Dissertation for receiving a professional doctorate degree
Introduction: according to the conducted studies, the prevalence of various causes of intestinal obstruction is different in the west and east of the globe, and finding the common causes in Shahrood, which is the goal of this research project, can lead the doctor to a better diagnosis. During the studies that were conducted, the most common cause of intestinal obstruction in some countries was obstruction following surgery, which causes adhesions and ultimately intestinal obstruction. Other common causes include malignancy and herniation.
Methodology: In this case series, 860 patients with abdominal pain referring to Imam Hossein Shahroud Hospital with entry and exit criteria were included in the study. Patients' symptoms, complications and cause of intestinal obstruction were investigated. The results were analyzed by SPSS software with the help of statistical tests.
Results: Among 860 patients, 130 people (15.1%) had intestinal obstruction with the age range of 2 to 89 years and the average age of these patients was 40.87 ± 20.11 years in one year. The most common cause of intestinal obstruction in the examined patients was adhesions after surgery (15.4%), Meckel's diverticulum significantly caused intestinal obstruction in men more than women (P=0.02), adhesions caused intestinal obstruction in women more than men (P=0.001).
Key words: intestinal obstruction, abdominal pain
1-1 Preface
Intestinal obstruction is not a common disease in human societies. Despite the lack of accurate statistics on the prevalence of intestinal obstruction in Iran and the serious complications of intestinal obstruction in terms of intestinal gangrene and the need to resection part of the intestine and perform a colostomy (ostomy) and cause short bowel syndrome. Knowing the causes of obstruction and justifying the symptoms, as well as investigating its various causes and the prevalence of each of these causes, becomes important. According to the conducted studies, the prevalence of various causes of intestinal obstruction is different in the west and east of the planet, and finding the common causes in Shahrood, which is the goal of this research project, can lead the doctor to a better diagnosis. During the studies that were conducted, the most common cause of intestinal obstruction in some countries was obstruction following surgery, which causes adhesions and ultimately intestinal obstruction. Other common causes include malignancy and herniation.
Of course, it should be noted that the most common cause of obstruction in some Asian countries is herniation, followed by malignancy and adhesions, and the interesting thing is that TB has taken the fourth place in this list, and the reason is the prevalence of this disease in Asia, especially in Iran. These were followed by Intussusception, Volvulus and then miscellaneous. (1) Considering the various causes of intestinal obstruction in different geographical locations, the investigation of these causes in Shahrood shows its importance more. style="direction: rtl;">Inspection of the prevalence of each of the causes of intestinal obstruction
Inspection of the prevalence of intestinal obstruction in different age groups
Inspection of the prevalence of intestinal obstruction in both sexes
1-3 General
1-3-1 Pain Abdominal
1-3-2 General Considerations
Abdominal pain is caused by the damage of intra-abdominal organs in the somatic structures of the abdominal wall or extraintestinal diseases. Visceral pain occurs when the nerves inside the gut detect the damage, are unmyelinated, and the sensation of pain is vague, dull, slow-onset, and without a specific location. Some stimuli such as natural peristalsis and various chemical and osmotic factors activate these fibers to some extent and cause a relative sensation of normal intestinal activities. Regardless of the type of stimulus, visceral pain is felt when the duration and intensity of the stimulus exceeds the threshold.If the pain threshold is activated at a lower level, non-painful stimulations will feel vague discomfort, and in more severe cases, these fibers will feel pain. Excessive activity of the sensory system in the abdomen may be the cause of some abdominal pains such as functional abdominal pain. (2)
Somatic pain, unlike visceral pain, is caused by damage to the abdominal wall. Somatic structures include the parietal peritoneum, fascia, muscles and skin of the abdominal wall. Unlike the vague, unlocalized pain that originates from visceral injury, somatic sensory afferent fibers are myelinated and can rapidly transmit painful stimuli that are highly localized. When intra-abdominal processes spread and cause inflammation or damage to the peritoneum or other somatic structures, localized visceral pain becomes somatic and strictly localized pain. In acute appendicitis, visceral sensory fibers are activated in the early stages of infection. When the inflammatory process spreads and involves the parietal peritoneum, the pain becomes more acute and is usually localized in the lower and right quadrant of the abdomen. This condition is called somatoparietal pain.
Referred pain is a painful sensation in an area of ??the body that is far from the actual source of pain. The physiological cause of this condition is the activation of somatic sensory cells in the spinal cord, which is caused by strong signals brought by visceral afferent nerve fibers to the same level of the spinal cord. The place of pain propagation can be predicted based on the location of visceral damage. Cardiac visceral pain is accompanied by T1-5 somatic parts on the left side, stomach pain radiates to the epigastric region and behind the sternum, and liver and pancreatic pain spreads to the epigastric region. Gallbladder pain often radiates to the area below the right scapula. Somatic pathways that are stimulated by the visceral afferent nerves of the small intestine affect the areas around the umbilicus, and the lesion in the colon causes radiating pain in the area below the umbilicus.
1-3-3 Acute abdominal pain
Differentiating features: Acute abdominal pain may be caused by a serious intra-abdominal process such as appendicitis or intestinal obstruction, or the origin It is extraintestinal such as lower lobe pneumonia or urinary tract stones. Not all attacks of acute abdominal pain require emergency intervention. Appendicitis should be ruled out as soon as possible. Evaluation should be effective, sufficiently focused and rapid. Only a small number of children presenting with acute abdominal pain actually require emergency surgery. Patients requiring surgery should be separated from those that can be managed conservatively. (2
Abstract
Introduction: regarding to different studies incidence of intestinal obstruction is varying in different parts of the world. Intestinal obstruction has a wide spectrum of causes. Notifying intestinal obstruction`s causes and epidemiology in Iran and Shahrood city would be helpful in faster and better diagnosis and treatment processing. In some researches adhesion bands, herniation and malignancy are the most common causes of obstruction. Method: in a case series study, 860 patients with abdominal pain who were referred to Imam Hosein hospital were evaluated. Data was analyzed by SPSS software 860 patients with abdominal pain 130 individuals (15.1%) were affected by intestinal obstruction, their age spectrum was from 2 to 89 years old and its average was 20.11 ± 40.87 years. The most common cause of intestinal obstruction was adhesion bands (15.4%). Meckel's diverticulum was significantly more observed in men (P=0.02) and adhesion band was more common in women (P=0.001). Gall stone illus has a higher incidence in female patients (P=0.005).
Conclusion: the most common cause of intestinal obstruction was adhesion bands and the most prevalent sign was cramps abdominal pain.