TITLE:
Acute Bowel Obstructions of the Elderly in a Low African Country
AUTHORS:
Kouame Bernadin Kouakou, Kouakou Ibrahim Anzoua, Mamadou Traore, Ismael Kalou Leh Bi, Ahou Bernadette N’Dri, Aka Gerard Kakou, Serge Amos Ekra, Blaise Amos Kouakou, Inza Bamba, Djahou Ezechiel Akowendo, Roger Lebeau, Bamourou Diane
KEYWORDS:
Acute Bowel Obstruction, Elderly, Etiology, Morbi, Mortality, Surgery
JOURNAL NAME:
Surgical Science,
Vol.13 No.3,
March
31,
2022
ABSTRACT: Background: Acute bowel obstruction is one of the main causes of non-traumatic gastro—intestinal
surgical emergencies. When they occur in elderly patients, they seem to induce
higher morbi-mortality. The aim of our study was to identify the causes of
these bowel obstructions in elderly patients and to expose the results of their surgical management. Patients
and Methods: Retrospective
and analytical study of patients aged 65 years and over, operated on between
January 2013 and December 2019 for acute bowel obstruction at the University
Hospital of Bouake. Demographic, diagnostic, therapeutic and evolutionary data
were analysed. Results: The study involved 36
men and 23 women (sex ratio = 1.6). The mean age of these patients was 70 ± 4.6
years (65 and 90 years). A history and/or co-morbidities were found in 67.8% of
them. Patients were classified as ASA I (20.3%), ASA II (42.4%), ASA III
(33.9%) or ASA IV (3.4%). The average consultation time was 5.3 ± 4.1 days (2 days and 28 days). Bowel obstructions were due
to colonic volvulus (38.9%), colonic cancer (22%), postoperative
adhesions (18.6%), strangulated groin hernia (16.9%) or internal bowel hernia
(3.3%). Volvulated or necrotic bowel and resectable cancers were resected
followed by immediate anastomosis or stoma.
Near upstream stomas were performed for unresectable cancers. A herniorrhaphy
for groin hernias and a mesenteric breach suture for internal hernia were
performed after bowel disinterment. Adhesions were released. The time to
surgery was 22.3 ± 12.4 hours (2 hours and 72 hours). The post-surgery
morbidity was 32.2%, marked by parietal suppurations (47.4%). The post-surgery
mortality was 16.9%. Hemodynamic or septic shock, ASA score ≥ III, bowel
necrosis and ICU stay were the significant risk factors. Conclusion: Acute bowel obstructions in the elderly are dominated by colonic volvulus.
The high mortality is related to various factors highlighting the frailty of
the elderly. A multidisciplinary management involving the geriatrician could
improve the prognosis.