Surgical outcomes of mechanical intestinal obstruction due to neoplasms at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Western Kenya have experienced increasing incidence of intestinal neoplasms. With high burden of the disease and limited resources, the morbidity and mortality rates are high. Therefore, there is need to assess the clinical presentation, surgery findings and interventions offered, postoperative complications and mortality rates associated with mechanical intestinal obstruction due to neoplasms. Broad Objectives: To assess the surgical outcomes of mechanical intestinal obstruction due to neoplasms in adults at Moi Teaching and Referral Hospital, Eldoret, Kenya. Methods: A prospective observational hospital-based study was carried out on 59 adult patients who presented with acute mechanical intestinal obstruction due to neoplasms undergoing laparotomy at Moi Teaching and Referral Hospital. All patients were recruited into the study from January to December 2023. The data collection form was used to collect the patients’ demographic information, presenting signs and symptoms at the emergency department, intraoperative findings obtained, surgical interventions offered, postoperative complications, length of hospital stay and 30-day mortality rates. Categorical data was summarized as frequencies and their corresponding percentages while the numerical data was summarized as means and standard deviation. Bivariate analysis using Chi square /Fisher’s exact tests and t- test/Mann Whitney U test were used to determine variable associations. Results: Out of 59 study participants enrolled, 64.4% (n=38) were males and the average age of diagnosis was 51.4 years. Large bowel obstruction by neoplasm was more common than small bowel (72.9% vs 27.1%). In large bowel obstruction, the rectum (37.2%, n=16) and sigmoid colon (27.9%, n=12) were more commonly affected while in small bowel obstruction, the proximal ileum (43.7%, n=7) and duodenum (37.5%, n=6) were commonly affected. Adenocarcinoma was the commonest neoplasm causing small and large bowel obstruction (83.1%). The Tumor size (T) of T4 and T3 malignant neoplasms were more common accounting for 62.7%, n=37 and 20.3%, n=12 with nodal involvement (77.9%, n=46) and metastatic (57.6%, n=34). The surgical site infection (28.7%, n=29), electrolyte imbalance (23.8% n=24), and persistent ileus of >72 hours (19.8%, n=20) were the commonest postoperative complications encountered. The median length of hospital stay was 10 days. Grade 1 and 2 neoplasms and large bowel obstruction were associated with higher risk of complications and longer length of hospital stay (p value <0.001). The 30-day postoperative mortality rate for mechanical intestinal obstruction due to neoplasms was 10.8%. Conclusion: Majority of the neoplasms causing acute mechanical intestinal obstruction in adults at MTRH were large bowel adenocarcinomas presenting at advanced stages and were associated with high post-surgery complication rates. Recommendations: There is need to sensitize men and clinicians dealing with neoplasms causing mechanical intestinal obstruction at Moi Teaching and Referral Hospital in order to downstage the disease at presentation and improve early treatment outcomes.