Gowhar A BHAT, Shahbaz BASHIR, Tahir B DAR, Bilal A WAGAY, Natasha THAKUR, Rauf A WANI
Euroasian Journal of Hepato-Gastroenterology - 2026;16(1):72-79
Background: Intestinal obstruction remains one of the most common surgical emergencies encountered in tertiary care settings globally, carrying significant morbidity and mortality if not promptly diagnosed and managed. The etiological spectrum, clinical presentation, and optimal surgical strategies vary considerably between small bowel and large bowel obstruction (LBO) and are further influenced by the patient's comorbidity burden, nutritional status, and oncological history. This study was undertaken to systematically evaluate the surgical management of intestinal obstruction at a tertiary care institute and to characterize the demographic profile, clinical presentation, preoperative parameters, intraoperative findings, and surgical decision-making in this cohort. Materials and methods: A prospective observational study was conducted over 4 years from January 2022 to January 2026 at a tertiary care institute. Four hundred consecutive patients who underwent surgical intervention or operative assessment for intestinal obstruction were enrolled. Data pertaining to demographics, comorbidities, clinical presentation, radiological evaluation, hematological and biochemical parameters, operative findings, surgical procedures performed, and final histopathological or intraoperative diagnoses were systematically recorded and analyzed. Results: The study cohort comprised 400 patients with a mean age of 47 +/- 12 years (range: 16-70 years), with a male predominance (56%). Sixty percent of patients had no comorbidities; hypertension (HTN) was the most prevalent associated condition (16%). All patients underwent contrast-enhanced computed tomography (CECT) of the abdomen and pelvis, which identified obstruction in 96% of cases and suggested the etiology in 82%. The mean serum albumin was 3.0 +/- 0.7 gm/dL, and the mean serum lactate was 2.8 +/- 2.4 mmol/L. Small bowel obstruction (SBO) accounted for 202 operative procedures (50.5%), with post-adhesion obstruction as the predominant etiology (80.2%). Large bowel obstruction accounted for 198 procedures (49.5%), of which malignancy was responsible in 95.9% of cases. Stoma formation was required in 218 patients (54.5%), while primary anastomosis was performed in 182 patients (45.5%). Overall postoperative morbidity (Clavien-Dindo grade I-IV) was 41.5% (n = 166). The commonest complications were surgical site infection (SSI) (7.0%), anastomotic leak requiring re-exploration (3.0%), and hospital-acquired pneumonia (3.0%). The 30-day in-hospital mortality (Clavien-Dindo grade V) was 11% (n = 44), with septic shock and multi-organ failure being the leading cause of death. Conclusion: Intestinal obstruction at a tertiary care center presents with a bimodal etiology comprising adhesion-related SBO and malignancy-driven LBO. A structured protocol incorporating early CECT imaging, risk stratification by comorbidity indices, selective conservative management for SBO, and individualized surgical decision-making based on radiology and intraoperative findings results in acceptable outcomes. An overall morbidity of 41.5% and a 30-day mortality of 11% are consistent with established benchmarks for emergency bowel surgery in a tertiary care setting. Stoma formation remains an important and frequently utilized surgical strategy, particularly in the setting of malignant LBO and complicated SBO with bowel gangrene or perforation.
