title: Gastrointestinal obstruction in patients previously treated for malignancies.
abstract: Bowel obstruction is a common condition in acute surgery. Among the patients, those with a history of cancer consist a particular group. Difficulties in preoperative diagnosis - whether obstruction is benign or malignant and limited treatment options in patients with reoccurrence or dissemination of the cancer are typical for this group. The aim of the study was to analyze causes of bowel obstruction in patients with history of radical treatment due to malignancy.
  
  
  METHODS
  Patients with symptoms of bowel obstruction and history of radical treatment for malignancy who were operated in 2nd and 3rd Department of General Surgery JUCM between 2000 and 2014 were included into the study. The patients were divided into 2 groups based on type of mechanical bowel obstruction (group 1 - adhesions, group 2 - malignant process).
  
  
  RESULTS
  128 patients were included into the study - group 1: 67 (52.3%) and group 2: 61 (47.7%). In the second group bowel obstruction was caused by reoccurrence in 25 patients (40.98%) and dissemination in 36 (59.02%). The mean time between onset of the symptoms of bowel obstruction and the end of treatment for the cancer was 3.7 and 4.4 years, respectively in group 1 and 2 (p>0.05). Median time between onset of the symptoms and admission to Emergency Department was significantly longer in patients with malignant bowel obstruction compared to those with adhesions (11.6 ±17.8 days vs 5.1 ± 6.9 days, p=0.01). Considering type of surgery due to bowel obstruction, in first group in most patients (69.2%) bowel resection was not necessary and in the second group creation of jejuno-, ileo- or colostomy was the most common procedure. Morbidity was significantly higher in second group (45.9% vs 28.26%, p<0.05) but there was no difference in mortality (26% vs 24%, p>0.05). In both groups the most common localization of primary malignancy was colon.
  
  
  CONCLUSIONS
  In analyzed group of patients frequency of bowel obstruction caused by adhesions and malignancy was similar. However, in patients with bowel obstruction caused by malignancy morbidity was significantly higher and duration of symptoms was longer. There was no diagnostic procedure which would allow to differentiate the cause of bowel obstruction preoperatively and the diagnosis was made during the operation.
authors.forename: Piotr
authors.initials: P
authors.lastname: Budzyński
authors.forename: Michał
authors.initials: M
authors.lastname: Pędziwiatr
authors.forename: Jakub
authors.initials: J
authors.lastname: Kenig
authors.forename: Anna
authors.initials: A
authors.lastname: Lasek
authors.forename: Marek
authors.initials: M
authors.lastname: Winiarski
authors.forename: Piotr
authors.initials: P
authors.lastname: Major
authors.forename: Piotr
authors.initials: P
authors.lastname: Wałęga
authors.forename: Michał
authors.initials: M
authors.lastname: Natkaniec
authors.forename: Mateusz
authors.initials: M
authors.lastname: Rubinkiewicz
authors.forename: Joanna
authors.initials: J
authors.lastname: Rogala
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński
mesh_terms: D000008:Abdominal Neoplasms / Q000150:complications* / Q000601:surgery*; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011044:Poland; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000601:surgery*