Mechanical Bowel Obstruction: Then and Now

Albert B. Lowenfels, MD


May 11, 2012

Change in Mechanical Bowel Obstruction Demographic and Etiological Patterns During the Past Century: Observations From One Health Care Institution

Drożdż W; Budzyński P
Arch Surg. 2012;147:175-180


How have the causes of bowel obstruction changed over time? The investigators compared 193 patients treated for mechanical bowel obstruction from 1868 to 1898 with 207 patients treated from 2000 to 2003.

The site of obstruction remained similar between the 2 groups; about three quarters of the patients had small-bowel obstruction, and about one quarter had large-bowel obstruction. Incarcerated hernia was the most common cause of small-bowel obstruction in both groups. However, the most common cause of large-bowel obstruction changed dramatically between the 2 periods: One hundred years ago, it was volvulus of either the sigmoid or the cecum, whereas today, cancer is the cause of 80% of cases.


In this remarkable study, the investigators reviewed clinical records dating back to 1868, approximately the time when general anesthesia first became available. Of note, only 13 patients from the 19th century had bowel obstruction caused by colon cancer. In contrast, cancer is by far the most common cause today. Information on mortality and morbidity from bowel obstruction in the 19th century would have been interesting to review. Unfortunately, these data were not available.



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