[Obstruction of the small intestine caused by bridles and adherences. Analysis of 157 operated cases].
We retrospectively studied a series of 157 patients who were operated for post-operative occlusion of the small bowel. Our aim was to analyze the clinical and operative aspects with particular emphasis of the factors predicting intestinal necrosis. We also reviewed the literature. There were 103 females and 54 males with a mean age of 61 and 51 years respectively (p < 0.01). Patients with neoplasia, hernia or irradiated bowel syndrome were excluded. Perioperative variables were analyzed and compared with the incidence of intestinal necrosis and post-operative morbidity and mortality. Data were compared with the chi 2 test. The most frequent prior surgery was appendectomy (33%) and pelvic operations (25%). The mean latency period was 15 years and 5 patients (3%) developed immediate post-operative occlusion (mean 7 days). The preoperative interval was 24 hours on the average. The pathologies involved were: bridles 48%, bridles + adherences 35%, adherences 17%. No clinical sign could distinguish between these three categories, but strangulation was more frequent in patients with bridles (p < 0.003). The following factors were significantly related to intestinal necrosis: signs of abdominal defence (p < 0.0002), white-cell-count > 16000 (p < 0.002), systolic hypotension (p < 10(-7)) and the lack of a history of occlusion (p < 0.04). Mortality was 6% (all at age > 70 years). Age was the only factor significantly related to morbidity-mortality. Emergency surgery shoulder be performed for patients at risk of intestinal necrosis, especially elderly patients.
Service de Chirurgie Générale A, C.H.U. de Rennes, Hôpital Sud.
A
A
La Gamma
J P
JP
Letoquart
N
N
Kunin
J
J
Chaperon
A
A
Mambrini
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors
Les occlusions du grêle par brides et adhérences. Analyse sur 157 cas opérés.