Etiology, clinical profile, management, and outcomes of intestinal obstruction in a resource-limited setting: a prospective study

Acute intestinal obstruction is a common surgical emergency, defined as a partial or complete interruption of the forward flow of intestinal contents. It is associated with significant morbidity and mortality, and timely diagnosis and management are essential. This study aimed to evaluate the causes, clinical presentation, management, and outcomes of patients admitted with intestinal obstruction to Al-Thawra Modern General Hospital, Sana'a, Yemen. A prospective descriptive study was conducted on 105 patients diagnosed with intestinal obstruction between January 1 and December 31, 2024. Patients younger than 10 years or with early postoperative obstruction were excluded. Data on demographics, clinical features, laboratory and radiological findings, management, complications, and outcomes were collected and analyzed using SPSS. Of the 105 patients, 74 (70.5%) were male, with a male-to-female ratio of 2.38:1 and mean age of 45.2 ± 19 years; the 31-60 years age group was most affected (35.2%). Mechanical obstruction accounted for 75 cases (71.5%), while 30 cases (28.5%) were due to intestinal ileus. Adhesions and malignancy were equally the most common causes (21% each), followed by secondary peritonitis (18.1%), hernia (11.4%), and volvulus (15.3%). The majority of patients presented within 3-7 days of symptom onset, although 81% of malignant obstructions occurred in patients aged 19-60 years and often presented after more than 14 days. Conservative management was successful in 13.3% of patients, while the remainder required surgical intervention according to etiology and intraoperative findings. Postoperative complications occurred in 19% of patients, and overall mortality was 14.3%, highest among patients with malignancy, mesenteric ischemia, and obstructed hernia. Mechanical obstruction is the predominant type of intestinal obstruction, with adhesions and malignancy as leading causes. Advanced age, comorbidities, ischemia, and recurrent neoplasm were associated with poor outcomes. Preventive strategies, including reduction of adhesions, elective hernia repair, early cancer screening, and timely surgical intervention, are essential to reduce morbidity and mortality associated with intestinal obstruction.