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Study of Efficacy of Various Parameters in Predicting Strangulation Obstruction

Sheetal Gautam Gole, Professor & HOD, Department of Pathology, ESIC Medical College & Hospital, Faridabad, Haryana 121001, India. , Gautam N. Golea , Sheetal G. Goleb , B. Sujeeth Kumarc

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New Indian Journal of Surgery 9(1):p 41-47, Jan-Feb 2018. | DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9118.8

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Abstract

Introduction: Strangulation is the most dreaded complication of bowel obstruction and has a great bearing on morbidity and mortality. Early diagnosis remains great concern to a surgeon, as strangulation carries considerable mortality. Aims & Objectives: To evaluate efficacy of various parameters in predicting strangulation obstruction.

Material and Methods: Present study was a prospective, hospital based study involving 100 patients admitted for acute bowel obstruction. All patients were classified into strangulated and nonstrangulated bowel obstruction. The incidence of 4 parameters: fever, tachycardia, rigidity and leucocytosis were calculated in all patients. The sensitivity, specificity, positive and negative predictive value of these parameters was calculated and results were analyzed.

Results: Of the total 100 cases, 31% had strangulated bowel. The evidence of strangulated bowel due to obstructed hernia was seen in 36.84% cases and 29.62% cases of adhesive obstruction. Fever was present in 54% cases, tachycardia in 46%, leucocytosis in 36% and rigidity in 32% cases. These individual parameters were not statistically significant. If a combination of 2 parameters is used instead of single parameter, then rate for predicting strangulation increases to 20% and it rises to 71.42% when all the 4 parameters are considered.

Conclusion: Amongst the clinical parameters for strangulation (tachycardia, fever, rigidity, and leucocytosis), none is sensitive or specific for prediction of strangulated bowel obstruction. Preoperative definitive diagnosis of strangulation cannot be made reliably by any clinical and laboratory parameters included in the present study. However, a reasonable prediction about strangulation can be made if all parameters are considered together.

 

 

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DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9118.8

Keywords

Strangulated Bowel Obstruction; Leucocytosis; Adhesive Obstruction; Obstructed Hernia. 

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