Authors: Jean Paul Engbang, Basile Essola, Bekolo Fouda, Sosthene Baira, Marcelin Ngowe Ngowe.
Background: Malignant bowel obstruction (MBO) is the complete cessation of physiological intestinal transit made up of matters and gases for more than 24 hours having as etiology an obstructive malignant neoplasia, which may be intra or extra abdominal. It requires a specific diagnostic evaluation and multidisciplinary care. MBO is not only less frequent in our context but little update are known about the disease, hence the interest of our work.
Objective: to study the epidemiological profile and management of MBO in three hospitals in the Douala city.
Methodology: This was a transversal analytical study with collected retrospective data collection over a period of 10 years, ranging from January 2010 to December 2019 within eight months. The study, which took place in three hospitals in Douala’s city, had included the complete files of admitted patients and management of MBO with evidence of histological malignancy. Patients who had been managed out of our study sites as well as those who died before treatment and incomplete records were excluded. Results analysis is done statistically using sphinx plus2 version 5.0 and Microsoft Excel 2016 software. Results means from the experiment were compared using chi2 variable comparison. P<0.05 is taken as statistically significant with a confidence interval of 95%.
Results: We recruited 83 MBO cases. The hospital prevalence was 3.3% with a male predominance of 53% and the male / female sex ratio was 1:1. The mean age was 52.9 ± 17.8 years with the most affected being subjects from 60 years of age. Abdominal pain was the main reason for consultation (95.2%; 79 cases). Overall, 2.4% (03 cases) of our population were admitted with a state of hemodynamic instability and only 1.2% (01 case) was feverish. Meteorism was the most constant physical sign (81.9%; 68 cases). The X-ray examination of the abdomen was one of the most prescribed morphological tests (40.3%) but the thoraco-abdomino-pelvic scanner was most reliable for its precision of the occlusion site by obstructive mass with an reliability at 70.4% (p> 0.0001). The left colon was the majority obstruction site (43.4%). Intestinal resection with anastomosis was the most commonly performed surgical procedure (71%; 59 cases). In addition to surgical treatment, 31,3% of our population study benefited from exclusive chemotherapy, 2,4% from adjuvant radiotherapy and 20,4% from concomitant radio and chemotherapy. Post-operative morbidity was represented by infections and bleeding from operative wound (2.4% respectively) and recurrence of bowel obstruction. Post-operative mortality rate of 16.8% was dependent on the existence of metastases (p> 0.0001).
Conclusion: Malignant bowel obstruction is generally more frequent among aged people with a male predominancy. Surgery is the essential treatment with adjuvant methods. The prognosis is pejorative especially in the presence of metastases. Therefore, we recommend strengthening the monitoring of patients having a cancer to increase their life expectancy.
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