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SURGICAL MANAGEMENT OUTCOMES AND ITS ASSOCIATED FACTORS OF
INTESTINAL OBSTRUCTION IN PATIENTS TREATED AT WOLAITA SODO
UNIVERSITY TEACHING AND REFERRAL HOSPITAL, SOUTH ETHIOPIA, 2021

By MuhebaBetebo(MSc Candidate)(1)

A RESEARCH PROPOSAL SUBMITTED TO WOLAYITA SODO UNIVERSITY

COLLEGE OF HEALTH SCIENCE AND MEDICINE DEPARTMENT OF
INTEGRATED EMERGENCY SURGERY AND OBSTETRICS AS A PARTIAL
FULLFILLMENT FOR THE REQUIREMENTS FOR DEGREE OF MSC IN
INTEGRATED EMERGENCY SURGERY AND OBSTETRICS.
SURGICAL MANAGEMENT OUTCOMES AND ITS ASSOSCIATED FACTORS OF
INTESTINAL OBSRUCTION PATIENT TREATED IN WOLAYITA SODDO
UNIVERSITY TEACHNG AND REFERRAL HOSPITAL, SOUTH, ETHIOPIA

By MuhebaBetebo(MSc Candidate)

ADVISORS-

1.BereketlorisoLoha [MD, General Surgeon, Assistant professor of surgery)

2. LolemoKelbiso (MSc Adult Nursing, Assistant professor)

A RESEARCH PROPOSAL SUBMITTED TO WOLAYITA SODO UNIVERSITY

COLLEGE OF HEALTH SCIENCE AND MEDICINE DEPARTMENT OF
INTEGRATED EMERGENCY SURGERY AND OBSTETRICS AS A PARTIAL
FULLFILLMENT FOR THE REQUIREMENTS FOR DEGREE OF MSC IN
INTEGRATED EMERGENCY SURGERY AND OBSTETRICS.

MAY, 2021

WOLAYITA SODO, ETHIOPIA

ii
SUMMERY
Background: -Intestinal obstruction (IO) is one of the serious surgical emergenciesandIt is
associated with high mortality and morbidity throughout the World.Itis one of the most
commonacute abdominal disorder that often requires emergency surgical management in hospital
setting.Surgical management outcome of intestinal obstruction ends with high morbidity and
mortality. According to our country little is known about the surgical outcome of intestinal
obstruction.

Objective: -The aim of this studyisto assess the surgical management outcomes and its
associated factorsamongpatientswithintestinal obstruction treated in WolaitaSodo
University teaching and referral Hospital, Southern Ethiopia,2021.

Methods: -Institution based cross sectional study will be conducted among patients who
surgically treated for Intestinal obstruction (IO) in WolaitaSodo University teaching and
referral Hospital during the last 3 years.A total of 141patient’smedical records will be
selectedbyusingsystematic random sampling technique. The semi-structured research tool
will be used to collect all the necessary data. The data will be entered into epi data version
7.1 and analyzed by using SPSS version 25.The bivariate logistic regression model will be
used to explore factors associated with surgical management outcome of intestinal
obstruction. Variables with p value of more than 0.25 in the bivariate regression model will
be entered in the final model (Multivariable logistic regression model). Then finally, odds
ratio with 95% confidence interval will be used identify variables which are significantly
associated with dependent variable.

Work plan and Budget: -This research will be conducted from May to June 30,2021 and a
total budget needed to accomplish this study is 28,028.70 Ethiopian Birr.

iii
ACKNOWLEDGMENTS
First of all, I would like to thank ALLEH, who is Alpha and Omega, for giving me insight
in my life; all I am and all I have are because of him.

My grateful thank also goes to Wolaitasodo University, College of Health Science and
Medicine, Department of Obstetrics/Gynecology and General Surgery for giving me this
golden and educative opportunity.I would also like to extend my deepest gratitude to my
advisors,Dr. BerketLoriso and Mr.Lolemofor their unreserved encouragements and
provision of constructive comments and guidance throughout this study.

Last, but not least I would like to express my special gratitude to my friends for their
technical support during this proposal development.

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TABLE OF CONTENTS

Contents
SUMMERY.............................................................................................................................iii

ACKNOWLEDGMENTS......................................................................................................iv

TABLE OF CONTENTS........................................................................................................v

LIST OF TABLES.................................................................................................................vi

LIST OF FIGURES..............................................................................................................vii

LIST OF ABBREVIATION AND ACRONYMS...............................................................viii

1. 2 Background......................................................................................................................1

1.2 Statement of problem........................................................................................................2

1.3 Significance of the study...................................................................................................3

2.LITERATURE REVIEW.....................................................................................................4

2.1 Overview about intestinal obstruction...............................................................................4

2.2 surgical management outcome among patients with intestinal obstruction......................5

2.3 Factors associated with surgical management outcome among patients with patients
with intestinal obstruction.......................................................................................................5

2.4. Conceptual Framework....................................................................................................7

3. OBJECTIVES.....................................................................................................................8

3.1. General objective..............................................................................................................8

3.2 Specific objective..............................................................................................................8

4. MEHODS AND MATERIALS..........................................................................................9

4.1 Study Area and period.......................................................................................................9

4.2. Study Design....................................................................................................................9

4.3. Source population.............................................................................................................9

v
4.4. Study population..............................................................................................................9

4.5. Inclusion and exclusion criteria........................................................................................9

4.5.1 Inclusion Criteria.............................................................................................................9
4.5.2. Exclusion Criteria...........................................................................................................9
4.6. Sample Size determination.............................................................................................10

4.7. Sampling Procedure.......................................................................................................10

4.8. Study variable.................................................................................................................10

4.8.1 Dependent variable........................................................................................................10
4.8.2. Independent variable....................................................................................................10
4.9. Data Collection process..................................................................................................11

4.10. Data processing and analysis........................................................................................11

4.11. Validity and reliability..................................................................................................11

4.12. Ethical consideration in the study................................................................................12

4.13. Operational terms.........................................................................................................12

4.14. Plan for dissemination of Findings...............................................................................12

5.WORK PLAN AND BUDGET BREAK DOWN.............................................................13

5.1 Work Plan........................................................................................................................13

5.2. Budget Breakdown.........................................................................................................14

6.REFERENCES...................................................................................................................16

ANNEX.................................................................................................................................19

LIST OF TABLES

vi
Table 1:- work plan for conducting research on surgical management outcome among patients with
intestinal obstruction........................................................................................................................13
Table 2:- Budget breakdown for research entitled with surgical management outcome and
associated factors among patients with IO........................................................................................14

LIST OF FIGURES

vii
Figure 1:- The conceptual framework about surgical management outcome and associated factors
among patients with intestinal obstruction in Wolayita Sodo Refferal Hospital.................................7

viii
LIST OF ABBREVIATION AND ACRONYMS.
AOR Adjusted Odds Ratio

BP Blood Pressure

CI Confidence Interval

EPI Statistical Package for epidemiological information analysis.

GSBV Gangrenous Small Bowel Volvulus.

GSV Gangrenous Sigmoid Volvulus

HCT Hematocrit

Hgb Hemoglobin

IO Intestinal Obstructions

IV Intravenous

LBO Large Bowel Obstruction.

MIO Management of Intestinal Obstruction

NGO Non Governmental Organization

NGT Naso Gastric Tube

OPD Out Patient Department

OR Odds Ratio

P P-value

RD Risk Difference

RR Respiratory rate

RR Relative Risk

SBO Small Bowel Obstruction

SPSS Statically Package for Social Science

SSBV Simple Small Bowel Volvulus

SSI Surgical Site Infection

WBC White Blood Cell

WSUTRH WolaitaSodo University Teaching and Referral Hospital

ix
1. INTRODUCTION

1. 2 Background
Intestinal obstruction or bowel obstruction is agastrointestinal condition in which digested
material is prevented from passing normally through the bowel.Itis inability of forward
propulsion of intestinal content and second causes of acute abdomen next to acute appendicitis.It
has different classifications. Based on pathophysiologyit is classified as adynamic and dynamic
intestinal obstruction. Based on anatomical classification it is classified as small bowel and large
bowel obstruction. Intestinal obstruction also classified based on how obstruction is occurredas
intrinsic and extrinsicIO(1–4).

It is one of the serious surgical emergenciesandassociated with high mortality and morbidity
throughout the World. Some studies conducted in some developing countries including Ethiopia
reported high magnitude of intestinal obstruction. Studies conducted in Attat hospital and Ayder
referral hospital, mekelle in Ethiopia reported that the magnitude of intestinal obstruction
accounts for 30 and 42 percent of all emergency surgically treated Patients respectively(5–7)

According to different study, the cause of intestinal obstruction[IO] is varied in different

population and geography.The most frequent causes of intestinal obstruction in developing
countries are hernia and volvulus however,current studies reported hernia as leading causes of
[IO] in developing countries. Adhesion is the most common cause of IO in developed
countries(6).

Hence it is important to conduct studies to assess the surgical management outcome and
associated factors among patients with intestinal obstruction in our country especially in my
study area.

1
1.2 Statement of problem
Intestinal obstruction accounts for approximately 15 percent of all visits of emergency
department for acute abdominal pain. Surgical management outcome associated with this health
problem(intestinal obstruction) improved since the development of more sophisticated diagnostic
tests and imaging machine, but still the condition remains major public health problem(6,8,9).

Surgical management outcome of intestinal obstructionisthe challenging problem which is

determined by many patientsrelated and clinical related factors like surgical site infection, wound
dehiscence, leakage, pneumonia and sepsis. Many of this unfavorable outcome is minimized if
the factors related to surgical management outcome of intestinal obstruction is predetermined
and all the necessary action is taken to prevent the factors associated with it before and after the
procedure(10,11).

Surgical management is quoted ‘evidence based surgical treatment andaconcept on which

surgical health professional relied on the updated and well evidenced data to recommend for the
patients rightfully on plugging of disease. Physicians are not only expected to perform evidence-
based procedure but also, theymustunderstand about the postoperative recovery, the impact of
quality of procedure and expected functional outcome. The procedure of [IO] is careful diagnosis
using some predictive syndromic approach with diagnostic testing and imaging management
according to physiological needs.Though sophisticated investigation such as some advanced
imaging and laboratory technology, clinical approach is remaining superior one still on
contemporary time(11).

Though some studies have been done to assess prevalence and causes of intestinal obstruction in
our country Ethiopia, the condition related with surgical management outcome among patients
with intestinal obstructionis largely remain unstudied.There are only two studies conducted in
north and central Ethiopia to assess the surgical management outcome of intestinal obstruction.
The researcher will be initiated to know about surgical management outcome of [IO] in order to
document, as reference to other researchers, to help on time clinical decision depending on its
severity and sensitivity,andtoget some supportive fund from both governmental and non-
governmental institution(3,12–14).

2
Hence, the aim of this study is to assess the surgical management outcome of intestinal
obstruction and its associated factors in WolayitaSoddo University TeachngAnd Referral
Hospital, Southern Ethiopia.

1.3 Significance of the study

The result of this study will enhance the physicians through updating their knowledge on the
current world bowl surgical management concerns utmost. It will also help the government
because the result will amendthe policy including the focus diversification. The hospital will also
get a means to treat the patients easily and quickly.The finding of this study also helps the
society by enhancing latest and need based service and health status improvement that in turn
will boosts their livelihood economic status.

Further the research finding will help other researchers by providing evidence which in turn
helps them to conduct further studies.

3
2.LITERATURE REVIEW
2.1Overview about intestinal obstruction
Intestinal obstruction is one of the commonest abdominal surgical emergencies. When intestinal
obstruction is not relieved in time, the patient may die. Early diagnosis and prompt management
are therefore mandatory(15).The diagnosis and prompt management of intestinal obstructions
involves the following three main stages with numerous sub steps: (a) History and Physical
Examination: in this stage patients should be asked about their history of abdominal neoplastic,
hernia or hernia repair, and inflammatory bowel disease, because these conditions increase the
risk of obstruction. (b) Diagnostic Testing and Imaging (laboratory tests, radiography that may
include computed tomography, contrast fluoroscopy, ultrasonography, magnetic resonance
imaging); (c) Treatment: Management of intestinal obstruction is directed at correcting
physiologic derangements caused by the obstruction, bowel rest, and removing the source of
obstruction (16).

Retrospective descriptive study conducted in Kibogola Hospital in Rwanda reported that about
105patients with intestinal obstruction seen during the study period under review. The leading
cause of it was obstructed/strangulated external hernias in 41(39.0%) of patients and was
followed by intussusception in 22(21.0%)(15).However, study conducted in Nakamte referral
hospital reported that sigmoid volvulus was the leading cause of large bowel obstruction
37(86.0%) followed by ilieo-sigmoid knotting 5(11.6%) and colorectal CA 1(2.3%).Another
study conducted in Gondor referral Hospital also reported that the commonest causes detected
during preoperative period are Sigmoid volvulus 105(58%), Small bowel volvulus 36(19.9%),
Adhesion 15(8.3%), Intussusception 8(4.4%) and Hernia1 2(6.6%) (3,16).

A cross sectional study conducted in Adama referral hospital revealed that the prevalence of
intestinal obstruction was 21.8 % and 4.8 % among patients admitted for acute abdomen surgery
and total surgical admissions, respectively. Another descriptive cross-sectional study conducted
in Debre BirhanRefferal Hospital reported that from 357 study subjects/particiants with acute
abdomen 181 (50.7%) cases were intestinal obstruction. From the total cases of obstruction
72(39.8%) are small bowel obstruction and 109(60.2%) are large bowel obstruction with the
remaining 141(39.5%), 15(4.2%), 11(3.1%), 2(0.6%), 3(0.8%), 2(0.6%), 1(0.3%), and 1(0.3%)

4
case were dueto acute appendicitis. cholecystitis, Perforated peptic ulcer disease (PPUD),
ilialperforation, Pelvic inflammatory Disease (PID), primary peritonitis, intraabdominal abscess
and pancreatitis respectively. The finding fromAdama referral hosital also revealed that most
common cause of small bowel obstruction was intussusceptions in 48 patients (30.9 %), followed
by small bowel volvulus in 47 patients (30.3 %). Large bowel obstruction was caused by sigmoid
volvulus in 60 patients (69.0 %) followed by colonic tumor in 12 patients (13.8 %)(14,17).

2.2 surgical management outcome among patients with intestinal obstruction

Surgical management outcome among patients with intestinal obstruction is affected by different
pre-operative and post-operative factors. A cross sectional study conducted in Harar referral
hospital reported that the magnitude of poor surgical management outcome of intestinal
obstruction was 21.3% (95% CI: 16.5-26.4). From these poor outcomes more than half (55.5%)
had wound site infection (hematoma and incisional surgical site infection), 14.8% postoperative
pneumonia, and 11.1% anastomotic leak(18).

A Cross sectional study conducted in Gondor referral hospital shows 189 (83.3%) of 227 patients
have favorable surgical management outcomes of IO which was defined as the absence of all
types of postoperative complications, whereas the rest 38 (16.7%) patients have unfavorable
outcomes which was defined as the presence of one or more types of postoperative
complications. Furthermore, the overall success rate of the surgery is 95.6%, with 217 patients
discharged on improvement, although 10 (4.4%) inpatient postoperative deaths were
documented, among a total of 227 analyzed cases who were engaged for the surgical
management of IO at a tertiary healthcare facility in northwestern Ethiopia(3)

2.3 Factors associated with surgical management outcome among patients

with patients with intestinal obstruction
A Cross sectional study in Nigeria revealed thatthe most common post-operative complication
and cause of death were wound infection (29.6%) and sepsis (66.7%). The mortality rate was
14.3%(19).

Studies conducted in our country also identified some important factors which affected the
outcome of surgical management of intestinal obstruction. A cross sectional facility-based study

5
conducted in Harar referral Hospital revealed that the age group of ≥55 years, duration of illness
of ≥24 hours, preoperative diagnosis of gangrenous SBO, and gangrenous LBO were
significantly associated with poor surgical outcomes. Patients with the age of ≥55 years were
nearly 3 times more likely to develop poor outcomes as compared with patients whose age was
≤55 years (AOR = 2:9, 95% CI: 1.03, 8.4). Patients who came late (≥24 hours) were about three
times more likely to develop poor outcomes compared with patients who came early(18).

Another facility based cross sectional conducted in Gonder Referral hospital showed that patients
seeking healthcare for IO within 24 hours of illness were about eleven times (AOR 11.35; 95%
CI: 1.88–19.54; P 0.009) more likely to have a favorable outcome than those seeking healthcare
after 24 hours of illness. Patients presenting with a comorbid disease are ninetyfive percent
(AOR= 0.05; 95% CI: 0.01–0.33; P = 0.002) less likely to have a favorable outcome on the
surgical management of IO when compared to those without any comorbid disease. Patients
those who stayed in the hospital for ≤8 days after surgery were about three times (AOR = 3.11;
95% CI: 1.11–8.70; P = 0.030) more likely to have favorable outcome than those who stayed in
the hospital for >8 days after surgery(3).

Other study done in AdamaRefferal hospital shows that the major predictors of management
outcome of intestinal obstruction were: duration of illness before surgical intervention (adjusted
odds ratio (AOR) = 0.49, 95 % CI: 0.25–0.97); intra-operative findings [Viable small bowel
volvulus (SBV) (AOR = 0.08, 95 % CI: 0.01–0.95) and viable (AOR = 0.17, 95 % CI: 0.03–0.
88)]; completion of intra-operative procedures (bowel resection & anastomosis (AOR = 3.05, 95
% CI: 1.04–8.94); and length of hospital stay (AOR = 0.05, 95 % CI: 0.01–0.16). Cross sectional
study from NakamteRefferal hospital shows that patients who were <14 years of age were 15.4
times more likely to have good management outcome as compared with other age group
[AOR=15.4, 95% CI (1.61-19.98)]. Patient who came from rural area 5 times higher to have bad
management outcome as compared to patient who came from urban [(AOR=7.5, 95% CI (1.46-
38.46)]. (13,16).

6
 2.4. ConceptualFramework

Demographic factors

 Age
Pre-Operative
 Sex
 Presenting symptoms  Residence
 Duration of illness  Marital status
 Pre-operative diagnosis  Religion
 Preoperative cares received  Occupation
 Co-morbidity
 Previous surgery
 
Employed investigation

Intra operative

 Causes of illness
 Intra operative diagnosis
 Type of intra surgical procedures
 Education background of surgeon Surgical management outcomes of intestinal
obstruction

Post-operative

 Post-operative antibiotics
 Length of hospital stays

Figure 1:- The conceptual framework about surgical management outcome and associated factors
among patients with intestinal obstruction in WolayitaSodoRefferal Hospital

7
3. OBJECTIVES

3.1. General objective

To asses surgical management outcomes of the intestinal obstruction and its associated factors
among patients treated at WolaitaSodo teaching and referral Hospital, southern Ethiopia, 2021.

3.2 Specific objective

 To determine the magnitude of surgical outcomes of Intestinal ObstructioninWolaitaSodo
teaching and referral Hospital.
 To identify the type of Intestinal obstructions and management outcomes in WolaitaSodo
teaching and referral Hospital.
 To identify factors associated with surgical management outcomes of intestinal obstruction in
WolaitaSodo teaching and referral Hospital.

8
4. MEHODS AND MATERIALS
4.1 Study Area and period
This study will be conducted at wolaitasodo university teaching and referral hospital located in
WolaitaSodo town which is about 329 km far away from the capital city Addis Ababa and 151
km far from Hawassa, the capital city of Southern Nation Nationalities and Peoples Regional
State.The former ‘Otona Hospital’ the current wolaitasodo university teaching and referral
hospital was established in 1920 E.C.

In 2004 E.C, the hospital established the following departmentslikeintensive care unit,
outpatient department, emergency OPD, Laboratory, operation room, post anesthetic care unit,
and recovery unit. Regarding staff, the department has 12 surgeons, Scrub nurses, residents,
IESO students and medical Interns currently practicing. The study will be conducted from May
to June 30, 2021.

4.2.Study Design
Hospital based cross sectional study will be conducted using secondary data from patients’
records.

4.3. Source population

AllPatients admitted with the diagnosis of Intestinal obstruction and treated surgically at
WSUTRH in the previous three years (Jan 1, 2018-Jan 30 2021).

4.4. Study population

All selected Patients admitted with the diagnosis of Intestinal Obstruction and managed
surgically at WSUTRH during the study period with fulfillment of inclusion criteria become
study population

4.5. Inclusion and exclusion criteria

4.5.1 Inclusion Criteria
Patients who fulfilled the following criteria will be included:

 AllPatients with any age group admitted with the diagnosis of Intestinal obstruction and
treated surgically at WSUTRH during the study period will be included.

4.5.2. Exclusion Criteria

The following patients will be excluded from the study

9
  All patients with incomplete data all patients with missed medical record.

4.6. Sample Size determination

The sample size for this study is computed by using single population proportion formula
assuming the level of CI to be 95%, 5% margin of error. Taking the proportion of outcomes of
surgical management of IO is p= 83.3% from similar study done at Gonder,Northern Ethiopia.

N= (Z1/2)2 (p(1-p))

. d2

P is proportion of good outcomes for surgically treated IO patients =83.3 % used and
unfavorable outcome of IO is 16.7% which also will be used in the sample size calculation.

Z1/2= 1.96 at 95% CI at normal standard and margin of error 5%

d= 0.05

n= (1.96) (1.96) (.833) (.167)/0.05)2 =214, by adding 10% non-participatoryrate

Researcher needs to adjust by Yamane’s formula after knowing n= 214, N=412

nf =n/n/N+1, =214*412/626=141.

Hence, the final sample size for this specific study will be 141.

4.7. Sampling Procedure

First all patients’ medical record card who are surgically managed for intestinal obstruction will
be selected.Then to apply systematic random sampling k is calculated by the formula,
k=N/n,412/141= 3. So, every 3rd card will be taken to collect actual data after the selection of the
first patient’s record randomly. The researcher will collect data from available record on every
k=3 interval, by replacing next card based on selected interval.

4.8. Study variable

4.8.1 Dependent variable
Surgical management outcomes of intestinal obstruction

4.8.2. Independent variable

 The socio demographic variables likesex, age, religion, culture, ethnicity, address and
marital status of the respondents,

10
  pre-operative like presenting symptom from and progression of symptoms, duration of
illness from onset of symptoms up to surgery done for IO. preoperative diagnosis,
comorbidity, preoperative care received, previous abdominal surgery.
 Intra operative time like intraoperative diagnosis and procedure done
 Post-operative time antibiotics, and length of hospital stay after surgery done
 Type of obstruction SBO vs LBO, simple vs strangulated,
 Causative agent; tumor [benign vs malignant]

4.9. Data Collection process

Data will be collected from the patients’ documents of the hospital. But the type of data will
include texts (written descriptions) and figure (numerical reports of the case) but the data will be
gathered mainly in the form quantitative form to mean that figurative, because the aim of the
research is to relate the patients’ outcome with the reported associated factors.

Data gathering tool will be used in this research is the questionnaire/checklist/, which developed
based on the all-surgical activities inclusive way using, the data collection techniques called
observational document analysis. Data collection will be carried out from the archive of the
hospital

4.10. Data processing and analysis

Data will be entered intoepidata version 7.1then the data will be exported to SPSS version 25 for
analysis. Descriptive statistics will be carried out. Bivariate analysis and Multivariable binary
logistic regression will be conducted. Variables in bivariate analysis with p-value < 0.25 will be
candidate variables for Multivariable binary logistic regression model. Model fitness will be
tested by Hosmer and lemshow goodness of fit test. The magnitude of association between
dependent and independent variables will be measured by odds ratio with 95% Confidence
interval. Statistical significance will be declared at p-value 0.05. Finally, the result will be
presented in text, frequency, percentages, tabulation, and charts.

4.11. Validity and reliability

The validity and reliability of this study will be once on taking care to minimize the biases as
well as checking and managing using the data collection and unethical manipulation.
Furthermore, the researcher will approve the validity using the cross description with the related
literatures those were studied relatively on the same period, the same location and Hospital status
studies. This research’s reliability will be pinched using the debriefing the procedures and the
11
limitation of the study accordingly, because simple statistical tools are not full enough to
maintain complete validity and reliability edges of the study.

4.12. Ethical consideration in the study

Ethical approval will be obtained from Ethical review board of WolaitaSodo University, College
of Public Health & Medical Science. WolaitaSodoUniversity Teaching and Referral Hospital
will give permission to conduct the study. Then, study permit will be granted from Hospital in
accordance with the letter from the University. The data will be collected using pre tested
checklist. Informants will be assured that the data will be handled exclusively by the
investigators and no one will be able to recognize. Results will be communicated to the relevant
bodies after the completion of the paper

4.13. Operational terms

Duration of illness:isasymptom from onset of illness to time management decision.Pre-operative
diagnosis: clinical diagnosis before surgery by using presenting symptoms, laboratory
diagnosis.Preoperativeperceived:type of medication given before surgery.Morbidity: any
condition of disease which is severe than normal healing process. Duration of hospital stay: time
of hospital stay in relation to surgical outcome.

4.14.Plan for dissemination of Findings

Findings will be presented to Wolaita University, Faculty of Public Health & Medical Science,
and school of Graduate Study. The results will be submitted to the department of IEOS, the
hospital input to improve some areas of the program in the future. There will be an attempt to
publish it

12
5.WORK PLAN AND BUDGET BREAK DOWN
5.1 Work Plan
Table 1:- work plan for conducting research on surgical management outcome among patients
with intestinal obstruction

Activities Time needed /months/2021

Feb March May June July

Topic selection

Proposal development

Preparing checklist

Obtaining ethical clearance

Pretesting instrument

Data collection

Data analysis

Submission of first thesis draft

Submission final draft

Final thesis defense

13
5.2. Budget Breakdown.
Table 2:- Budget breakdown for research entitled with surgical management outcome and
associated factors among patients with IO.

5.1 Personal cost

Activities Individuals Qualification No Working Perdium/day Tot/birr
involved days
Patient chart Record keepers Secretary 2 05 200 2000
collection
Training Data collectors MW Nurse 2 2 300 1200
Data collection Data collector MW Nurse 2 10 300 6000
Data coding Data clerker Computer 2 10 200 4000
and entry technician

Total(birr) 13,200
5.2 Transport and communication cost
Transportation Investigator IESO 1 600

Internet service Investigator IESO 1 3000

Communication call service Investigator IESO 1 400

Total(birr) 4000

Sr. no Items Unit Quantity Unit price Total price

1 Duplication of Duplication of Page 1 2000

questionnaire questionnaire
2 Duplicating paper NOVA BK 5 80 400
TOP 80 gm
3 Duplicating Ink Tube 2 90 180
4 Photocopy paper PK 3 50 150
5 Toner for laser jet No 1 1000 1000
6 Note book No 10 10 100
7 Pen No 10 5 50
8 Pencil No 12 2 24
9 Sharpener/Eraser No 3 5 15
10 Clip board No 15 20 300
11 Stapler No 2 50 100
12 Staples Packet 5 10 50

13 CD, RW Pieces 5 25 125

Total (birr) 4494

14
Budget Summary
Activities Total

Personnel cost 16,200 Birr

Transport and 4000 Birr

Communication
Cost of Supplies 6494 Birr
5%contingency 1334.7 Birr
Grand total Birr 28,028.7 Birr

15
6.REFERENCES
1. Jackson PG, Raiji M. Evaluation and management of intestinal obstruction. Am Fam
Physician. 2011;83(2):159–65.

2. Eren T, Boluk S, Bayraktar B, Ozemir IA, Boluk SY, Tombalak E, et al. Surgical
indicators for the operative treatment of acute mechanical intestinal obstruction due to
adhesions. Ann Surg Treat Res. 2015;88(6):325–33.

3. Mariam TG, Abate AT, Getnet MA. Surgical Management Outcome of Intestinal
Obstruction and Its Associated Factors at University of Gondar Comprehensive
Specialized Hospital , Northwest Ethiopia , 2018. 2019;2019.

4. Tiwari SJ, Mulmule R, Bijwe VN. A clinical study of acute intestinal obstruction in
adults-based on etiology , severity indicators and surgical outcome Original Research
Article A clinical study of acute intestinal obstruction in adults-based on etiology ,
severity indicators and surgic. Int Res Med Sci. 2017;(February).

5. Tekalign Admasu G, Tilahun Beyene H, Shemsu Nuriye H. Management Outcome and

Associated Factors of Surgically Treated Non Traumatic Acute Abdomen at Attat
Hospital, Gurage Zone, Ethiopia. Int J Surg Res Pract. 2019;6(2).

6. Wossen MT. Pattern of Emergency Surgical Operations Performed for Non-Traumatic

Acute Abdomen at Ayder Referral Hospital , Mekelle University , Tigrai , Ethiopia by the
Year 2000-2003 Ec. 2019;9(5).

7. Quill DS, Plant A, Mcnay RA, Morris D. Surgical operation rates : a twelve year
experience in Stockton on Tees. 1983;65.

8. Malik AM, Shah M, Pathan R, Sufi K. Pattern of Acute Intestinal Obstruction : Is There a
Change in the Underlying Etiology ? 2010;16(4):272–4.

9. Tsegaye S, Osman M, Bekele A, Tsegaye S, Hospital L. East and Central African Journal
of Surgery Volume 12 Number 1 - April 2007. 2007;12(1):53–7.

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intestinal obstruction requires surgical intervention and their outcome. 2020;7(8):2563–7.

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Patients Treated Surgically , Eastern Ethiopia. :1–18.

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Hospital in Rwanda. East Cent African J Surg. 2009;14(2):103–8.

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ANNEX
Questionnaire

This checklist is prepared to asses emergency surgical operation performed for intestinal
obstruction in WolaitaSodo University Teaching and Referral hospital during the year. This will
be filled by the investigator from secondary data (from surgical operation registration book and
patients profile card).Date ------------------------ Card. No------------

Part I. Socio Demographic characteristics

Ro. no Variables Options Remark

1 Age of the patient -----------
2 Sex of the patient 1.Male
2.Female
3 Address 1.Urban
2. Rural
4 Marital status 1.Married
2. Single
3. Divorced
4. Widowed
5 Religion 1.Orthodox
2.Musilim
3. protestant
4. Catholic
5. Other (specify)---
6 Occupation status 1.Student
2.government
employed
3.NGO employed
4. Merchant
5.Farmer
6. other (secify)
Part I: Life Style Characteristics of The Patients

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 1. Tobacco use a) Yes b) No

2. Illicit drug use a) Yes b) No

Part I: Patient History at Admission.

1. Presenting complaints of the patient

Abdominal pain a) Yes b) No

Vomiting a) Yes b) No

Nausea a) Yes b) No

Abdominal distentiona) Yes b) No

Constipation a) Yes b) No

Fever a) Yes b) No

Others a) Yes b) No

2. Duration of the illness before arrival to hospital………………..Hrs.

3. Is there any co-morbidity

a) Yes, Specify…………… b) No….

Part Iv: Physical Examination Finding

1. V/S Finding

a) BP…………………

b) PR……………… c) RR……………….d) Temperature………………

2. Abdominal finding

a) Abdominal tenderness Yes No

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 b) Abdominal distension Yes…. No

c) Rebound tenderness Yes…. No

d) Guarding Yes…. No

e) Hypoactive bowel sound Yes… No

f) Hyperactive bowel sound Yes… No

3. DRE finding

a) Blood

b) Empty rectum

c) Mass

d) Others……

4. Labratory Finding

a) White Blood Cell count……

b) Hemoglobin…….

c) RFT-CR

BUN……

5. Preoperative diagnosis-

a) SBO 1-simple2. gangrenous

b)LBO 1. simple 2. gangrenous

C) Others, specify ……………………..

6. Preoperative care for the patient

a) Antibiotics initiated……………………. …

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 b) NG-tube inserted…………………………

c) IV fluid resuscitation…………………....

d) if catheterized, amount of urine output…………..

PART V: If Preoperative diagnosis is SBO, what are the causes

a) Primary volvulus

b) Adhesion/band

c) Hernia

d) Intussusceptions (ileocolic)

e) Others……………….

Part Vi: Intra Operative Findings

1) If primary volvulus a) Viable b) Nonviable

2) If adhesion/band a) Viable b) Nonviable

3) If hernia a) Viable b) Nonviable

4) If intussusceptions a) Viable b) Nonviable

5) Sigmoid Volvulus a) Viable b) Nonviable

6) Colorectal CA a) Viable b) Nonviable

7) Iliosigmoid Knotting a) Viable b) Nonviable

6) Others---------------- a) Viable b) Nonviable

Part VII: Intra Operative Diagnosis

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 1) SS 2) Strangulated hernia 3) Adhesion and band

4) Intussusceptions 5) Tumor and carcinoma 6) GSV

7) SSBV 8) GSB 9) Incarcerated hernia

10) Other, specify………..

Part VIII: Intra Operative Procedure

a) Untwisting the volvulus

b) Resection and anastomosis

c) Hartman’s colostomy

d) Herniorrhaphy

e) Adhesiolysis and band release

f)Manualreduction

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PART IX: -- Post operativecomplicationS

1. Hematoma and seroma a) Yes b) No

2. Superficial incision SSI a) Yes b) No

3. Deep incision SSI a) Yes b) No

4. Anastamotic leak a) Yes b) No

5. Organ space SSI a) Yes b) No

6. Facial dehiscence a) Yes b) No

7. Pneumonia a) Yes b) No

8. Septic shock a) Yes b) No

9. Hypokalemia a) Yes b) No

10. Respiratory failure a) Yes b) No

11. Sudden cardiac arrest a) Yes b) No

12. Post operative death a) Yes b) No

PART X CONDITION OF THE PATIENT ON DISCHARGE

(1). Improved

(2). Worsened

(3). Referred

(4) Died

PART 11. Postoperative hospital Stays of the patient ……………..days.

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