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Invited Critique |

Mechanical Bowel Obstruction:  A Tale of 2 Eras
Comment on “Change in Mechanical Bowel Obstruction Demographic and Etiological Patterns During the Past Century”

Robert Kozol, MD, MSA
Arch Surg. 2012;147(2):180. doi:10.1001/archsurg.2011.1415.
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Drożdż and Budzyński1 offer a comparative study of mechanical bowel obstruction at the same institution in Poland during 2 periods, 1868 through 1898 and 2000 through 2003. The information provides insight into medicine and surgery in the distant past. Differences in the etiology of obstruction in the 2 periods can be explained in part by multiple factors. First, public health in the 19th century was poor and is reflected in the short life expectancy and the frequency of infectious diseases that are rarely seen today. With the short life expectancy, we would not expect the number of colon cancers or cases of sigmoid diverticulitis that are seen today with patients living beyond 70, 80, or 90 years of age. We would expect the higher surgical mortality in the 19th century considering the lack of intravenous resuscitation, blood transfusions, and antibiotics, among other factors.

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