A Study of Clinico-Epidemiological Profile, Management and Outcome of Acute Intestinal Obstruction in a Tertiary Care Hospital

e-ISSN: 0976-822X, p-ISSN:2961-6042 Available online on http://www.ijcpr.com/ International Journal of Current Pharmaceutical Review and Research 2025; 17(9); 464-470 Biswas et al. International Journal of Current Pharmaceutical Review and Research 464 Original Research Article A Study of Clinico-Epidemiological Profile, Management and Outcome of Acute Intestinal Obstruction in a Tertiary Care Hospital Rahul Biswas1, Manoranjan Kar2, Saurabh Das3 1Tutor, MBBS, MS, DNB, Department of General Surgery, IPGME & R, SSKM Hospital, West Bengal, Kolkata-700020 2Professor, MBBS, MS, Department of General Surgery, Midnapore Medical College and Hospital, Midnapore, West Bengal, India –721101 3Associate Professor, MBBS, MS, Department of General Surgery, IPGME & R, SSKM Hospital, ,West Bengal, Kolkata-700020 Received: 01-07-2025 / Revised: 16-08-2025 / Accepted: 02-09-2025 Corresponding Author: Dr. Rahul Biswas Conflict of interest: Nil Abstract Introduction: Acute intestinal obstruction (AIO) is a common surgical emergency characterized by the partial or complete blockage of the intestines, leading to impaired passage of intestinal contents and significant morbidity if not promptly managed. Aims: Acute intestinal obstruction is a common surgical emergency requiring prompt diagnosis, perioperative management, and surgical skill to achieve favorable outcomes. This study aimed to evaluate the causes, clinicepidemiological features, and severity indicators of intestinal obstruction, as well as to assess patient outcomes following conservative and surgical management. Materials & Methods: This was a prospective clinical study conducted at Midnapore Medical College and Hospital, Midnapore, from 1st April 2021 to 1st October 2022. The study included a total of 100 patients diagnosed with acute intestinal obstruction. Result: The most frequent diagnosis was obstructed hernia in 35 patients (35%), followed by adhesions in 18 patients (18%), sigmoid volvulus in 12 patients (12%), growths in 14 patients (14%), ileal strictures/TB in 8 patients (8%), intussusception in 6 patients (6%), small gut gangrene in 3 patients (3%), and other causes in 4 patients (4%) (p < 0.00001). In our study, postoperative complications were observed in a minority of patients, with 64 patients (64%) experiencing no complications. Wound infection occurred in 20 patients (20%), wound gaping in 10 patients (10%), and death was reported in 6 patients (6%)it was highly statistically significant (p < 0.0001). Conclusion: We conclude that, the most common diagnosis was obstructed hernia, followed by adhesions, sigmoid volvulus, neoplastic growths, ileal strictures/TB, intussusception, small gut gangrene, and other less frequent causes. Postoperative complications were relatively uncommon, with the majority of patients experiencing an uneventful recovery. The most frequently observed complications included wound infection, wound dehiscence, and mortality. Overall, the outcomes suggest that while surgical intervention carries inherent risks, most patients recover without significant postoperative complications. Keywords: Acute intestinal obstruction, Hernia, Adhesions, Bowel obstruction and Wound infection. This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided original work is properly credited. Introduction Acute intestinal obstruction (AIO) is a common surgical emergency characterized by the partial or complete blockage of the intestines, leading to impaired passage of intestinal contents and significant morbidity if not promptly managed. It affects patients across all age groups, with a higher incidence in males and peak occurrence between 20 and 60 years [1]. The etiology is multifactorial, with obstructed hernias, postoperative adhesions, volvulus, tumors, and strictures being the most frequent causes [2,3]. Clinically, patients present with abdominal pain, vomiting, distension, and obstipation, while examination may reveal highpitched bowel sounds, tenderness, and visible peristalsis [3]. Management involves early resuscitation, conservative measures, and timely surgical intervention based on the underlying cause, with outcomes dependent on prompt diagnosis and perioperative care [4]. Understanding the clinicepidemiological profile, management strategies, and outcomes of AIO is essential for optimizing patient care and reducing associated morbidity and mortality. Whether brought on by hernia, tumour, adhesions, or biochemical changes, intestinal International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Biswas et al. International Journal of Current Pharmaceutical Review and Research 465 obstruction of either the small or large bowel continues to be a major cause of morbidity and mortality. It is one of the most frequent intraabdominal issues encountered by general surgeons in their practise. They represent 12% to 16% of admissions for surgery for sudden abdominal pain. Acute intestinal obstruction symptoms might range from a very normal appearance with only little abdominal pain and distension to a condition of hypovolemic or septic shock (or both) necessitating an emergency procedure. The number of fatalities brought on by acute intestinal obstruction is declining as pathophysiology is better understood. Improvements in diagnostic methods, hydration and electrolyte management, very effective antimicrobials, and critical care skills. The majority of fatalities involve elderly patients who seek therapy too late and have co-occurring conditions including diabetes mellitus, heart disease, or pulmonary disease. Early detection of obstruction, expert surgical management, correct technique during surgery, and thorough postoperative care all yield positive results. Study aims acute intestinal obstruction is a common surgical emergency requiring prompt diagnosis, perioperative management, and surgical skill to achieve favourable outcomes. This study aimed to evaluate the causes, clinic-epidemiological features, and severity indicators of intestinal obstruction, as well as to assess patient outcomes following conservative and surgical management. Materials and Methods Type of Study: Prospective Clinical Study Place of Study: Midnapore Medical College and Hospital, Midnapore Study Duration 1st April 2021 to 1st October 2022 Sample Size: 100 Acute Intestinal Patients Inclusion criteria • Patients of all ages and both sexes presenting with features suggestive of acute intestinal obstruction. • Patients diagnosed with intestinal obstruction based on clinical evaluation, radiological imaging, or both. • Patients admitted to the tertiary care hospital for surgical management of intestinal obstruction. • Patients who provided informed consent for participation in the study. • Patients undergoing either emergency or elective surgery for confirmed causes of intestinal obstruction. Exclusion criteria • Patients with chronic or partial intestinal obstruction without acute presentation. • Patients managed entirely on an outpatient basis without hospital admission. • Patients with severe comorbidities and only managed conservatively. • Patients who refused to give informed consent for participation in the study. • Patients with incomplete clinical or radiological records preventing proper evaluation. Study variables • Age • Sex • Presenting symptoms • Clinical signs • Causes of obstruction Statistical analysis Data were entered into excel and analyzed using SPSS and graphpad prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including fisher’s exact test for small sample sizes) were used for categorical data comparisons. Pvalues ≤ 0.05 were considered statistically significant. Result Table 1: Distribution of Age group Age Group Number of Patients Percentage (%) pvalue 10–19 4 4% .0005 20–29 13 13% 30–39 17 17% 40–49 15 15% 50–59 20 20% 60–69 17 17% 70–79 14 14% International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Biswas et al. International Journal of Current Pharmaceutical Review and Research 466 Table 2: Distribution of Sex-wise distribution of Patients Sex Number of Patients Percentage (%) pvalue Male 68 68% < .0001 Female 32 32% Table 3: Distribution of Clinical Symptoms, Signs, Disease Spectrum Number of Patients Percentage (%) pvalue Clinical Symptoms Abdominal Pain 100 100% < .00001 Vomiting 81 81% Distension 67 67% Obstipation 52 52% Clinical Signs Bowel Sounds 79 79% < .00001 Ballooning on DRE 53 53% Visible Peristalsis 10 10% Diagnosis Obstructed Hernia 35 35% < .00001. Adhesion 18 18% Sigmoid Volvulus 12 12% Growth 14 14% Ileal Strictures / TB 8 8% Intussusception 6 6% Small Gut Gangrene 3 3% Others 4 4% Type of Hernia Inguinal 29 82.80% < .00001 Incisional 3 8.60% Femoral 2 5.70% Epigastria 1 2.90% International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Biswas et al. International Journal of Current Pharmaceutical Review and Research 467 Table 4: Distribution of Management Treatment Number of Cases Percentage (%) pvalue Reduction and Hernia Repair 30 30% < .00001 Adhesiolysis 17 17% Resection and Anastomosis 13 13% Sigmoidectomy 11 11% Right Hemicolectomy 5 5% Hartman Procedure 4 4% Ileostomy 4 4% Double Barrel Ileostomy 3 3% Others 13 13% Table 5: Distribution of Complications Complication Number of Patients Percentage (%) pvalue No Complications 64 64% < .0001 Wound Infection 20 20% Wound Gaping 10 10% Death 6 6% International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Biswas et al. International Journal of Current Pharmaceutical Review and Research 468 Figure 1: Distribution of Complications Figure 2: Distribution of: Clinical Symptoms and Signs In our study, the age distribution of patients showed that the majority were in the 50–59 years group, with 20 patients (20%), followed by 17 patients (17%) each in the 30–39 and 60–69 years age groups. Fifteen patients (15%) were aged 40–49 years, 14 patients (14%) were in the 70–79 years group, 13 patients (13%) were 20–29 years, and the least number of patients, 4 (4%), were in the 10–19 years group. The age distribution was statistically significant (p = 0.0005). In our study, the majority of patients were male, with 68 patients (68%), while females accounted for 32 patients (32%). This difference in sex distribution was highly statistically significant (p < 0.0001). In our study, the most common clinical symptom was abdominal pain, present in all 100 patients (100%), followed by vomiting in 81 patients (81%), abdominal distension in 67 patients (67%), and obstipation in 52 patients (52%) (p < 0.00001). Clinical signs included bowel sounds in 79 patients (79%), ballooning on digital rectal examination in 53 patients (53%), and visible peristalsis in 10 patients (10%) (p < 0.00001). The most frequent diagnosis was obstructed hernia in 35 patients (35%), followed by adhesions in 18 patients (18%), sigmoid volvulus in 12 patients (12%), growths in 14 patients (14%), ileal strictures/TB in 8 patients (8%), intussusception in 6 patients (6%), small gut gangrene in 3 patients (3%), and other causes in 4 patients (4%) (p < 0.00001). Among types of hernia, inguinal hernia was predominant in 29 patients (82.8%), followed by incisional hernia in 3 patients (8.6%), femoral hernia in 2 patients (5.7%), and epigastria hernia in 1 patient (2.9%) it was highly statistically significant (p < 0.0001). In our study, the most common treatment was reduction and hernia repair, performed in 30 patients (30%), followed by adhesiolysis in 17 patients (17%), resection and anastomosis in 13 patients (13%), sigmoidectomy in 11 patients (11%), right hemicolectomy in 5 patients (5%), Hartman procedure in 4 patients (4%), ileostomy in 4 patients (4%), double barrel ileostomy in 3 patients (3%), and other procedures in 13 patients (13%) it was highly statistically significant (p < 0.0001). In our study, postoperative complications were observed in a minority of patients, with 64 patients (64%) experiencing no complications. Wound infection occurred in 20 patients (20%), wound gaping in 10 patients (10%), and death was reported in 6 patients (6%)it was highly statistically significant (p < 0.0001). International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Biswas et al. International Journal of Current Pharmaceutical Review and Research 469 Discussion We found that in our study, the most common age group among patients was 50–59 years, comprising 20 individuals (20.0%), a finding that was statistically significant (p < 0.0001). In similar study byZhang J et al. observed a continuous increase in the incidence of inguinal, femoral, and abdominal hernias among older adults from 1990 to 2021, with a notable rise in cases among those aged 60 and above [5]. We found that in our study, the male population was higher, with 68 patients (68.0%) compared to 32 females (32.0%), in a male-to-female ratio of 2.1:1; however, this difference was statistically significant (p < 0.0001). In other study by Zarokosta M et al., where 280 males (68.6%) and 128 females (31.4%) were reported in a cohort of 408 patients undergoing inguinal hernia repair [6]. We found that abdominal pain was the universal presenting symptom in all 100 patients (100%), followed by vomiting in 81 patients (81%), abdominal distension in 67 patients (67%), and obstipation in 52 patients (52%), highlighting their importance in identifying intestinal obstruction. Clinical signs such as bowel sounds were present in 79 patients (79%), ballooning on digital rectal examination in 53 patients (53%), and visible peristalsis in 10 patients (10%), supporting the clinical diagnosis. Obstructed hernia was the most frequent diagnosis in 35 patients (35%), followed by adhesions in 18 patients (18%), growths in 14 patients (14%), sigmoid volvulus in 12 patients (12%), ileal strictures/TB in 8 patients (8%), intussusception in 6 patients (6%), small gut gangrene in 3 patients (3%), and other causes in 4 patients (4%). Among hernia types, inguinal hernia predominated in 29 patients (82.8%), followed by incisional hernia in 3 patients (8.6%), femoral hernia in 2 patients (5.7%), and epigastric hernia in 1 patient (2.9%). These findings were highly statistically significant (p < 0.0001).In similar study by Bajracharya S et al. observed that abdominal pain (93%), vomiting (74%), and abdominal distension (65%) were the most common presenting symptoms in patients with intestinal obstruction, which aligns with our findings.[7] We observed that the most common treatment in our study was reduction and hernia repair, performed in 30 patients (30%), followed by adhesiolysis in 17 patients (17%), resection and anastomosis in 13 patients (13%), and sigmoidectomy in 11 patients (11%). Less frequently performed procedures included right hemicolectomy in 5 patients (5%), Hartman procedure in 4 patients (4%), ileostomy in 4 patients (4%), and double barrel ileostomy in 3 patients (3%), while other procedures accounted for 13 patients (13%). These treatment patterns were highly statistically significant (p < 0.0001). In similar study by 3. Bajracharya S et al.observed that hernia repair was the most frequently performed procedure (28%), followed by adhesiolysis (20%) and resection with anastomosis (15%) among patients with intestinal obstruction [7]. We found that the majority of patients, 64 (64%), experienced no postoperative complications. Wound infection occurred in 20 patients (20%), wound gaping in 10 patients (10%), and death was reported in 6 patients (6%). These outcomes were highly statistically significant (p < 0.0001). In similar study by Le ST, et al. (2025) highlighted postoperative complication rates in intestinal obstruction surgery [8] Conclusion We concluded that, acute intestine blockage is still a major surgical emergency that primarily affects patients between the ages of 50 and 59, with a small male preponderance. The most common presenting symptom was abdominal discomfort, which was often accompanied by vomiting, distension, and constipation. The diagnosis was made easier by clinical examination results including bowel sounds and ballooning on digital rectal examination. Adhesions and obstructed hernias were the main causes, with inguinal hernias being the most common form. The most frequent surgical techniques were reduction and hernia repair, with adhesiolysis and resection added where necessary. Although wound infection, wound gaping, and mortality happened in a small percentage of patients, the majority experienced an uneventful postoperative course. In order to maximize results for patients with intestinal obstruction, these data highlight the significance of early detection, prompt surgical intervention, and careful perioperative care. Reference 1. Jena SS, Obili RC, Das SA, Ray S, Yadav A, Mehta NN, Nundy S. Intestinal obstruction in a tertiary care centre in India: Are the differences with the western experience becoming less?. Annals of Medicine and Surgery. 2021 Dec 1;72:103125. 2. Rani S, Puranik A, Chaudhary R, Elhence P, Yadav T, Varshney VK, Puranik Sr A. Clinicoepidemiological analysis of small bowel obstruction in adults at a Tertiary Care Center in India. Cureus. 2024 Jun 27;16(6). 3. Shinde V, Dixit Y, Penmetsa P, Nair KR. Clinical and epidemiological profile of patients presenting with acute abdomen to the emergency department of a tertiary care hospital. Cureus. 2024 Aug 16;16(8). 4. Benites Quispe R. Frecuencia del dolor abdominal agudo no traumático en emergencia de un hospital Essalud de Huancayo, 20222023. 5. Zhang J, Wang J, Han X, Fan J, Huang C, Dong Y. Global burden and future trends of inguinal, International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Biswas et al. International Journal of Current Pharmaceutical Review and Research 470 femoral, and abdominal hernia in older adults: A systematic analysis from the Global Burden of Disease Study 2021. PLoS One. 2025 Jun 6;20(6):e0323790. 6. Zarokosta M, Paraskevas G, Chrysanthou C, Piperos T, Foutsitzi A, Nikas D, MariolisSapsakos T. Intestinal necrosis and sigmoid colon obstruction due to bilateral strangulated femoral hernia in a male: a rare surgical and anatomic case report. Journal of surgical case reports. 2021 Nov;2021(11):rjab453. 7. Bajracharya S, Shrestha A, Joshi A, Maharjan R. Qualitative Analysis of Resident as a Teacher Module in Post Graduate General Practice Residency Program. Journal of Nepal Health Research Council. 2022;20(03):786-93. 8. Le ST, Corbin JD, Myers LC, Kipnis P, Cohn B, Liu VX. Development and validation of an electronic health record-based score for triage to perioperative medicine. Annals of surgery. 2023 Mar 1;277(3):e520-7.