scholarly journals Peritoneal adhesion: state of issue and modern methods of prevention

2019 ◽  
Vol 36 (3) ◽  
pp. 72-90
Author(s):  
V. A. Samartsev ◽  
V. A. Gavrilov ◽  
B. S. Pushkarev ◽  
A. A. Parshakov ◽  
M. P. Kuznetsova ◽  
...  

Peritoneal adhesion (PA) is still an actual surgical issue. It is known that any surgical intervention causes abdominal adhesion that, in its turn, induces a number of complications such as adhesive intestinal obstruction. There is registered a high lethality among patients with the developed acute adhesive intestinal obstruction. Adhesive intestinal obstruction hurts health of patients, leading to eight (on average) days of hospitalization and intrahospital lethality of 3 % per episode. The cause of the development of a significant number of lethal cases is imperfection of preventive, diagnostic, therapeutic measures; 20 to 30 % of patients with adhesive intestinal obstruction need surgical treatment. Heavy expenses in the system of healthcare are required for treatment of peritoneal adhesions. The review presents the data regarding modern state of the problem, advanced tendencies in diagnosis, prevention and treatment of patients with peritoneal adhesions, their use in practical studies.

2018 ◽  
Vol 11 (2) ◽  
pp. 97-100
Author(s):  
Marat A Nurtdinov ◽  
Ildar F Sufiayrov ◽  
Gusel R Yamalova ◽  
Aiaz A Shakirianov

The problem of determining indications for surgical treatment for peritoneal peritoneal disease is relevant in connection with the lack of reliable criteria that allow us to detect intestinal obstruction at early stages. The authors studied the x-ray picture of chronic peritoneal peritoneal disease in two groups of patients, without obstruction (6 patients) and in the group of patients with obstruction (5 patients). X-ray computer tomography diagnostics was carried out using the Aquilion RXL, Toshiba Japan, VitreaAdvanced software was used to build the virtual model. For the comparative analysis, nonparametric statistics were used to calculate the Pearson criterion, with the Yates correction. The authors proposed the criteria of X-ray tomographic examination, which allow differentiating the adhesive intestinal obstruction from exacerbation of peritoneal adhesion. To these signs, the authors refer, pneumatized loops of the intestine, the presence of fluid in the lumen of the small intestine, the accumulation of fluid more than 200.0 ml, in two or more areas, thickening of the intestinal wall more than 2.1 mm. It was shown that the use of the developed complex of symptoms in the diagnosis of the disease positively affects the results of surgical treatment.


2018 ◽  
pp. 55-59
Author(s):  
I. F. Sufiyarov ◽  
F. F. Mufazalov ◽  
G. R. Yamalova

The most important problem determining the indications for surgical treatment of peritoneal adhesion is associated with the uncertainty of the criteria for early diagnosis of intestinal obstruction. Of all the most common acute surgical diseases of the abdominal cavity, acute intestinal obstruction gives the highest lethality. The main reason for this is untimely diagnosis. In two groups of patients, we performed a study of chronic peritoneal peritoneal disease using X-ray computed tomography (RCT), with obstruction (58 patients) and absence of this pathology (56 patients). Analyzing nonparametric statistics with the calculation of the Pearson criterion, with the Yates correction. We presented the criteria for the RCT study, differential diagnosis of adhesive intestinal obstruction from exacerbation of peritoneal adhesion. The main indicators of this disease: the fluid content in the lumen of the small intestine is more than 200.0 ml, in two or more regions, the inflated intestinal loops, an extension of 2.1 mm and more of the intestinal wall. The validity of the diagnostic criteria for RCT research leaves no doubt about the need for their use in preoperative access prognosis and the scope of surgical intervention.


2021 ◽  
Vol 2 (3) ◽  
pp. 52-56
Author(s):  
D.N. Khidoyatova ◽  
◽  
R.M. Abdujamilova ◽  
L.M. Zuparova ◽  
M.R. Mirkhalilova ◽  
...  

Transient ischemic attack(TIA), being a precursor of stroke, increases the risk of its development by up to 30% low awareness of the population about TIA symptoms, may cause late hospitalization of patients with its development and thereby cause stroke and reduce the effectiveness of treatment. Using a simple, practical ABCD 2 scale (age, arterial hypertension, presence of paresis and aphasia, duration of symptoms more than 60 minutes, diabetes mellitus) may be of predictive value in patients’ hospitalization. It is necessary to start the secondary prevention of stroke as soon as possible. The issue of choosing modern methods of prevention and treatment of patients with TIA, the choice of the optimal method of surgical treatment of patients with stenosis ofthe carotid arteries is currently not completely resolved.Keywords: transitory ischemic attack, stroke, prognosis, atherosclerosis, diagnosis, prevention, treatment.


2021 ◽  
Vol 2 (1) ◽  
pp. 44-48
Author(s):  
Dilbar Khidoyatova ◽  
◽  
Rano Abdujamilova ◽  
Lobar Zuparova ◽  
Madina Mirkhalilova ◽  
...  

Transient ischemic attack (TIA), being a precursor of stroke, increases the risk ofits development by up to 30%. Low awareness of the population about TIA symptoms may cause late hospitalization of patients with its development and thereby cause stroke and reduce the effectiveness of treatment. Using a simple, practical ABCD 2 scale (age, arterial hypertension, presence of paresis and aphasia, duration of symptoms more than 60 minutes, diabetes mellitus) may be of predictive value in patients' hospitalization. It is necessary to start the secondary prevention of stroke as soon as possible, choosing modern methods of prevention and treatment of patients with TIA, the choice of the optimal method of surgical treatment of patients with stenosis of the carotid arteries is currently not completely resolved


Author(s):  
K. D. Rybakov ◽  
G. S. Sednev ◽  
E. M. Askerov ◽  
A. M. Morozov ◽  
A. N. Pichugova ◽  
...  

Topicality. Adhesive intestinal obstruction is a common disease in abdominal surgery with a significant increase from year to year. During the last 20 years, the frequency of cases of adhesive intestinal obstruction (SCN) has increased by 2 times and has no tendency to decrease. In the UK, small bowel obstruction was an indication for 51% of all emergency laparotomies. Scott et al. reported seven emergency surgeries, accounting for 80% of all hospital admissions, morbidity, mortality, and health care costs in relation to general surgery in the United States. These seven operations included partial colectomy, small bowel resection, cholecystectomy, peptic ulcer surgery, adgeolysis, appendectomy, and laparotomy. Adhesive intestinal obstruction of the small intestine was the most frequent diagnosis in the behavior of four out of seven surgical interventions (partial colectomy, resection of the small intestine, adgeolysis and laparotomy). Postoperative adhesive processes are the main cause of small intestine obstruction, accounting for 60% of cases. Among all cases of intestinal obstruction, acute small intestine is 64.3–80%, while having a severe course and a worse prognosis. This causes a high mortality rate in this pathology. It ranges from 5.1% to 8.4%, occupying a leading place among all urgent diseases.The purpose of the study was to evaluate various modern methods of diagnosing adhesive intestinal obstruction.Material and methods. In this study, the method of classical analysis of domestic and foreign literature was applied, based on current data on the diagnosis of adhesive intestinal obstruction.Results. Historically, there has been a certain algorithm for examining patients arriving with suspected adhesive intestinal obstruction, which includes: complaints, anamnesis of the disease and life, objective status, as well as additional diagnostic methods. Patients with OCD usually present a wide range of complaints, such as nausea, vomiting and periodic abdominal pain. Nausea and vomiting follow the appearance of pain and are an early sign of proximal adhesive OCN. However, clinical symptoms are only partially able to diagnose adhesive intestinal obstruction. Laboratory data are of little significance in the diagnosis of intestinal obstruction, but they help to determine the presence and severity of metabolic disorders, homeostasis disorders, as well as to indicate possible starngulation. For the diagnosis of OCN, OBP survey radiography is routinely used. Computed tomography (CT) has a higher sensitivity and specificity compared to abdominal X-ray examination and is recommended by the Bologna Guidelines. Ultrasound examination (ultrasound) is increasingly used in the diagnosis of OCD. Ultrasound is a relatively simple inexpensive non-invasive imaging method that is devoid of radiation exposure, but depends on the operator's experience. To minimize the effects of ionizing radiation in children and pregnant women, magnetic resonance imaging is an effective alternative to computed tomography for intestinal obstruction.Conclusion. The problem of adhesive intestinal obstruction remains highly relevant, given the prevalence of the disease and high mortality rates. Currently, new promising methods for diagnosing this disease, including biomarkers and high-tech methods for visualizing the pathological process, such as computed tomography and magnetic resonance imaging, are acquiring high importance. At the same time, one should not forget about the routine research methods – X-ray of the abdominal cavity and classical methods of examining the patient – collecting complaints, anamnesis and determining the objective status. 


2020 ◽  
Vol 24 (2) ◽  
pp. 62-70
Author(s):  
O. V. Karaseva ◽  
Kseniia E. Utkina ◽  
A. L. Gorelik ◽  
A. V. Timofeeva ◽  
D. E. Golikov ◽  
...  

Introduction. Currently, there is no any unified approach to the treatment of complicated forms of acute appendicitis in children. The purpose of our study is to evaluate the effectiveness of the local Protocol for diagnostics and treatment of appendicular peritonitis (AP) in children. Material and methods. 149 children with AP, aged 2 - 17 (11 ± 3.5 ), were included into the study. All of them were treated at the Clinical and Research Institute Emergency Pediatric Surgery and Trauma (CRIEPST) in 2015-2018. In the gender structure, boys (104; 69.8%) prevailed over girls (45; 30.2%). The following parameters were evaluated: AP structure, surgical tactics, postoperative course (incidence of postoperative intestinal failure syndrome (IFS), postoperative complications, length of hospital stay). A tactics for surgical treatment and volume of intensive care in the postoperative period were defined depending on AP severity and according to the local Protocol. Laparoscopic appendectomy was performed in 145 (97.3%) patients. There were no intraoperative complications and conversions in the studied group. In case of periappendiular abscess (PA) 3 (2.7%), patients had puncture and abscess drainage under ultrasound control. Results. While analyzing the AP structure by forms , the following picture was shown: free and abscessed forms were approximately equal - 72 (48.3%) and 77 (51.7%), respectively (p > 0.05). Diffuse peritonitis - 31.5%; generalized - 16.8%; combined - 17.4%; periappendicular abscess (PA) stage 1-14.8%; PA 2-16.8%; PA 3-2.7%. Postoperative complications - 4 (2.7%): postoperative abdominal abscesses - 3 (2.0%); early adhesive intestinal obstruction - 1 (0.7%). In postoperative abscesses, puncture and drainage were performed under ultrasound control; in early adhesive intestinal obstruction - laparoscopic adhesiolysis. All the children recovered. Length of intensive care was 2.9 ± 1.8 days; hospitalization - 12.0 ± 5.2 days. Conclusion. The local Protocol developed by the researchers helps to define a surgical tactics and volume of intensive care in the postoperative period. Laparoscopic surgery, in the vast majority of cases, is an optimal and effective technique for AP surgical treatment in children. Contraindications to laparoscopic surgery are PA 3 and total abscessing peritonitis.


2019 ◽  
pp. 59-62
Author(s):  
V. B. Bоrisenko ◽  
А. М. Kovalev

Summary: Develop a comprehensive program for the diagnosis, treatment and prevention of intestinal adhesive obstruction.  Analyzed the results of diagnosis and treatment of 60 patients with acute adhesive intestinal obstruction. The diagnostic program included clinical, laboratory, X-ray and ultrasound diagnostics. Local barrier prevention of peritoneal adhesive disease was performed with a solution of polyethylene glycol 4000 according to the method developed by us. Conservative therapy was effective in 19 (31.7%) cases. 41 (68.3%) patients with a progression of adhesive ileus were operated. Laparoscopic adheolysis was performed in 4 (9.8%) patients. In 37 (90.2%) cases, surgical treatment was performed in the traditional method. The proposed diagnostic and treatment program with priority use of ultrasound diagnostics allows in a short time to establish a detailed diagnosis of adhesive intestinal obstruction and to determine the indications for surgical treatment. Intraoperative use of hypotonic solution polyethylene glycol 4000 allows to reliably prevent the development of peritoneal adhesive disease and adhesive obstruction.


Author(s):  
Paola Fugazzola ◽  
Federico Coccolini ◽  
Gabriela E. Nita ◽  
Giulia Montori ◽  
Davide Corbella ◽  
...  

Peritoneal adhesion index (PAI) is a score based on appearance and distribution of peritoneal adhesions. The study aims to assess the validity of PAI in order to standardize the definition of peritoneal adhesions. The study includes an expert survey to assess the feasibility of the score and a prospective observational and multicenter trial to assess its validity. 96% of surgeons of the survey consider PAI a useful tool. From January 2013 to March 2015, 205 patients were enrolled to undergo a surgical intervention for bowel obstruction caused by peritoneal adhesions in 21 centers. PAI was significantly higher in the population with previous surgery (P=0.043) and in patients who underwent two previous surgical interventions, if compared to those with only one previous intervention (P=0.012). Length of surgery was significantly longer in patients with higher PAI (P<0.001). Patients with a higher PAI showed a clinically higher risk for early bowel re-obstruction and for early re-intervention. The AUC of the ROC curve for early re-occlusion is 0.8. PAI can be considered a feasible and useful score.


Sign in / Sign up

Export Citation Format

Share Document