ART OF MEDICINE 2017
THE COURSE AND TREATMENT RESULTS OF ABDOMEN PERITONEAL ADHESIONS COMPLICATED WITH ACUTE INTESTINAL OBSTRUCTION IN THE CONDITIONS OF CENTRAL DISTRICT HOSPITAL
V.B. BORISENKO, A.N. LITVINENKO , F.N. KOVALOV
Kharkov Medical Academy of Postgraduate Education,
Communal Health Protection Institution “Valky Central District Hospital”
Introduction. Acute small intestinal obstruction with adhesions is one of the most widespread diseases in abdomen surgery. The frequency of acute small intestinal obstruction with adhesions varies from 54 to 90% among other types of intestinal obstructions. Its frequency increase is related to the growing number and volume of operative interventions on the abdomen organs.
Nowadays this disease treatment results cannot be considered as satisfying, as acute intestinal obstruction shows high death rate (8-30%) comparing to other acute surgical diseases of abdomen organs. It is vitally important to pay attention to the necessity of the development of the unified and generally agreed diagnostic tactics as well as the programs of conservative and surgical treatments of these patients category.
Aim of the research. To hold a retrospective analysis of the treatment of patients with acute small intestinal obstruction with adhesions and to find disadvantages of the standard diagnostic program.
Materials and methods. The work held is based on the data of the retrospective analysis of the diagnostics and treatment results among 60 patients with acute small intestinal obstruction with adhesions who received medical treatment in the department of surgery in the Communal Health Protection Institution “Valky Central District Hospital” during the period from 2012 to 2016.
The diagnostics of acute small intestinal obstruction with adhesions consisted of anamnesis data, physical, laboratory, roentgen and ultrasound examinations.
Results. Discussion. As the result of the anamnesis data study it was found that in all 100% cases patients had had one or more operative measures in the past. The most frequent surgeries that had led to further appearance of acute small intestinal obstruction with adhesions were appendectomy, measures on the pelvic organs and open surgeries caused by acute cholecystitis or hernioplasty. 22 (36,7%) patients had the anamnesis with one operative measure, 38 (63,3%) ones had two or more of them. 3 (5%) people had surgeries caused by acute small intestinal obstruction with adhesions.
The manifestation of acute small intestinal obstruction with adhesions using standard diagnostic program during first 12 hours was noticed in 47 (78,3%) cases, 13 (21,7%) patients with mild symptoms of acute small intestinal obstruction with adhesions were diagnosed only after 48 hours after the admission to hospital.
In 36 (60%) cases Swartz reaction was used.
23 (43,3%) patients underwent ultrasound treatment, however, acute small intestinal obstruction with adhesions was found in only 21 (91,3%) cases.
Significant difficulties were related to the diagnostics of high bowel obstruction that had 11 (18,3%) patients. All of them were diagnosed with it tardily, only after 12 hours starting from the moment of the admission.
Conservative treatment worked positively in 19 (31,7%) cases, 41 (68,3%) had surgeries.
In 32 (53,3%) cases intraoperative adhesion prophylaxis via peritoneal lavage with Dekasan liquid was implemented. Anus divulsion by Subbotin was also used.
Electrical stimulation was applied during the postoperative period in 31 (75,6%) cases for additional stimulation of vermicular movement caused by low efficiency of conservative therapy.
Intestinal tubes were removed on the 4-5th day after vermicular movement redressment.
2 (3,3%) patients had complications in the form of suture sinuses during the postoperative period. Fatal cases were absent.
Conclusions. The usage of standard diagnostic program of acute small intestinal obstruction with adhesions with predominant involvement of clinical and radiographic research methods allows to make the diagnosis on time only in 78,3% cases.
The limitations on timely and repeated ultrasound examinations do not allow to determine the diagnosis of acute small intestinal obstruction with adhesions in proper time and therefore conduct dynamic monitoring of the disease.
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