Adel Salih Mushari@
& Zaki Al-Faddagh#
@MB,ChB, FICMS, AlQurna Hospital. # MB,ChB, CABS, Professor, Department of Surgery, Basrah
College of Medicine, Basrah University.
Intestinal obstruction remains one of the commonest surgical emergencies, with hernias being
electively repaired; adhesive obstruction has emerged as the leading cause of intestinal
obstruction in the west, while the obstructed hernia remaining the main cause in developing
This is a prospective study involving 464 patients admitted with intestinal obstruction to the
surgical unit in AL-Mawane general hospital, Al-Sadir teaching hospital, Al-Basrah maternity and
child hospital and Al-Basrah general hospital during the period between (January 2004-
December 2007).
All patients were admitted and thorough careful history, particularly history of previous surgery
and examination were done involved the hernial orifice. Type of treatment, time surgical
intervention, operative finding and period of hospital stay were noted.
Most of our patients were attended for postoperative followed up for complications and recording
the mortality in the hospital.
The study included 464 patients, their age ranged from 2 days to 75 years. (Mean 33.8years),
and they are more frequent in female 258 patients (55.7%) than male206 patients (44.3%).
Acute onset of presentation was found in 296 patients (63.7%). Constipation in 419 patients
(90%) and abdominal pain in 380 patients (82%) were the main presenting symptoms. Previous
admissions for same complain were reported by 64 patients (13.7%). History of previous
surgery were reported by 71 patients (15.4%), and time interval from previous surgery, varies
from one month to (5) years. Simple obstruction was the most common form of intestinal
obstruction (67.7%). Of all patients included in the study, 288 patients (62%) present with small
bowel obstruction and 176 patients (38%) with large bowel obstruction. The commonest cause
of intestinal obstruction was strangulated external hernia in 99 patients (21.3%), intestinal
adhesions in 73 patients (15.7%). The hernia (29.2%) together with adhesions from previous
surgery (25.4%) constitute the bulk of causes of small bowel obstruction , while volvulus of
sigmoid colon (23.6%)and tumours (22.7%) form the main cause of large bowel obstruction.
Intussusception was the most prevalent variety of intestinal obstruction in child age group
(27.2%), followed by hirschsprungs disease (22.2%). Of strangulated hernia, inguinal hernia
was the most frequent type of hernia seen (71.7%). Surgical intervention was necessary in 409
patients (88.2 %).The period of conservative treatment ranges from 3-14 days, with average
(6.3) days. Post operative complication occurred in 167 patients (40.8%). The mortality was 6.8
% and it was related to extreme of life, delay in presentation and mismanagements.
The study concluded that simple intestinal obstruction is the commonest type of obstruction,
higher rate of strangulated hernia than the rate of obstruction due to adhesions, which is
opposite to a typical pattern of developed countries. Intussusception is the most frequents
cause of intestinal obstruction in children, early presentation and diagnosis is the key to
reducing morbidity and mortality.