangulation was observed in 12 (24%) cases. The most common etiologies were hernias (50%), sigmoid volvulus (41.6%), and mesenteric ischemia (8.4%). Radiological findings of ascites >500 ml and reduced bowel wall contrast enhancement were significant predictors of strangulation, with sensitivities of 58.3% and 75%, respectively. Surgical outcomes showed that early intervention improved prognosis, with a mortality rate of 4%.

Conclusion: Strangulation in acute intestinal obstruction is associated with increased morbidity and mortality. Early recognition through clinical and radiological markers aids timely surgical intervention, improving patient outcomes. Further studies with larger sample sizes are needed to validate predictive models.

Keywords: Acute intestinal obstruction, strangulation, hernia, volvulus, bowel ischemia, radiological predictors.