韓國人 腸閉鎖症의 臨床的考察

Abstract

[한글]

[영문]

The material in this report is based on 303 cases seen at the Yonsei medical center during the past 7 years from may 1, 1957 through Apr. 30, 1964. 241 cases were treated surgically, 60 cases were non-surgical and 2 cases came to autopsy.

The object of this report is the analysis of the general clinincal picture of intestinal obstruction and the compare this with those of the literature.

Generally speaking our findings are not much different from those of others except in regard to the etiological factiors. In reviewing the literature most of the authors agree that the causes of intestinal obstruction are as follows in the order of frequency: Adhesion and adhesive bands, hernia, neoplasme and so on. In contrast we found that intussusception, adhesion and aohesive banos, and neoplasms were the main causes. However developmental anomalies such as imperforate anus, Hirschprung's disease and malrotation of the small gut are in the second place as important causes of intestinal obstruction.

We can not say that this is a fundamental difference in incidence because of the sporadic occurrence of these cases at the medical center.

More than 50% of 303 cases were included in the 0-1 and 21-40 year old groups.

This demonstrates the importance of gastrointestinal tract anomalies in intestinalobstruction. The ratio of male to female was 2 to 1.

The time from the onset of the illness to hospital admission could be divided into two groups; approximately 50% were admitted within 72 hours after the onset of the illness and the remainder were seen after 72 hours.

The incidence of bowel necrosis was 15.2%. This is not much different from the 10-15% of incidence reported in the literature.

The most common clinical symptoms were intestinal colic, abucominal distention and vomiting. Intestinal colic and distention were usually so extensive that the correct diagnosis could be made without X-ray. We wish to emphasize that clinical

symptoms were always preceded by X-ray manifestations. Furthermore the time from strangulation to gangrenous obstruction varies greatly. Therefore we emphasize early diagnosis and early operation. The sooner operation is performed, the better will be the results. In preoperative preparation suction decompression has been used widely. but not always wisely.

We also emphasize this problem because quite often there was too much dependence on this measure which might cause oegligence in the patients' care. Therefore a worse situation could develop and the operation be delayed causing patients fatally.

Recently we have made the following policy for all cases of intestinal obstruction: Once clinical diagnosis has een established.

Operation should be done immediately. By so doing we have saved many patients and also reduced orbidity and mortality rates.

According to our experience 50% resection of the small bowel could be made without too much difficulty in the postoperative course. Necessary bowel resection should be done without hesitation. If this is not done unfortunate results will be

encountered. In cases of ileal resection leave the ileccecal valve if possible.

These patients are more comfortable postoperatively.

In spite of general improvement in surgical technique there still remains high mrotality rate (10-15%) in intestinalobstruction. The authors believe that hemodynamic and metabolic changes in strangulation obstruction should be more

thoroughly investigated in the future. Knowing the basis for these and applying the findings clincially should bring better results in the treatment of intestinal obstruction. For the time being the best way to handle those cases seems to be early diagnosis and early surgical intervention.