Small Bowel Obstruction: Epidemiological, Clinical and Therapeutic Aspects in the General Surgery Department of Hôpital Sominé DOLO de Mopti

Small bowel obstruction (SBO) is defined as a complete and persistent cessation of the transit of materials and gases. It occurs in a segment of the digestive tract located between the pylorus and the colorectal junction. We report an observational study which aims to describe the epidemiological, clinical and therapeutic aspects of small bowel obstruction. This study was carried out in the General Surgery Department of Hôpital Sominé DOLO de Mopti from October 1, 2016 to October 1, 2018. A total of 114 patients were recorded for whom the diagnosis was related to an occlusion. The median age was 37 years with extremes ranging from 6 months to 90 years. Male sex was predominant with a sex-ratio of 1.8. The frequency of small bowel occlusions over all occlusions was 74.03%. The most encountered clinical signs were as followed: abdominal pain (100%), vomiting (88.6%), cessation of materials How to cite this paper: Traoré, B., Coulibaly, M., Traoré, D., Guindo, O., Keita, F.M., Samassekou, N., Traoré, A., Sanogo, S., Mallé, K., Keita, K.I., Coulibaly, P., Diallo, A.B., Cissé, D., Samaké, D. and Kanté, L. (2021) Small Bowel Obstruction: Epidemiological, Clinical and Therapeutic Aspects in the General Surgery Department of Hôpital Sominé DOLO de Mopti. Surgical Science, 12, 196-203. https://doi.org/10.4236/ss.2021.126021 Received: May 17, 2021 Accepted: June 26, 2021 Published: June 29, 2021


Introduction
Bowel obstruction is defined as a complete and persistent cessation of transit (materials and gases) in a segment of the digestive tract located between the pylorus and the colorectal junction [1]. They are the cause of 10.0% to 20.0% of acute abdominal pain in adults in general [2]. In Europe, bridle and adhesions were the etiology in 70.0% of cases with a non-negligible mortality of 4.0% to 17.0% depending on the series [3]. In the United States, Williams S.B. et al., found a death rate of 2.1% in 2001 in about 339 cases [4]. In Africa and Morocco, 128/191 (67.02%) of cases of intestinal obstruction were in the small bowel, with an overall mortality of 7.85% according to Canis M. et al. [5]. Harouna et al., in Niger reported 39.36% of bowel obstruction in emergency department [6]. Dembélé B.T. et al. reported 659 acute intestinal obstructions, including 100 small bowel obstructions on flanges and adhesions, i.e. a frequency of 17.8% [7].
Acute small bowel obstruction (SBO) is a pathology whose character of extreme medical and surgical emergency has long been illustrated by the famous aphorism: "you should never let the sun rise and set on an intestinal obstruction" [3] [4] [8]. The most common cause of SBO is the development of adhesion, abdominal surgery or spontaneous flanges, which account for 50% to 80% of cases [4]. SBO diagnosis relies on the medical examination and medical imagery such as X-ray of the abdomen without preparation (AWP), abdomen ultrasonography and computed CT scan. These can be used respectively as the first-line examination, and by extension as a second-line, and thereby provide sufficient information necessary for conservative medical treatment or surgery decision-making process [5] [6]. Nevertheless, CT scan remains the goal standard, because it provides information on the cause, location, and especially the vitality of the loop [9]. SBO treatment is medico-surgical, the decision of conservative or surgical

Patients and Methods
We carried out a prospective and retrospective observational study over two

Results
A total of 114 cases of SBO were identified in the department of general surgery of Hôpital Sominé DOLO de Mopti (  Table 3). All of our patients were resuscitated before, during and postoperatively. General anesthesia with orotracheal intubation and antibiotic prophylaxis have been taken in all patients. The occlusion was on the ileum in 53.5% ( Figure 1) and the loop was healthy in 81.6% of cases. Laparotomy was the most common route of entry in 81.6% of cases. The section of the bridle was the most performed procedure (28.1%) followed by anastomosis resection in 18.4% of cases (

Discussion
We conducted a prospective and retrospective observational study from 2016 to 2018 at the general surgery department of Hôpital Sominé DOLO de Mopti. A total of 114 cases of SBO was enrolled in this study, 53 prospectively and 61 retrospectively. We found (114/154) or 74.03% of SBO. This rate was higher than that of Arnold PB et al., 2000 [11]. This difference could be explained by the rarity of bridle occlusions in the French series due to the contribution of minimally invasive surgery (laparoscopy). In contrast, our result does not differ statistically from those of the Pakistani and Moroccan series [12] [13], p-value > 0.05. The age is discussed to be or not considered as a risk factor for SBO [11], we found no difference in term of age between our series and those from Russia and Côte d'Ivoire. However, it was significantly lower than that of French series [11], p-value = 0.003. This could be explained by the youth of the African population in general and Malian in particular [7]. The gender influence on the occurrence of SBO is also discussed, however in our study as well as in the other series [6] [10] [14] the majority of patients were represented by men. The 28-day consultation period of our study is statistically comparable to those of the Japanese and French series [15] [16] with p-value = 0.05. On the other hand, it is lower than that of Beyrout in Tunisia [17], p-value < 0.05. Occlusion syndrome is the main symptom of SBO [16]. The proportion of 18.4% of occlusive syndrome in our study is significantly lower than those of the Japanese, French and Tunisian series which respectively reported 100.0%, 50.0% and 57.0%, all p-value < 0.05. This difference could due to the inconsistency of certain signs of SBO such as abdominal distension, stopping of materials and gas in our study. Abdominal pain and vomiting are very common symptoms of SBO [18]. Abdominal pain was observed in all of our patients and in all other series [6] [10] [14]. The proportion of vomiting and cessation of materials in our study were 88.6% and 79.8%, respectively. These proportions did not differ from those of other African series [6] [14]. The abdominal X-ray (ASP) is the first-line examination followed by abdomen ultrasonography and CT scan for any suspicion of small bowel obstruction [19] [20], in our study, abdomen X-ray was performed in 95.6%. This proportion was in line with those of the other African series [6] [10] [14]. When it happens to deal with SBO, the surgical procedure depends on the condition of the loops, the etiology and the hemodynamic condition of the patient. The section of the bridle was the most performed surgical procedure in our series with 28.1%. This proportion was significantly different from those of Kouadio and Beyrout [10] [17] p-value < 0.05. This difference could be explained by the condition of the loop and other associated lesions in our series. Adhesiolysis and anastomosis resection were performed in 13.2% and 18.4%, respectively in our study. The proportion of adhesiolysis in our series did not differ from those reported by Kouadio and Beyrout [10] [17]. We have performed ileostomy in 6.1% unlike the other series [10] [17]. The high proportion of ileostomy in our series can be explained by the delay in patients' management, itself linked to the delay in seeking medical facilities. The bridle and adhesion were the most frequent etiologies in our study 55.2% which was higher than that of the other series [6] [10] [14] [21] with a p-value < 0.05. This difference could be related to the sample size, medical and surgical history. Morbidity in our study was 13.2% and was dominated by surgical site infection with a rate of 8.8%. This was comparable to those reported by the Ivorian and French authors [10] [22] with p-value > 0.05. However, we found a significant difference with the Tunisian, American and Japanese series [17] [20] [23], p-value <0.05. This difference could be related to the surgical technique, the age and the general condition of our patients. The average length of hospital stay in our series was 8 days. This hospital stay was comparable to that reported by Arnold P.B. et al. [11], p-value > 0.05. However, it is lower than that reported by Harouna et al. [6]. This difference could be linked to the high number of postoperative complications in their series.

Conclusion
SBO is a medico-surgical emergency that requires early management to improve the prognosis. In Africa, it often affects very young population and occurs most frequently after an inflammatory process in the abdominal cavity even in the absence of history of surgery. The delay in seeking medical facilities and the advanced age of the majority of these patients make the seriousness of this pathology. Despite the multiplicity of diagnostic, therapeutic and surgery modalities, morbidity and mortality still remain high.