INTESTINAL OBSTRACTION SURGICAL MANAGMENT OUTCOME AND ASSOCIATED FACTORS IN JOGLA GENERAL HOSPITAL, HARARI REGIONAL STATE, EASTERN ETHIOPIA.

Abstract

Background: Intestinal Obstruction is the failure of propagation of intestinal contents, and may be due to a mechanical or functional pathology. It is the most common surgical emergency worldwide. Several factors contribute to poor management outcomes in the case of intestinal obstruction. Some of these determinants may include poor health seeking behaviour, ignorance and poverty. Poor clinical judgment is also one of the negative factors 1leading to poor prognosis in case of intestinal obstruction. Despite the severe burden of Intestinal obstruction in different countries, that is limited evedance on management outcome of intestinal obstruction and associated factors in low income country like Ethiopia, include study area Objective: The main aim of this study was assess the surgical management outcome of intestinal obstruction and associated factors in surgically treated patients at Jugla General Hospital. Method: Facility based retrospective cross-sectional study was conducted simple randomly selected 238 patients surgically treated in Jogla General Hospital. Hospital records of surgical patients operated for intestinal obstruction wire reviewed from registration book, operation log book and patients chart using a structured pre-tested and pre-prepared checklist. Data were entered onto Epi-Data version 3.1 computer software and export to SPSS statically software version 22 for analysis. Descriptive statistic such as frequencies and numerical summary measure used to describe the date .Bivariable binary logistic regression was used to saw the association between each independent variable and dependent. All variable with P-value<.25,

xiv during bi-variable analysis to control for all possible confounders and to identify factors associated with surgical management outcome of intestinal obstruction. Odd ratio along with 95%CI wire estimate to measure the strength of the association. Level of statically significance was declared at P value less or equal to 0.05. Result: The participant ages ranged from 4 month to 80 years with the mean ( ±SD) of 33.9 (±6) years. Small bowel volvulus 111(48.7%) was the leading cause of intestinal obstruction, followed by sigmoid volvulus (15.3%) and adhesion (12.3%). Intussusceptions and hernia occupied the third and fourth positions respectively. Bowel resection rate was at 26.7%. Length of stay ranged from 1hr – 30 days with a mean of 9.26 days. The commonest complications were pneumonia (12.1%) and wound infection (4.6%). Complication and Mortality rates were 20.7% and 8.8%respectively.In multivariable logistic regression analysis, age>25[AOR=7.8; 95%CI; (3.94-15.49)], resection and anastomosis [AOR=5.8; 95%CI; (2.97-11, 33)], nonviable bowel OR=3.5; 95%CI (1.86-6.59), and a treatment delay of more than 24 hours [AOR=7.4; 95%CI; (1.01-55.36)] were significantly associated with unfavorable management outcome of intestinal obstruction. Conclusion: High mortality, complication and prolonged hospital stay were observed in patients with obstruction presented 24 hours after the onset of symptoms. Early diagnosis, adequate preoperative resuscitation and proper post-operative care would help to reduce further the observed mortality. This could be achieved by increasing public awareness on clinical features of intestinal obstruction as well as by improving the knowledge of mid and lower level health professionals on the diagnosis, resuscitation and importance of early referral to higher canter. Moreover, health facilities capable of handling patients with intestinal obstruction should be available within the reach of the community