Relationship Between History/Physical Examination and Radiological Findings with Surgical Findings to Determine the Level of Obstruction

Abstract

Objective: To assess the correlation between the clinical findings and radiological findings with surgical findings in patients with intestinal obstruction and the subsequent determination of the level and severity of the obstruction.

Methods: This prospective observational study was done at the general surgery department of JPMC Karachi, during 12-month from January 2022 to December 2022. Adults aged 15 years and above, clinically and radiologically suggestive of intestinal obstruction and underwent surgical intervention were included. Clinical data was collected through thorough physical examinations and detailed medical history reviews. Parameters such as abdominal pain, distension, bowel sounds, and other relevant symptoms were documented. Radiological investigations were analyzed for evidence of obstruction and its location. Patients who undergone surgical intervention, their operative findings were correlated with clinical and radiological findings. Data analysis was done by using SPSS version 26.

Results: Overall, 44 patients were studied with mean age of 38.59 ± 7.77 years, 56.8% were male and 42.3% female. Common clinical findings included inability to pass gas or stool (97.7%), constipation (95.5%), dehydration (93.2%), and tachycardia (93.2%). Radiologically, air-fluid levels with valvulae connivences were most frequent (52.3%). Intra-operatively, omental bands (22.7%) were the most common finding. There was a significant association between clinical symptoms, such as tenderness and anorexia, with specific intraoperative findings (p=0.004). Radiological findings, particularly air-fluid levels, were strongly associated with surgical diagnoses (p=0.001), highlighting their importance in guiding treatment.

Conclusion: Clinical assessments and abdominal X-rays in diagnosing intestinal obstruction, applicable in only a few instances. It emphasizes the superior diagnostic capability of abdominal CT scans, may enhance the surgeon's understanding of the underlying pathology.