Page 31 - World Journal of Laparoscopic Surgery

Rama Hegde

Patients who presented with pain abdomen, distension, points, age, sex, symptoms, examination finding, previous
vomiting who previously underwent some abdominal surgical surgeries, operative procedure adopted and duration of
procedure were considered for the study. Patients who hospital stay.
recovered after conservative management were not included
in study. RESULTS
The patients with above symptoms are admitted to ward
The study of 50 cases of postoperative adhesions by laparo-
with provisional diagnosis of acute, subacute intestinal
tomy and laparoscopic procedures from March 2007 to
obstruction and pain abdomen, assuming postoperative
February 2009.
adhesions as a cause. A detailed history, previous surgery
and examination were done. The routine investigations were
Age vs Sex Correlation
done. RBS, S, blood urea, serum creatinine was also done.
Serum electrolytes were done for patient who presented In our study, Male:Female ratio is 1:1. 28% of the cases
with features of obstruction. Plain X-ray abdomen was done that is 14 off the 50 cases were in the age group of 31 to 40
for all cases presenting with features of obstruction. CT followed by 26% of the cases in age group of 21 to 30.
scan of abdomen was not done on any patients as diagnosis
of obstruction was made out by X-ray. ECG and chest X- Sex vs Pain Abdomen, Distension and Vomiting
ray were done in elderly individuals and individuals with
All the 50 cases presented with pain abdomen. Distension
significant clinical findings. Routine ultrasound scanning of
of abdomen was present in 20 off the 25 male patients.
abdomen was not done due to want of 24 hours emergency
Among females 13 cases presented with distension of
services but they were done during office hours and out
abdomen and absent in 12 cases. This shows distension of
side the institution wherever possible.
abdomen is less common in females than in males in our
Immediately after admission along with above procedure
study. Ten cases presented with vomiting 7 male and 3
resuscitation with IV fluids especially ringer lactate and
female.
normal saline infusion started till hydration and urine output
becomes normal. For patients with obstructive features
Age and Sex vs Previous Surgeries and
nasogastric decompression with Ryles tube carried and Frequency
antibiotic prophylaxis started. Close observation of all
parameters (like pulse rate, blood pressure, abdominal girth, Previous appendicectomy was the commonest surgery done
bowel sounds, tenderness and guarding looked for. Patients constituting 20(40%) of the 50 cases. Among males
who recovered from obstructive features by passing bowels, appendicectomy was the commonest previous surgery
reduction in pain and tenderness were managed conser- followed by cholecystectomy. Among females 11 cases
vatively and were excluded from the study. Patients with underwent previous cesarean section followed by
above signs and symptoms and in patients with clear cut hysterectomy. Cases which underwent previous appendi-
signs and symptoms of intestinal obstruction for long cectomy and cesarian section are of younger age group.
duration were managed with surgical procedures. Patient Previous hysterectomy and cholecystectomy belonged to
presenting with features of obstruction were posted for older age group.
laparotomy and adhesiolysis was done. Patients presenting
with long-lasting pain abdomen were chosen for Diagnosis
laparoscopic procedure. I attended operative procedures in
34 cases presented with obstructive features. 14 with acute
majority of cases and findings were recorded and
and 20 with subacute intestinal obstruction. 16 cases
photographs were taken. Surgery adopted and criteria for
presented with chronic pain abdomen.
deciding the procedures were noted. The postoperative period
was monitored carefully and all parameters were recorded
Sex vs Diagnosis Correlation
four hourly bases depending upon patient’s general
condition. Postoperative follow-up after discharging of Acute intestinal obstruction was more common among
patients was done in majority of patients up to 3 months. males (44%). Among females, subacute intestinal
Most of the patients did not come for follow-up after one obstruction and chronic pain abdomen (44%) was a common
or two visits. The results are tabulated stressing the following presentation.

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