During the period January, 1987 to June, 1991, 208 adults with mechanical bowel obstruction were managed at The Aga Khan University Hospital (AKUH). Post-operative adhesions accounted for 34% of the cases and were the most frequent cause of intestinal obstruction. External hemia (16%), malignancy (13.5%) and tuberculous stricture (10%) were the next most frequent causes. The predominance of adhesive intestinal obstruction at AKUH shows a trend towards a Western disease pattern. Socioeconomic status was a significant determinant of the cause of obstruction. The proportion of self paying to welfare patients was significantly lower in tuberculous obstruction as compared with adhesive or malignant obstruction and in obstruction caused by hernia as compared with that due to malignant disease (P < 0.05). The present study demonstrates the synchronal occurrence of old and new diseases in a population and points towards the epidemiological transition which is affecting urban areas in the developing world.
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