Diagnostic program and tactical approaches to treatment of patients with obturative colonic obstruction of tumor genesis

Aim. To determine the value of ultrasound investigations, colonoscopy and laparoscopy in the complex diagnosis of acute obturative colonic obstruction of tumor genesis and in selecting the optimal treatment strategy. Methods. Conducted was an anlysis of results of treatment of 112 patients with obturative colonic obstruction of tumor genesis. A set of diagnostic procedures was carried out for every admitted patient: digital rectal examination, radiography of the abdomen, ultrasound examination, fiber colonoscopy, and laboratory studies. Results. Based on the clinical and radiographic the diagnosis of obturative colonic obstruction was established in 64.3%, ultrasound investigation revealed the presence of bowel obstruction without specifying its location in 92% of the cases. Emergency colonoscopy was informative only in 55.5% of cases due to inadequate prior preparation of the colon. Using the developed methodology of preparing the colon, it was possible to perform colonoscopy up to the level of the tumor in 26 patients (92.9%) out of 28 patients. In the 32 cases minimal surgical intervention were performed by way of formation of an ileotransverse anastomosis by-pass, double-barreled ileostomy or colostomy. 80 patients underwent resection of the bowel with the tumor, including operations with the formation of a primary anastomosis, which were performed in 20 patients when the tumor was located in the right segments of the colon. In 22 patients an intraoperative colonic lavage was performed. Postoperative complications were recorded in 30 (26.8%) patients. Postoperative mortality was 24.1% (27 patients). Conclusion. Based on the radiographic and ultrasound investigations of the abdominal cavity it is possible to establish the presence of bowel obstruction without specifying the localization of the obstruction zone; in order to determine the cause of the obturative colonic obstruction it is necessary to perform an emergency colonoscopy with rigorous preparation of the colon according to the developed technique, while the volume of surgical intervention should be determined in each case individually.

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Diagnosis and surgical treatment of liver echinococcosis

Medicni perspektivi (Medical perspectives) ◽

10.26641/2307-0404.2021.4.248172 ◽

2021 ◽

Vol 26 (4) ◽

pp. 113-117

Author(s):

V.O. Shaprinskyi ◽

O.O. Vorovskyi ◽

O.A. Kaminskyi ◽

Ya.M. Pashynskyi

Keyword(s):

Blood Loss ◽

Pleural Cavity ◽

Abdominal Cavity ◽

Diagnostic Value ◽

Results Of Treatment ◽

Before And After ◽

Residual Cavity ◽

Right Lobe ◽

The Right ◽

Duration Of Operation

The results of treatment of 72 patients with echinococcosis of the liver were analyzed, women – 62 (86.2%), men – 10 (13.8%). Primary echinococcosis was detected in 69 (95.8%) patients, secondary – in 3 (4.2%). Among instrumental research methods, ultrasound and computed tomography examination were of diagnostic value. Single liver cysts were found in 63 (87.5%) patients, multiple – in 9 (12.5%). Among patients with solitary cysts, the right lobe was more often affected than the left – 48 (66.7%) vs 24 (33.3%) cases. Echinococcosis of central localization was less common and was noted in 8 (11.1%) cases. Echinococcosis complications were observed in 16 (22.2%) patients. Among them, most often there were suppurations of the cyst – in 13 (18.1%); a bursting of the cyst into the free abdominal cavity – in 1 (1.4%), in the pleural cavity – 1 (1.4%), in the biliary tract – in 1 (1.4%). Partial or complete liming of the hand was observed in 12 (16.7%) patients. In 20 (27.8%) cases, the operation was performed from the upper median access, in 42 (58.3%) – from oblique hypochondria accesses by Kocher or by Fedorov. Pericystectomy was performed in 48 (66.7%) patients, in 8 (11.1%) patients underwent resections of liver segments with an echinococcal cyst, in 4 (5.6%) – cyst opening with removal of contents and treatment of its cavity. Laparoscopic echinococectomy was used in 12 (16.7%) patients. In the postoperative period complications were observed in 16 (22.2%) patients. The use of the welding electrocoagulator EK-300M "Swarmed" in the thermal rehabilitation of the walls of the residual cavity after echinococectomy allowed to reduce blood loss from 2200±210 ml to 250±50 ml. With the use of laparoscopic echinococectomy, intraoperative blood loss was reduced by 9 times (р=0.0001); duration of operation – 2 times (р<0.05), stay in hospital – 3.3 times (р=0.002). There were no fatal outcomes. Before and after operation antirelapse antiparasitic therapy with albendazole (Vormil) was performed in two cycles of 28 days, separated by a 14-day break. The dose at body weight over 60 kg was 400 mg 2 times a day, and for less than 60 kg the drug was calculated at a rate of 15 mg/kg/day. There were 2 (2.8%) cases of relapse, there was no mortality.

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SURGICAL TREATMENT STRATEGY FOR COMMON PERITONITIS IN THE ELDERLY PATIENTS

Успехи геронтологии ◽

10.34922/ae.2020.33.6.023 ◽

2021 ◽

pp. 1186-1192

Author(s):

Б. В. Сигуа ◽

В. П. Земляной ◽

С. В. Петров ◽

В. А. Игнатенко ◽

П. А. Котков

Keyword(s):

Abdominal Cavity ◽

Treatment Algorithm ◽

Age Groups ◽

Postoperative Mortality ◽

The Elderly ◽

Abdominal Sepsis ◽

Adverse Outcomes ◽

Surgical Interventions ◽

Results Of Treatment ◽

Intra Abdominal Infection

Несмотря на очевидный прогресс в изучении вопросов лечения распространенных форм вторичного перитонита, ближайшие результаты далеки от удовлетворительных, в особенности у больных старших возрастных групп. В ряде случаев однократного оперативного вмешательства оказывается недостаточно для полноценной санации источника внутрибрюшной инфекции, что побуждает к проведению повторных санационных вмешательств, порядок и сроки выполнения которых на настоящий момент не являются строго регламентированными. Изучена эффективность применения лечебного алгоритма, подразумевающего дифференцированный подход к проведению плановых хирургических санаций в краткие сроки у больных с выраженными патоморфологическими изменениями в брюшной полости. Результаты лечения больных с применением плановых санационных вмешательств продемонстрировали эффективность разработанного алгоритма, позволив снизить общую послеоперационную летальность за счет сокращения удельного веса абдоминального сепсиса в структуре неблагоприятных исходов. Despite the obvious progress in the treatment of secondary peritonitis common forms, the results are far from satisfactory, especially among patients of older age groups. In some cases, a single surgical intervention is not enough for a complete elimination of the intra-abdominal infection source, which leads to repeated sanitation interventions, the order and timing of which are currently not strictly regulated. The effectiveness of the treatment algorithm, which considers a differentiated approach to planned surgical interventions in a short time in patients with severe pathomorphological changes in the abdominal cavity, was studied. The results of treatment using planned sanitation interventions demonstrated the effectiveness of the developed algorithm, allowing to reduce the overall postoperative mortality by reducing the proportion of abdominal sepsis in the structure of adverse outcomes.

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COMPARATIVE RESULTS OF RECOVERY STAGE IN TWO-STEP TREATMENT OF MALIGNANT COLONIC OBSTRUCTION

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2017-176-1-70-75 ◽

2017 ◽

Vol 176 (1) ◽

pp. 70-75

Author(s):

V. I. Pomazkin

Keyword(s):

Colonic Obstruction ◽

Abdominal Cavity ◽

Postoperative Mortality ◽

Main Group ◽

Control Group ◽

Recovery Stage ◽

Malignant Colonic Obstruction ◽

Analysis Of Results ◽

Comparative Results ◽

Adhesion Process

The aim of the study was a comparative analysis of results of different approaches to two-stage treatment of malignant colonic obstruction on the stage of recovery of the integrity of intestinal tract. The main group included 260 patients. A double-barreled colostomy was formed at the first stage, than resection of the colon with tumor removing and stoma excision were performed. The control group consisted of 192 patients. An obstructive resection of the colon was made at the first stage with following reconstructive operation. Intraoperative damage of the small intestine was observed in 6,9% patients of the main group and 18,2% patients of the control group. Postoperative mortality consisted of 1,2% in the main group and it was 1,5% in the control group. The early postoperative complications numbered 9,2% and 17,7%, respectively. The main risk factor of complication development was an expressed adhesion process of the abdominal cavity in the control group of patients. CONCLUSIONS. The method, which included the colostomy formation at the first stage with following radical surgery at the second stage, had advantages in case of elimination of malignant colonic obstruction.

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MAIN ASPECTS OF ADHESIVE SMALL BOWEL OBSTRUCTION

10.25005/2074-0581-2021-23-2-269-279 ◽

2021 ◽

pp. 269-279

Author(s):

M.K. GULOV ◽

◽

D.S. SALIMOV ◽

S.G. ALI-ZADE ◽

A.R. DOSTIEV ◽

...

Keyword(s):

Small Bowel ◽

Conservative Treatment ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Surgical Intervention ◽

Treatment Method ◽

Long Term Results ◽

Adhesive Small Bowel Obstruction ◽

Results Of Treatment ◽

Abdominal Organs

Immediacy of the problem of acute adhesive small bowel obstruction (AASBO) is due to its high prevalence and presence of certain difficulties in diagnosis, which affect the choice of the treatment method. In addition, the long-term results of treatment cannot be considered satisfactory due to the large number of AASBO recurrences. In 64-93% of cases, adhesions form on the abdominal organs after surgery. It should be noted that their recurrence after open surgery reaches 30% of cases, and after repeated operations this value increases to 78%. Determination of the main etiological factor is of great importance, which makes it possible to assess the feasibility surgery, since it is known that if adhesions do not develop, treatment can be conservative. In this regard, X-ray methods of investigation can be of great help. Surgical intervention is recommended in the presence of intestinal dysfunction symptoms that do not disappear after conservative treatment or when it worsens. Surgical intervention is recommended if symptoms of intestinal dysfunction do not disappear after conservative treatment or if they deteriorate. n recent decades, specialists in the field of abdominal surgery have been striving to expand the indications for laparoscopic interventions in order to reduce the invasiveness of surgery, which will also decrease the risk of adhesions.

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Small Bowel Obstruction Caused by an Incarcerated Hernia after Iliac Crest Bone Harvest

ISRN Surgery ◽

10.5402/2011/836568 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Steven d'Hondt ◽

Savas Soysal ◽

Philipp Kirchhoff ◽

Daniel Oertli ◽

Oleg Heizmann

Keyword(s):

Small Bowel ◽

Bowel Obstruction ◽

Iliac Crest ◽

Abdominal Cavity ◽

Easy Access ◽

Autogenous Bone ◽

Elective Resection ◽

Left Femur ◽

Onlay Mesh ◽

The Right

The iliac crest has become an often used site for autogenous bone graft, because of the easy access it affords. One of the less common complications that can occur after removal is a graft-site hernia. It was first reported in 1945 (see the work by Oldfield, 1945). We report a case of iliac crest bone hernia in a 53-year-old male who was admitted for elective resection of a pseudarthrosis and reconstruction of the left femur with iliac crest bone from the right side. One and a half months after initial surgery, the patient presented with increasing abdominal pain and signs of bowel obstruction. A CT scan of the abdominal cavity showed an obstruction of the small bowel caused by the bone defect of the right iliac crest. A laparoscopy showed a herniation of the small bowel. Due to collateral vessels of the peritoneum caused by portal hypertension, an IPOM (intraperitoneal onlay-mesh) occlusion could not be performed. We performed a conventional ventral hernia repair with an onlay mesh. The recovery was uneventful.

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Surgical Aspects of the Treatment of Patients With Generalized Peritonitis

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2021-10-1-58-65 ◽

2021 ◽

Vol 10 (1) ◽

pp. 58-65

Author(s):

B. V. Sigua ◽

V. P. Zemlyanoy ◽

S. V. Petrov ◽

V. A. Ignatenko ◽

P. A. Kotkov

Keyword(s):

Statistical Significance ◽

Abdominal Cavity ◽

Postoperative Mortality ◽

Abdominal Sepsis ◽

Secondary Peritonitis ◽

Surgical Interventions ◽

Results Of Treatment ◽

Generalized Peritonitis ◽

Surgical Tactics ◽

Planned Relaparotomy

BACKGROUND Much attention is currently given to the issues of surgical treatment of common forms of secondary peritonitis, which is associated with unsuccessful results of treatment of this group of patients and the lack of a unified approach to surgical tactics among patients requiring repeated surgical interventions for adequate sanitation of the abdominal cavity.AIM OF STUDY Improvement of the immediate results of treatment of patients with generalized secondary peritonitis by determining the approaches to choosing the optimal surgical tactics.MATERIAl AND METHODS We analyzed the results of treatment of 220 patients with common forms of secondary peritonitis who were treated at the Elizavetinskaya hospital of St. Petersburg in the period from 2013 to 2019. The indicated patients were divided into two groups, comparable in terms of the main features, including the depth pathomorphological changes in the abdominal cavity, assessed by calculating abdominal cavity index (ACI) and the Mannheim peritonitis Index (MPI). The main group consisted of 109 patients, where developed algorithm was used, which supposed planned sanitation relaparotomies within up to 2 days in patients with high values of ACI and MPI. The comparison group included 111 patients who underwent sanitation interventions “on demand”, that is, in the presence of signs of persistence of the infectious process in the abdominal cavity. The results of treatment were compared by assessing the level and structure of postoperative mortality, the frequency of complications, and the length of stay in intensive care units and hospital. Mathematical-statistical dataprocessing, calculations of intensive and extensive coefficients of features, assessment of the statistical significance of differences in features for the studied groups were carried out.RESUlTS The use of a differentiated approach to performing planned relaparotomy in patients with generalized peritonitis made it possible to reduce the overall mortality 1.7-fold (from 51.3 to 30.2%) (p=0.001) due to a decrease in the proportion of abdominal sepsis as a cause of unfavorable the outcome. No significant effect of the use of this algorithm on the frequency and structure of complications, as well as the duration of multiple organ failure, was found.FINDINGS The use of planned relaparotomy among the selected patients helps to reduce postoperative mortality without significantly negatively affecting other treatment results.

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Syndrome of complete insensitivity to androgens of the 4-years-old child

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic566 ◽

2020 ◽

Vol 10 (1) ◽

pp. 89-94

Author(s):

Vasily P. Gavrilyuk ◽

Stanislav V. Kostin ◽

Maria I. Statina ◽

Dmitry A. Severinov ◽

Elena O. Ageeva

Keyword(s):

Vas Deferens ◽

Surgical Intervention ◽

Abdominal Cavity ◽

Outpatient Basis ◽

Female Reproductive System ◽

Bilateral Inguinal Hernia ◽

Pelvic Organs ◽

Hernial Sac ◽

Risk Of Malignancy ◽

The Right

To demonstrate an interesting and rare case in the clinical practice of testicular feminization syndrome in a child, as an accidental finding when performing a planned surgical intervention. A mother with a child E., born in 2010 (at the time the child was 4 years old) was hospitalized with the mothers complaints about the presence of protrusions in both inguinal areas from birth, the mother denied cases of infringement. The child was examined on an outpatient basis and the next day a scheduled surgical intervention was prescribed hernia repair on both sides. At the opening of the hernial sac on the right, the contents were the testicle, 1.6 1.6 1.0 cm in size, with an appendage and vas deferens. Then an opening of the hernial sac was performed on the left, the contents of the hernial sac was also a testicle measuring 1.8 1.2 1.0 cm with an appendage and d. deference. Examination was performed: on an ultrasound of the pelvic organs the bladder is full, the effusion in the pelvis is up to 1215 mm high, the uterus and ovaries are not located at the time of the examination. In the abdominal cavity (in the iliac regions), ovarian testicles with mediastinum are located on both sides 19 11 mm on the right, 16 10 mm on the left. The clinical case that we have provided will be of interest to pediatric surgeons and geneticists in view of the unusual and complex clinical diagnosis of this condition. In the presence of a female phenotype, the child completely lacked the organs of the female reproductive system, this disease was detected only due to the presence of a concomitant pathology in the child, a bilateral inguinal hernia. The early diagnosis of STF is especially important given the risk of malignancy of the gonads in the post-pubertal period.

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LIVER ECHINOCOCCOSIS: DIAGNOSIS AND SURGICAL TREATMENT EXPERIENCE

Kharkiv Surgical School ◽

10.37699/2308-7005.1.2021.12 ◽

2021 ◽

pp. 66-71

Author(s):

V. A. Shaprinsky ◽

O. O. Vorovsky ◽

О. О. Kamins’kyy ◽

A. V. Verba ◽

A. M. Formanchuk ◽

...

Keyword(s):

Blood Loss ◽

Abdominal Cavity ◽

Complete Recovery ◽

Diagnostic Value ◽

Liver Cysts ◽

Results Of Treatment ◽

Before And After ◽

Residual Cavity ◽

The Right ◽

Duration Of Operation

Summary. The purpose: to analyze the results of treatment of patients with liver echinococcosis. Materials and methods: results of treatment of 76 patients with echinococcosis of the liver were analyzed, women — 66 (86,8 %), men — 10 (13,2 %). Primary echinococcosis was detected in 73 (96,1 %) patients, secondary — in 3 (3,9 %). Among instrumental research methods, ultrasound and computed tomography examination were of diagnostic value. Single liver cysts were found in 66 (86,8 %) patients, multiple — in 10 (13,2 %). Among patients with solitary cysts, the right lobe was more often affected in 56 (73,7 %) patients than the left — 20 (26,3 %) cases. Echinococcosis complications were observed in 16 (21,1 %) patients. Among them, most often there were suppurations of the cyst — in 13 (17,1 %); a break of the cyst in the free abdominal cavity — in 1 (1,3 %), in the pleural cavity — 1 (1,3 %), in the biliary tract — in 1 (1,3 %). In 20 (26,3 %) cases, the operation was performed from the upper median access, in 46 (60,5%) — from oblique hypochondriac accesses by Kocher or by Fedorov. Pericystectomy was performed in 52 (68,4 %) patients, in 8 (10,5 %) patients had resections of liver segments with an echinococcal cyst, in 4 (5,3 %) — cyst opening with removal of contents and treatment of its cavity. Laparoscopic echinococectomy was used in 12 (15,8 %) patients. In the postoperative period, complications were observed in 16 (21,1 %) patients. The use of the welding electrocoagulator EK-300M «Swarmed» in the thermal rehabilitation of the walls of the residual cavity after echinococectomy allowed to reduce blood loss from (2200 ± 210) to (250 ± 50) ml, recurrences – with 2,8 up to 0 %. Before and after operation was performed antireсedive antiparasitic therapy with albendazole (Vormil) in two cycles of 28 days, separated by a 14-day break. The dose at body weight over 60 kg was 400 mg 2 times a day, and for less than 60 kg the drug was prescribed at a rate of 15 mg/kg/day. Results. With the use of laparoscopic echinococectomy, intraoperative blood loss was reduced by 9 times (р=0,0001); duration of operation — 2 times (р>0,05), stay in hospital - 3,3 times (р=0,002). There were no fatal outcomes. Conclusions. Pericystectomy is an effective operation for complete recovery and does not give recurrence of the disease. The use of a welding electrocoagulator and laparoscopic echinococectomy significantly improve the results of treatment of patients with parasitic liver cysts.

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Dysgenetic male pseudohermaphroditism

Orvosi Hetilap ◽

10.1556/oh.2012.29303 ◽

2012 ◽

Vol 153 (8) ◽

pp. 303-307 ◽

Cited By ~ 2

Author(s):

László Ságodi ◽

Janka Jakab ◽

Ákos Kiss ◽

Erzsébet Ladányi ◽

Erzsébet Balogh ◽

...

Keyword(s):

Gonadal Dysgenesis ◽

Surgical Intervention ◽

Abdominal Cavity ◽

Testicular Tissue ◽

Male Pseudohermaphroditism ◽

Histological Evaluation ◽

Surgical Removal ◽

Pelvic Magnetic Resonance Imaging ◽

The Right

The authors report a case of a dysgenetic male pseudohermaphroditism with a 45,X/46,XY karyotype in a mosaic form, which was diagnosed in an infant. The one-week-old infant was evaluated because of proximal hypospadias and retention of the right testis. The results of hormonal tests were the followings: serum FSH 5.2 mU/ml; LH: 2.0 mU/ml; testosterone: 144.3 ng/dl; androstendione: 0.42 µg/l; 17-hydroxyprogesterone: 1.12 ng/ml. Chromosomal analysis revealed 45,X/46,XY karyotype. Fluorescent in vitro hybridization showed that 51% of the lymphocytes had the Y chromosome and the SRY gene. Analysis of the SRY showed no deletion in the AZF a,b,c regions. Pelvic magnetic resonance imaging indicated the presence of vagina between the bladder and the rectum, and it showed a mass measuring 15×8 mm in the right inguinal canal as well as an oval gonadal mass with a size of 13×7 mm in the left scrotum. During surgical intervention, performed at the age of one, the right gonad was removed and biopsy of the scrotal testis was performed. Histological examination revealed dysgenetic testis in both sides. The authors emphasize the necessity of cytogenetic and endocrinological investigations of newborns with perineoscrotal hypospadia and bilateral or unilateral maldescent testes immediately after birth. Surgical removal of the dysgenetic testicular tissue located in the abdominal cavity and its histological evaluation provides separation of mixed gonadal dysgenesis, dysgenetic male pseudohermaphroditism, bilateral gonadal dysgenesis and ovotestis in the 45,X/46,XY mosaic cases. An accurate evaluation is necessary for a correct sex assignment and for surgical intervention to prevent neoplastic degeneration of the dysgenetic gonad. Orv. Hetil., 2012, 153, 303–307.

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CLINICAL CASE OF APPENDIX MUCOCELL, COMPLICATED BY PERFORATION AND THE FORMATION OF RETROPERITONEAL SPACE PHLEGMON

Kharkiv Surgical School ◽

10.37699/2308-7005.3.2020.21 ◽

2020 ◽

pp. 110-114

Author(s):

О. А. Povch ◽

Е. N. Shepetko ◽

О. V. Коvalchuk ◽

R. О. Leleta ◽

S. О. Rebenkov

Keyword(s):

Preoperative Diagnosis ◽

Surgical Intervention ◽

Clinical Symptoms ◽

Abdominal Cavity ◽

Retroperitoneal Space ◽

Medical Attention ◽

Timely Manner ◽

Gradual Improvement ◽

Mucocele Of The Appendix ◽

The Right

Summary. The aim. To analyze the anamnestic data, clinical symptoms, preoperative diagnosis, features of surgical intervention and the results of histological examination in a patient with mucocele of the appendix (MA), complicated by necrosis and perforation of the wall and formation of retroperitoneal space phlegmon (FRS). Material and methods. An analysis of the case of MA, which was complicated by the atypical course and the development of retroperitoneal space phlegmon, which was diagnosed after multispiral computered tomography of the abdominal cavity (MSCT AC). Results. The patient, despite periodic atypical complaints of discomfort in the right iliac region, did not seek medical attention and was not examined. Operated urgently after performing MSCT AC. Intraoperatively, a rupture of the MA was diagnosed with formation of FRS, which significantly complicated the course of the operation and the course of the postoperative period. Appendectomy, drainage of the abdominal cavity and retroperitoneal space were performed. Gradual improvement and recovery. Conclusions: The acute situation resulting from the rupture of the MA, led to a complex operation. Performing MSCT AC at the prehospital stage makes it possible to diagnose the problem and perform the operation in a timely manner, without waiting for serious complications.

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