Histopathological Study of Obstructive Lesions of Small and Large Intestine: A Cross-sectional Study in Uttarakhand, India

Introduction: Intestinal obstruction is the impairment or arrest of the passage of contents through the intestine. Tubercular aetiology is the commonest cause of small intestinal obstruction in developing countries, while postoperative adhesions are common in developed countries. Neoplastic aetiology is more common in Large Bowel Obstruction (LBO). Clinical and radiological findings are non specific, and histopathology is required for a definitive diagnosis of the aetiology. Aim: To study histopathological examination of obstructive lesions of the small and large intestine. Materials and Methods: The present cross-sectional study was conducted from January 2020 to September 2021, including a total of 77 cases of intestinal obstruction due to mechanical causes. Detailed gross and microscopic examinations were performed, along with routine and special stains (wherever required), in the Department of Pathology at Government Medical College, Haldwani, Nainital, Uttarakhand. Data were presented in numbers and percentages. Results: The present study showed a male predominance 46 (59.8%) with a male to female ratio of 1.5:1. The most commonly affected age group was 31-40 years 20 (25.9%). Constipation (76; 98.7%) was the most common clinical symptom, followed by abdominal pain 72 (93.5%). The small intestine was more commonly involved 35 (45.5%), with the ileum being the most commonly affected site 40 (53.2%). Among cases of large intestine obstruction, the caecum was the most common site 10 (14.2%). Perforation was the most common gross finding 25 (32.9%). Non specific inflammatory pathology was the most common cause of obstruction (23.5%), followed by adenocarcinoma (20.8%). Tubercular pathology was the third most common cause (11.9%). Conclusion: The present study highlights the important pathologies in the aetiology of obstruction. Prevention and early intervention can help control some of the infective diseases and avoid such emergencies. Early diagnosis and treatment of neoplastic pathology, which is a leading cause of LBO, are beneficial for the better management of patients. A detailed histopathological study of small intestinal specimens should be conducted in constant correlation with clinical and radiological findings for an accurate diagnosis.