Obstruction of the alimentary tract in St. Vincent - abstract

ABSTRACT

This study assesses the aetiology and incidence of alimentary tract obstruction seen by a single surgeon from 1964 to 1985 in St. Vincent. The data were from the clinical and operation records, private museum and library of photographs, and X-ray pictures. Of 299 cases, 231 (77 percent) were acute and 68 (23 percent) chronic. The commonest acute obstruction was of the appendix by faecoliths or fibrosis, 53 percent; hernial obstruction constituted 15 percent, small bowel obstruction by bands 10 percent, intussusception 9 percent, atresia of the bowel 5 percent, obturation of the lumen 4 percent, congenital pyloric stenosis 3 percent and volvulus due to malrotation and in a mentally ill patient 0.4 percent each. Cancer was the commonest chronic cause, 46 percent; fibrotic pyloric stenosis 26 percent, infection 15 percent, oesophageal achalasia 6 percent, obturation of the lumen by faeces 4 percent, jejunal leiomyoma and oral teratoma 1 percent each. Congenital conditions were 9 percent of all cases (atresia accounting for 44 percent). Operations for alimentary tract obstruction were 11 percent of the 2, 727 abdominal operations performed in the 22 years. Noteworthy were the absence of obstruction in infantile umbilical herniae, 2 fatal cases of herniation of ileum through tears in the mesentery, 40 percent of intussusceptions betwee 4 and 43 years, frozen pelvis in actinomycosis, advanced oesophageal achalasia in an 18-year-old, mango bolus obstruction, and 3 tumours at rare sites - teratoma of the mouth, carcinoid of the pyloric canal and an ileal leiomyosarcoma. This study demonstrates the causes and incidence of alimentary tract obstruction in St. Vincent (AU)