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POLSKI
PRZEGLD CHIRURGICZNY 10.2478/v10035-011-0058-92011, 83, 7,
367371
ILEUS AND INTESTINAL OBSTRUCTION COMPARISON BETWEEN
CHILDREN AND ADULTS
MeHran PeyVasteH1, sHaHnaM askarPour1, HazHir
JaVaHerizaDeH2,
soMaieH taGHizaDeH1
Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical
Sciences, Ahwaz, Iran1Arvand International Division , Ahvaz
Jundishapur University of Medical Sciences2
Bowel obstruction is the interference with movement of bowel
content. Large and small in testing fromduodenum to anal region can
be obstructed mechanical or non-mechanical and complete or
partial.
Mechanical obstruction can presented because of obstructive
causes in intestinal lumen, intestinal
wall or pressure from other tissue on intestine.
The aim of the study was to evaluate etiology, laboratory ndings
of intestinal obstruction and ileus
among children and adults who discharged with good
condition.
Material and methods. This retrospective study was carried out
from 2001 to 2006 in Imam Khomei-
ni Hospital (Ahvaz-Iran). Cases of bowel obstruction were
included in this study. For each case, a
questionnaire was lled. There are 752 cases with suspected bowel
obstruction.From 752 cases, 403
patients that agreed and treated and discharged with good
condition were studied. Cases were di-
vided into two groups: children (age < 15 yrs) and adults
(age> 15 yrs). Data were analyzed by SPSS
Ver 16.0 (Chicago, IL, USA) and Epi-info Ver 6.00.
Results.In our study, 221 adults and 192 children were included.
Mortality rate was 12.2%. Forty-eight percent of 403 cases were
children (m 61%, f 38%, ambigus genitalia 1%) and 52% were
adults (m 67%, f 33%). Etiology of bowel obstruction in children
were as follows: ileus (26%); adhe-
sion band (17.7%), partial obstruction (16.1%), and
Hirschsprungs disease (12%). Causes of bowel
obstruction in adults are: partial obstruction (29.9%); ileus
(19%); adhesion band (18.5%); colonic
pseudo obstruction(8.5%); GI cancer (5.2%); hernia (4.7%); Crohn
(2.8%); fecal impaction (3.3%); be-
zoar (2.4%), and 4.7% for other causes. Fifty-one percent of
children and 36% of adults were operated.
Of all children, 91.7% had upright abdominal X-ray, 51.6% had
supine X-ray, and 80.7% had sonogra-
phy. Hundred percents of adults had upright & supine plain
abdominal X-ray and 75.4% had sonog -
raphy. Most change in childrens CBC was 10000
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368 M. Peyvasteh et al.
tastases. Perforation can occur at the site of
the tumor or in a dilated caecum (6). LBO is
an emergency condition that requires early
identication and intervention. The etiology
of LBO is age dependent (7). There are possible
differences between etiology of bowel obstruc-
tion in different countries because of different
nutritional habits, weather, and other factors.
As one of the most important condition
surgical emergency we aimed to study of etiol-
ogy, laboratory ndings of intestinal obstruc-
tion and ileus among children and adults who
discharged with good condition.
MATERIAL AND METHODS
This retrospective study was carried out
between 2001-2006 in Imam Khomeini Hospi-tal a tertiary referral
hospital, Ahvaz, Iran. A
questionnaire was lled for each case. In this
study, 752 cases with diagnosis of bowel ob-
struction were admitted to hospital. From
these cases, 228 cases did not agree to par-
ticipate in our study and excluded. From all of
752 cases, in 29 cases bowel obstruction was
ruled out and transferred to other department
for treatment. Ninety- two cases were died and
excluded from this study. The remaining 403
cases that treated and discharged with goodcondition were
studied. Patients were divided
into two groups: children; before 15 years old
and adults; after 15 years old. A questionnaire
lled for each patient. Laboratory ndings
were recorded for patients. Data were analyzed
by SPSS Ver 16.0 (Chigaco, IL,USA) and Epi-
info ver 6.0.
RESULTS
Four hundred and three patients were
included in our study. From all patients, 192
(47.64%) patients were 15 yr. From 192 children pa-
tients, 119 (61.97%) patients were male, 72
(37.5%) patients were female, and 1 (0.5%)
patient had ambigus genitalia. From 211
adult patients, 142 (67.29%) patients were
male and 69 (32.7%) patients were female. Ofall 403 cases, 261
(64.76%) were males. Sev-
enty-six (36.01%) patients from 211 adult
patients and 98 (51.04%) from 192 of children
patients underwent surgery. As seen in tab.
1, partial obstruction, pseudo-obstruction,
and cancer were signicantly more seen in
adults than children (p
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369Ileus and intestinal obstruction comparison between children
and adults
Anemia was more common in children than
adults while polycythemia was more common
in adults. WBC
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370 M. Peyvasteh et al.
In the current study no cases of intussucep-
tion were seen in adults. In the Croomes study,
2-3% of obstruction was due to intussuception
(14). In the current study, the rate of intus-
susceptions in children was 6.77%. In Kaiser
et al. study, the most common cause of intes-
tinal obstruction in children was intussucep-
tion (15).
Hernia is the 6thcause of intestinal obstruc-
tion in adults and 7thin children. the current
study. In the study which carried out by Moon
et al., hernia was reported as the 3rdcommon
cause of intestinal obstruction (16). Madziga
and Nuhu also reported hernia as the most
common causes of intestinal obstruction
(17).
Adhesions may be acquired or congenital;
however, most are acquired as a result of peri-toneal injury,
the most common cause of which
is abdominal pelvic surgery (18). Intra ab-
dominal adhesions are the most common cause
of SBO in some reports, accounting for ap-
proximately 65% to 75% of cases (19, 20). Kssi
et al. studied post operative adhesion induced
obstruction from 1.1.1999 to 31.12.1999 on 123
hospitalizations. The most prevalent single
initial operation causing adhesion induced
intestinal obstructions were colorectal, upper
abdominal, and female reproductive systemprocedure (21).
The overall mortality rate was 1.6%, and
the mortality rates in conservative therapy
and surgical intervention groups were 1.3%
and 1.7% respectively (22).
In the current study, paralytic ileus, adhe-
sion, and partial obstruction are the most
common causes of intestinal obstruction in
children.
In the current study, obstruction due to
cancer is 5.2% of adult patients. Wyoski andKryzan showed that
intestinal obstruction due
to cancer has 17.2% (23).
Obstruction due to bezoar was seen in 2.4%
of adult cases and half of them were more than
50 years old.
Crohn disease accounting for 3-7% of small
bowel obstruction in some studies (24). In the
current study, Crohn was indentied in 2.84%
of cases.
In our study, malrotation was found in 4
(2.08%) of children and no adult cases. in up
to 90%, malrotation develop during the 1styear
of life (25). So, malrotation in unusuall ndings
after childhood period.
Volvulus was found in 2.08% of children and
1.42% of adults. Volvulus can be primary pa-
thology or secondary to malrotation of the in-
testine (26, 27).
There were 57.6% of the patients underwent
the surgical treatment. In our study, 51.04%
of children and 36.01% of adults underwent
surgical treatment.
Overall mortality rate in our study was
12.2%. In another study carried out in Poland,
mortality rate was 13.8%, but these patients
had intestinal obstruction due to large intes-
tine malignancy (28). Higher rate of diagnosis
of intestinal obstruction may be due to more
easy use of diagnostic procedure such as en-
doscopy and colonoscopy in adults than chil-dren. The higher
rate of malignancy in adults,
may be another cause.
In the current study all of the patients with
intestinal obstruction due to hernia was male.
Dakubo et al. showed that there is male/female
ratio was about 8/1 (29). The number of the
patients with hernia in our study was too low
to be reasonable.
In our study, 100% of patients with partial
obstruction were treated by conservative man-
agement.In Jeong et al. study 80% of patients with
partial obstruction were treated by non surgi-
cal management. In Teon et al. study, patients
had previous history of primary cancer and
this may be the result of difference in surgical
and non surgical treatment (30).
CONCLUSIONS
Ileus, adhesion band, and partial obstruc-
tion are the most common causes in children.Partial obstruction,
ileus, and adhesion band
are the most frequent causes of intestinal ob-
struction in adults. Most of patients were ad-
mitted between 5-10 days. Children were more
operated than adult. Sonography was used
more commonly in childrens but plain ab-
dominal X-ray for adult. In 45% of children
10000
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371Ileus and intestinal obstruction comparison between children
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Received: 31.05.2011 r.Adress correspondence: Imam Khomeini
Hospital, Azadegan St., Shaahada Square, Ahvaz, Iran
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