Preoperative Symptom Duration and Postoperative Ileus in Small Bowel Obstruction: An Observational Follow-up Study from a Tertiary Care Centre in Northern India

Abstract

Background: Small bowel obstruction (SBO) constitutes approximately 80% of all cases of mechanical intestinal obstruction, with significant morbidity, especially when complicated by postoperative ileus (POI) [1,2]. POI prolongs recovery, increases hospital stay, and escalates healthcare costs. The duration of preoperative symptoms has been hypothesised to influence POI, but limited literature exists exploring this association in detail.

Methods: We conducted a prospective observational follow-up study in the Department of General Surgery, Himalayan Institute of Medical Sciences, Dehradun, over 12 months. Forty patients aged >16 years, presenting with acute SBO and meeting inclusion criteria, were enrolled after informed consent. Data on demographics, comorbidities, duration of preoperative symptoms (pain, constipation, nausea/vomiting, distension), intraoperative findings, and postoperative recovery parameters were collected. The primary outcome was duration of POI. Spearman correlation and non-parametric tests were used; p<0.05 was considered significant.

Results: The mean age was 48.27±19.71 years, with male predominance (60%). The most common age group was 61–70 years (32.5%). Mean POI duration was 2.38±1.08 days. Significant positive correlations were found between POI duration and preoperative pain (rho=0.74, p<0.001), constipation (rho=0.41, p=0.009), nausea/vomiting (rho=0.45, p=0.004), distension (rho=0.70, p<0.001), and onset-to-procedure interval (rho=0.79, p<0.001). Time to passage of stool (rho=0.73, p<0.001) and time to oral intake resumption (rho=0.54, p<0.001) were also significantly correlated.

Conclusion: Preoperative symptom duration significantly predicts postoperative ileus in SBO patients. Early surgical intervention may reduce POI duration, enhancing recovery. Incorporating preoperative symptom timelines into decision-making can optimise postoperative outcomes.