title: Subacute intestinal obstruction: an enigma revisited.
abstract: Sixty-three patients presenting with subacute intestinal obstruction (SAIO) were studied. Thirty (47.6%) reported recurrent symptoms. Exaggerated bowel sound, visible/palpable bowel loops, distention of abdomen and abdominal lumps were observed in 60.3%, 28.5%, 25.3% and 19.0% patients, respectively. Thirty (47.6%) required emergency laparotomy. Investigations revealed lesions requiring surgery in 14 of 33 patients which were relieved with conservative treatment. The accuracy of ultrasonography, contrast enhanced computed tomography (CECT) scan and diagnostic laparoscopy was 57.1%, 100% and 100%, respectively. Ileum was the most common site of obstruction (79.5%). Adhesions and small intestinal strictures were the two most frequent cause of obstruction seen in 31.8% and 27.2%, respectively. Tuberculous pathology was demonstrated in 23 (52.2%). Previous abdominal surgery was found to be the only predictor of the success of conservative treatment (13/19 versus 7/44). All patients of SAIO, whose symptoms were relieved with conservative treatment, and who do not have history of abdominal surgery, should be subjected to CECT and/or diagnostic laparoscopy in order to discover the underlying cause of the obstruction. When these diagnostic modalities are not available, laparotomy is an effective alternative for this group of patients.
authors.affiliation: Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India. bhupendrakjain@gmail.com
authors.forename: Bhupendra Kumar
authors.initials: BK
authors.lastname: Jain
authors.forename: Juhi
authors.initials: J
authors.lastname: Agrawal
authors.forename: Vinita
authors.initials: V
authors.lastname: Rathi
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Garg
authors.forename: Indu Bhushan
authors.initials: IB
authors.lastname: Dubey
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D011859:Radiography; D000267:Tissue Adhesions / Q000150:complications; D055815:Young Adult