ASSESSMENT OF OUTCOME OF AND FACTORS ASSOCIATED WITH GANGRENOUS SMALL BOWEL OBSTRUCTION AMONG PATIENTS ADMITTED TO SURGICAL WARD OF HIWOT FANA SPECIALIZED UNIVERSITY HOSPITAL, HARAR, EASTERN ETHIOPIA

Abstract

small bowel obstructions account for 15% of hospital admissions for acute abdominal complaints and up to 30% of these patients will require operative intervention. Postoperative adhesions are the etiology of 75% of mechanical small bowel obstruction, followed by herniaandneoplasia. Ethiopia is one of the countries where intestinal obstruction is a major cause of morbidity and mortality. A clearer understanding of the incidence and outcome of these patients is essential for establishment of preventive strategies as well as treatment protocols. Objective: Toassess outcomeand factors associated with gangrenous small bowel obstruction among patients admitted to surgical ward of Hiwot Fana Specialized University Hospital from January 1, 2016-December 31, 2020. Methods:Aretrospective cohort study was conducted onallpatients with gangrenous small bowel obstruction admitted to surgical ward of Hiwot Fana Specialized University Hospital from January1,2016-December 31,2020.For this study, a customized data abstraction form was developed for data capturing from medical records of the patients. The captured data was coded, entered to EpiINFo and exported to statistical package for social sciences software, version 22.0. for analysis. To summarize demographic and clinical characteristics of the patients considered for this study, descriptive statistics such as percent and frequency was employed. All variables with P-value < 0.3, during bi-variable analyses were considered for multivariable logistic regression analyses. Odds ratio along with 95% Confidence interval were estimated to measure the strength of the association. Level of statistical significance was declared at p value less or equal to 0.05 Result:A total of 91patiens were included and finally analyzed in this study. From these 52 (57.1%) patients have un favorable surgical outcomes of gangrenous Small bowel obstruction. Of the52 patients with unfavorable outcome, the most common postoperative complication occurred was anastomotic leak (29.5) followed by surgical site infection (25.5%) and pneumonia (23.6%) . A total of 15 postoperative deaths were also documented asunfavorable surgical management outcomes of gangrenous Small bowel obstruction. Three factors including duration xv of illness before surgery, length of hospital stay after surgery and shock at presentation were significantly associated withthe surgical management outcome of gangrenous Small Bowel Obstruction. Conclusion: In this study, the majority of patients had unfavorable surgical managementoutcomes of gangrenous Small Bowel Obstruction, however the proportion of patients with favorable outcomes was considerable. Thus, designing a strategy that address the factors associated with unfavorable outcomes could be helpful to further increase the likelihood of favorable surgical management outcomes of gangrenous Small Bowel Obstruction.