Change in mechanical bowel obstruction demographic and etiological patterns during the past century: observations from one health care institution

Abstract

Objective: To compare epidemiological analysis concerning sex, age, location of blockage, and frequency of occurrence of etiological factors in 2 groups of patients treated for mechanical bowel obstruction 100 years apart.

Design: Epidemiological analysis of patients undergoing an operation for small-bowel obstruction (SBO) or large-bowel obstruction (LBO) from 1868 to 1898 (group 1) and from 2000 to 2003 (group 2).

Setting: Second Clinic of Surgery of the Jagiellonian University Medical College.

Patients: One hundred ninety-three patients in group 1 and 207 in group 2.

Main outcome measure: Change in demographic and etiological patterns of mechanical bowel obstruction during the past 100 years.

Results: In both groups, the prevalence of bowel obstruction was similar in particular segments of the intestine (approximately 75% for SBO and 25% for LBO). The primary cause of SBO in group 2 remained incarcerated abdominal hernia (30.8% for group 1 compared with 55.0%). The second most common cause of SBO was intraperitoneal adhesions (29.4% compared with 34.4%). Isolated small-bowel volvulus as the cause of bowel obstruction decreased significantly (P ≤ .05) (16.8% compared with 2.7%). Significant changes were also observed in the etiology of LBO. A century ago, the most common cause was volvulus of the sigmoid colon or of the cecum (72.0%); in the later group, obstruction was caused by cancer in 80.4% of cases.

Conclusions: During the past 100 years, no changes were observed concerning the location of bowel obstruction or the patients' sex. Etiological factors in SBO and LBO changed significantly. The age of surgical patients also increased significantly.