Clinical Characteristics And Etiological Analysis Of Small Bowel Obstruction In 824 Adults

Objectives To analyze the clinical manifestations,etiological characteristics and prognoses of small bowel obstruction(SBO)in three tertiary comprehensive hospitals from 2013 to 2020,and to explore the rare causes and pathological histochemistry of cases with small bowel ulcer and stenosis with obstruction.Methods Data of 824 patients with small bowel obstruction who were admitted to Fujian Medical University Union Hospital,The First Affiliated Hospital of Fujian Medical University,and Fujian Provincial Hospital from January 2013 to January2020 were collected,and their clinical manifestations and characteristics were summarized and analyzed.The etiology was summarized,and the cases of benign stenosis of the small intestine with small bowel obstruction were selected and summarized again.After excluding common causes,the clinical history of 5 patients with small bowel obstruction caused by small bowel ulcer and stenosis of unknown cause was reviewed,and the expression levels of cytoplasmic phospholipase A2-α(Cytoplasmic Phospholipase A2-α,c PLA2-α)in the small intestinal mucosal epithelium of these 5 patients,normal people and patients of Crohn’s disease and tumor necrosis factor-α(Tumor necrosis factor-α,TNF-α)were detected and statistically analyzed.Results In this group of studies,the top 10 causes of small bowel obstruction were:intestinal adhesion(353 cases,42.8%),tumor(80 cases,9.7%,70 cases of malignant tumor,10 cases of benign tumor),phytobezoar(77 cases,9.3%),hernia(44 cases,5.3%),Crohn’s disease(43 cases,5.2%),volvulus(24 cases,2.9%),mesenteric thrombosis(22 cases,2.7%),tuberculosis(12 cases,1.5%),intussusception(9 cases,1.1%),radiation enteritis(7 cases,0.8%).During the hospitalization,810(98.3%)of the 824 patients improved,and 14(1.7%)died.Univariate analysis suggested that age and hemoglobin level were the influencing factors that may be related to small bowel obstruction caused by small bowel malignant tumor(P<0.05).Binary Logistics regression analysis indicated that hemoglobin was an independent risk factor for small bowel obstruction caused by small bowel malignant tumor(P<0.001).The most common benign small intestinal strictures with obstruction are adhesion(68 cases,48.2%)and Crohn’s disease(26 cases,18.4%).The main cause of small intestinal ulcer and stenosis with obstruction was Crohn’s disease(15 cases,57.7%),small intestinal ulcers of unknown cause(5 cases,19.2%).Immunohistochemistry showed that the cumulative positive rate of c PLA2-α in the small intestinal mucosal epithelium of patients with small intestinal ulcer of unknown cause,IOD/Area,was lower than that of normal people and Crohn’s disease group,and its expression was statistically different(P<0.01),while there was no significant difference in the expression of c PLA2-α between the Crohn’s disease group and the normal group(P>0.05).The expression of TNF-α in the small intestinal epithelium of patients with unexplained small intestinal ulcer was higher than that of normal people,and lower than that of Crohn’s disease group,while the expression of TNF-α in Crohn’s disease group was higher than that of normal people,with statistical differences(P<0.0001).Conclusion Intestinal adhesion is the most common cause of small bowel obstruction.The most common benign small intestinal stenosis with obstruction is intestinal adhesion.Crohn’s disease is the main cause of small intestinal ulcer and stenosis with obstruction.In this group of studies,5 patients who had small intestinal ulcer and stenosis with obstruction of unexplained cause were screened out.The immunohistochemical characteristics of the intestinal mucosal epithelium were that the expression of c PLA2-α was lower than that of normal people and patients with Crohn’s disease,while the expression of TNF-α was higher than that of normal people and lower than that of patients with Crohn’s disease,suggesting that the pathogenesis of ulcer may be related to abnormal prostaglandin(PG)metabolism.The combination detection of c PLA2-α and TNF-α is expected to become an clinical histochemical index for distinguishing unexplained small intestinal ulcers from Crohn’s disease.