Acute Bowel Obstructions of the Elderly in a Low African Country
- 1 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
- 2 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
- 3 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
- 4 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
- 5 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
- 6 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
- 7 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
- 8 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
- 9 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
- 10 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
- 11 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
- 12 General and Digestive Surgery Department, University Hospital of Bouaké, Bouake, Ivory Coast
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.
- Costa, G., Nigri, G., Tierno, S.M., Tomassini, F., Varano, G.M. and Venturini, L. (2009) Emergency Abdominal Surgery in the Elderly: A Ten-Year Experience. BMC Geriatr, 9, Article No. A53. https://doi.org/10.1186/1471-2318-9-S1-A53
- Launay-Savary, M.V., Rainfray, M. And Dubuisson, V. (2015) L’urgence chirurgicale digestive chez le sujet âgé. Journal de Chirurgie Viscérale, 152, S20-S26. https://doi.org/10.1016/j.jchirv.2015.09.008
- Sharrock, A.E., McLachlan, J., Chambers, R., Bailey, I.S. and Kirkby-Bott, J. (2017) Emergency Abdominal Surgery in the Elderly: Can We Predict Mortality? World Journal of Surgery, 41, 402-409. https://doi.org/10.1007/s00268-016-3751-3
- Green, G., Shaikh, I., Fernandes, R. and Wegstapel, H. (2013) Emergency Laparotomy in Octogenarians: A 5-Year Study of Morbidity and Mortality. World Journal of Gastrointestinal Surgery, 5, 216-221. https://doi.org/10.4240/wjgs.v5.i7.216
- Arvieux, C., Laval, G., Voirin, D., Morra, I. and Reche, F. (2008) Spécificité du diagnostic d’un cancer digestif aux urgences chez le sujet âgé. InfoKara, 23, 29.
- Racz, J., Dubois, L., Katchky, A. and Wall, W. (2012) Elective and Emergency Abdominal Surgery in Patients 90 Years of Age or Older. Canadian Journal of Surgery, 55, 322-328. https://doi.org/10.1503/cjs.007611
- Wade, T.M.M., Ba, P.A., Diao, M.L., Diop, B., Cissé, M. and Konaté, I. (2016) Urgences chirurgicales digestives non traumatiques chez le sujet âgé au CHU Aristide-Le-Dantec de Dakar: A propos d’une série de 110 cas. Journal Africain d’Hépato-Gastroentérologie, 10, 190-193. https://doi.org/10.1007/s12157-016-0678-4
- Yangni-Angaté, A., Khoury, J., Kanga, J.B., Ehua, S. and Varlet, G. (1983) La géronto-chirurgie en milieu africain A propos de 72 cas. Annales de l’Université d’Abidjan: Série B (Médecine), 17, 83-96.
- Lebeau, R., Diané, B., Kassi, A.B.F., Yénon, K.S. and Kouassi, J.C. (2011) Urgences abdominales digestives non traumatiques chez les sujets âgés au CHU de Cocody à Abidjan, Côte d’ivoire. Medecine Tropicale, 71, 241-244.
- Koffi, G.M., Assohoun, K., Soro, K.B., Coulibaly, A., Ehua, S.F., Anzoua, K.I., et al. (2013) La Chirurgie digestive d’urgence du sujet âgé: Une contribution à la prise de décision du praticien. Revue International des Sciences Médicales, 15, 83-87.
- Tchangai, B., Alassani, F., Sakiye, K.A. and Dosseh, E.D. (2021) Pronostic des urgences chirurgicales abdominales non traumatiques du sujet âgé dans un centre hospitalier universitaire du Togo. Journal Africain de Chirurgie Digestive, 21, 3494-3498.