ورقة علمية / Research Paper

1. Background and rationale Acute bowel (intestinal) obstruction is a frequent surgical emergency worldwide and a leading cause of morbidity and mortality in low- and middle-income countries. In high-income settings postoperative adhesions are the dominant cause of small-bowel obstruction, while in many resource-limited settings obstructed hernias, volvulus and tuberculosis remain important contributors alongside adhesions and neoplasms. Short-term outcomes (postoperative complications, length of hospital stay, 30-day mortality) vary widely and are influenced by cause, delay to presentation, availability of diagnostics and operative resources. Studying local etiologic patterns, management choices and short-term outcomes allows design of context-appropriate pathways to reduce morbidity and mortality. Objectives Primary objective Describe the etiologic spectrum of bowel obstruction in adults presenting to the surgical service. Secondary objectives • Describe the surgical and non-operative management strategies used (including timing of surgery, operative procedures). • Measure short-term outcomes: postoperative morbidity (using Clavien–Dindo categories), surgical-site infection, need for bowel resection, length of hospital stay, and 30-day mortality. • Identify predictors of adverse short-term outcomes (e.g., delay to presentation >48 hours, etiology such as strangulated obstruction, need for resection, age, comorbidities). Study design A hospital-based retrospective study of adult patients (≥18 years) presenting with clinical and/or radiological diagnosis of intestinal obstruction in Northern Sudan. Study setting and duration Setting:tertiary/secondary hospitals Participants Inclusion criteria Adults (≥18 years) admitted with diagnosis of bowel obstruction (clinical ± radiological evidence) during the study period. Exclusion criteria Obstruction due to postoperative ileus without mechanical obstruction (if clinically distinguishable). Sample size Aim to estimate the proportion of patients experiencing an adverse short-term outcome (e.g., complication or 30-day mortality). We illustrate calculation for a presumed adverse outcome proportion p = 0.15, desired margin of error d = 0.05, 95% confidence (Z = 1.96): Z² = 1.96² = 3.8416 p(1−p) = 0.15 × 0.85 = 0.1275 Numerator = Z² × p(1−p) = 3.8416 × 0.1275 ≈ 0.489804 n = 0.489804 / d² = 0.489804 / 0.0025 = 195.92 → round up to 196 Add 10% for loss to follow-up/incomplete data → 216 patients. If local caseload is lower, recruit consecutively for a fixed study period and report precision accordingly. Data collection (tools and variables) Use a standardized data collection form (Google form). Key sections/variables: 1. Demographics & baseline Age, sex, residence (urban/rural), occupation, comorbidities (HTN, DM, TB history, HIV), prior abdominal surgery. 2. Presentations Duration of symptoms before presentation (hours/days), symptoms (pain, vomiting, constipation/obstipation, distension), vital signs, signs of peritonitis, dehydration. 3. Investigations labs (Hb, WBC, electrolytes), HIV/TB status if relevant. 4. Pre-operative management Resuscitation details (IV fluids, NG tube), antibiotics, time from admission to operation (hours), indications for surgery. 5. Intra-operative findings Site of obstruction (small vs large bowel), cause (adhesion, hernia, volvulus, tumor, intussusception, TB, foreign body), presence of strangulation/ischaemia, bowel resection (yes/no), type of repair/stoma. 6. Post-operative course / outcomes Complications (type, Clavien–Dindo grade), surgical-site infection, anastomotic leak, need for reoperation, length of hospital stay (days), discharge status, 30-day mortality. Data management and analysis • Descriptive statistics: means (SD) or medians (IQR) for continuous variables, counts and percentages for categorical variables. • Compare groups (favourable vs adverse outcome) using chi-square or Fisher’s exact test for categorical variables and t-test or Mann–Whitney U for continuous variables. • Multivariable logistic regression to identify independent predictors of adverse short-term outcome (include age, sex, delay >48 h, etiology [hernia/adhesion/volvulus/tumor], need for resection, comorbidities). • Report adjusted odds ratios (aOR) with 95% confidence intervals and p-values. • Significance: p < 0.05.

Patient records will be reviewed using anonymized data only, with no personal identifiers collected or reported, and all information will be handled with strict confidentiality.

This study will provide valuable local data on the etiologic patterns, management practices, and short-term outcomes of bowel obstruction in adults within a resource-limited setting. By identifying the most common causes and current treatment strategies, the findings can help optimize diagnostic and management pathways tailored to local realities.