Diagnostic indicators for the surgical treatment of acute adhesive intestinal obstruction

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.

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APPENDICULAR PERITONITIS IN CHILDREN: AN EFFICIENT SURGICAL APPROACH AND INTENSIVE CARE

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2020-24-2-62-70 ◽

2020 ◽

Vol 24 (2) ◽

pp. 62-70

Author(s):

O. V. Karaseva ◽

Kseniia E. Utkina ◽

A. L. Gorelik ◽

A. V. Timofeeva ◽

D. E. Golikov ◽

...

Keyword(s):

Intensive Care ◽

Laparoscopic Surgery ◽

Surgical Treatment ◽

Postoperative Complications ◽

Intestinal Obstruction ◽

Postoperative Period ◽

Diffuse Peritonitis ◽

Surgical Tactics ◽

Adhesive Intestinal Obstruction ◽

Local Protocol

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.

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DIAGNOSTICS AND COMPLEX TREATMENT OF ADGHESIVE INTESTINAL OBSTRUCTION

Kharkiv Surgical School ◽

10.37699/2308-7005.5-6.2019.12 ◽

2019 ◽

pp. 59-62

Author(s):

V. B. Bоrisenko ◽

А. М. Kovalev

Keyword(s):

Polyethylene Glycol ◽

Surgical Treatment ◽

Intestinal Obstruction ◽

Clinical Laboratory ◽

Hypotonic Solution ◽

Polyethylene Glycol 4000 ◽

Treatment And Prevention ◽

Ultrasound Diagnostics ◽

Adhesive Intestinal Obstruction ◽

Adhesive Obstruction

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.

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TREATMENT OF ACUTE ADHESIVE INTESTINAL OBSTRUCTION WITH MINI-INVASIVE METHODS

InterConf ◽

10.51582/interconf.19-20.02.2021.076 ◽

2021 ◽

pp. 768-773

Author(s):

Sanjar Ruziboev ◽

Gennady Khaydarov ◽

Abdurakhim Avazov ◽

Masrur Mukhammadiev

Keyword(s):

Surgical Treatment ◽

Intestinal Obstruction ◽

Intestinal Motility ◽

Abdominal Cavity ◽

Intestinal Resection ◽

Intestinal Fistula ◽

Results Of Treatment ◽

Adhesive Intestinal Obstruction ◽

Early Restoration ◽

Length Of Hospitalization

The authors studied the results of treatment of patients with adhesive disease of the abdominal cavity, determined the frequency of relapses of adhesive intestinal obstruction and studied the possibility of laparoscopic adhesiolysis in the surgical treatment of acute adhesive intestinal obstruction. A total of 987 patients with AIN were operated on: of whichlaparotomy adheziolysis - 539, intestinal resection laparotomy with interintestinal anastomosis-246, intestinal resection laparotomy with excretion of intestinal fistula-88, laparoscopy adhesiolysis-114. The use of laparoscopic adhesiolysispromotes to the early restoration of intestinal motility within 24-48 hours, reduces the frequency of relapses of adhesive disease, and reduces the length of hospitalization on average to 6.8 days.

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CAUSES OF EARLY RELAPAROTOMIES IN SURGERY

Kharkiv Surgical School ◽

10.37699/2308-7005.1.2021.14 ◽

2021 ◽

pp. 77-80

Author(s):

V. I. Lupaltsov ◽

K. O. Vander

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Intestinal Obstruction ◽

Early Postoperative Period ◽

Early Postoperative Complications ◽

Urgent Surgery ◽

Abdominal Abscesses ◽

Abdominal Organs ◽

Adhesive Intestinal Obstruction ◽

Suture Failure

Summary. Introduction. Despite the introduction of modern methods of diagnosis, tactics, and treatment of diseases of the abdominal organs, the risk of developing early postoperative complications remains high. The aim of this study is to clarify the causes of early postoperative complications and indications for their surgical treatment. Materials and methods. 3947 case histories of patients operated on for urgent indications were analyzed. In 73 cases, relaparotomies were performed in the early postoperative period (1.85 %). Results and discussion. The main nosologic unit, during the surgical treatment of which relaparotomies were performed, was acute appendicitis. Then there was a perforated pyloroduodenal ulcer and a strangulated hernia of various localization. The main indications for relaparotomy were progressive peritonitis, early adhesive intestinal obstruction, intra-abdominal abscesses, and infiltrates. In two cases, no pathology was detected during relaparotomy – there was an over diagnosis of postoperative peritonitis and anastomotic suture failure. Conclusion. 1. The main cause for relaparotomies in urgent surgery is the progression of preoperative peritonitis. 2. The second important cause is early postoperative adhesive intestinal obstruction. 3. Errors in intraoperative diagnostics, tactics, and techniques are the third leading cause of early relaparotomies.

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TREATMENT AND RECURRENCE PREVENTION OF ACUTE ADHESIVE INTESTINAL OBSTRUCTION

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov20179168-72 ◽

2017 ◽

Vol 9 (1) ◽

pp. 68-72 ◽

Cited By ~ 2

Author(s):

B P Filenko ◽

V P Zemlyanoy ◽

P A Kotkov

Keyword(s):

Surgical Treatment ◽

Intestinal Obstruction ◽

High Frequency ◽

Unsolved Problem ◽

Preventive Measures ◽

Long Term Results ◽

Results Of Treatment ◽

Adhesive Intestinal Obstruction ◽

Surgical Operations

Surgical treatment of acute adhesive intestinal obstruction is an unsolved problem due to the high frequency of relapses. The aim of this work was to improve the results of treatment of patients with acute adhesive intestinal obstruction by preventive measures improvement. The paper set out the principles of curative and prophylactic algorithm, that can help to reduce the frequency of relapses and improve long-term results. The algorithm includes operative treatment using endovideosurgical access and differentiated approach to the use of preventive measures. The best results were achieved by per- forming planned surgical operations.

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Peritoneal adhesion: state of issue and modern methods of prevention

Perm Medical Journal ◽

10.17816/pmj36372-90 ◽

2019 ◽

Vol 36 (3) ◽

pp. 72-90

Author(s):

V. A. Samartsev ◽

V. A. Gavrilov ◽

B. S. Pushkarev ◽

A. A. Parshakov ◽

M. P. Kuznetsova ◽

...

Keyword(s):

Surgical Treatment ◽

Intestinal Obstruction ◽

Surgical Intervention ◽

Modern State ◽

Peritoneal Adhesion ◽

Peritoneal Adhesions ◽

Modern Methods ◽

Prevention And Treatment ◽

Therapeutic Measures ◽

Adhesive Intestinal Obstruction

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.

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ROLE AND PLACE OF ULTRASONOGRAPHY IN DIAGNOSTICS OF ADHESIVE INTESTINAL OBSTRUCTION

Wiadomości Lekarskie ◽

10.36740/wlek202001115 ◽

2020 ◽

Vol 73 (1) ◽

pp. 83-86

Author(s):

Vadim B. Borisenko ◽

Artem N. Kovalev ◽

Tatyana А. Denysiuk

Keyword(s):

Surgical Treatment ◽

Intestinal Obstruction ◽

Conservative Therapy ◽

Ray Method ◽

Transabdominal Ultrasonography ◽

X Ray ◽

Abdominal Organs ◽

Ultrasound Study ◽

Treatment Indications ◽

Adhesive Intestinal Obstruction

The aim: To study the possibilities of ultrasound in adhesive ileus obstruction diagnosis and indications for surgical treatment determination. Materials and methods: The results of diagnosis and treatment of 60 patients with acute adhesive intestinal obstruction with comparative use of X-ray and ultrasound methods were analyzed. Results: The use of a standard X-ray examination of the abdominal organs upon admission to the hospital allowed the diagnosis of acute adhesions of small bowel obstruction in only 32 (53.3%) patients. Transabdominal ultrasonography allowed the establishment of adhesive ileus during hospitalization in 53 (88.3%) patients and also in 7 (11.7%) during a dynamic examination 2-3 hours after admission. Due to the lack of positive effect from the conducted conservative therapy relying on the data of ultrasound studies, 33 (55%) patients were operated on. During X-ray examination, only 10 (30.3%) of these patients demonstrated negative X-ray dynamics, and with an ultrasound study, deterioration of echo pictures was observed in all 33 (100%) patients. Conclusions: Compared with the X-ray method, transabdominal ultrasonography is established to be safe, affordable, simpler, non-invasive and highly informative method for the study of acute adhesions of the small intestinal obstruction. The method allows the assessment of the ongoing conservative therapy dynamics and determination for surgical treatment indications.

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