scholarly journals Clinical cases of late adhesive intestinal obstruction after liver and kidney transplantation in children and surgical methods of their treatment

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
O. Bodnar ◽  
◽  
V. Khaschuk ◽  
A. Bocharov ◽  
B. Bodnar ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Small Intestine ◽  
Kidney Transplantation ◽  
Intestinal Obstruction ◽  
Clinical Case ◽  
Sodium Hyaluronate ◽  
Lateral Part ◽  
Surgical Methods ◽  
Adhesive Intestinal Obstruction ◽  
Clinical Cases

Abdominal adhesions are one of the most common complications in abdominal surgery. In 56-70 % it is the cause of small bowel obstruction, which often requires repeated surgery. To date, a few cases of late adhesive intestinal obstruction (LAIO) as a complication of organ transplantation in children have been described. The purpose of the study was to investigate clinical cases of LAIO in a 9-year-old child after liver transplantation, and in an 8-year-old child after kidney transplantation. Materials and methods. Clinical case I. A 62-day-old girl was treated with Kasai procedure before a liver transplantation, according to type III atresia of the biliary tract. Orthotopic liver transplantation of the left-lateral section from living related donor was performed at the age of 9 months. The surgeries were accompanied by damage to the mesothelium and trauma of the serous membrane, which led to the formation of intraabdominal adhesions. With the growth of the child there was a growth of abdominal organs and adhesions stretching. LAIO was diagnosed 8 years after first surgery. Clinical case II. The boy was diagnosed with hypoplastic dysplasia of the right kidney, left-side ureterohydronephrosis, resulting in chronic end-stage renal disease. Peritoneal dialysis was performed at the age of 6 years. The effect of dialysate on the mesothelium led to the formation of small intestine pseudo-diverticula. At the age of 7 years a bilateral nephrectomy and kidney transplantation from a deceased donor were performed. At the age of 8 LAIO was diagnosed. In both cases, children underwent adhesiolysis. The peritoneum was sutured from the lower and upper edges of the wound to the middle, so that a hole remained in the middle of the wound. A Nelaton catheter was inserted through the hole and 250 ml of sodium hyaluronate solution "Defensal" was injected into the left-lateral part, small pelvis and right lateral abdominal cavity. Then anterior abdominal wall was sutured. Results. The successful surgical treatment of LAIO in children using local adhesiolysis in combination with sodium hyaluronate was performed. The careful handling of vascular anastomoses and changes in organ topography were required during surgery. The purpose of the surgery on LAIO was not only to restore the chyme transport in the gastrointestinal tract, but also to release the small intestine from the adhesions with the normal anatomy and function preservation. The observation of children for 5 years indicate the effectiveness of intraabdominal application of sodium hyaluronate solution.

scholarly journals Modern methods for adhesive bowel obstruction diagnosis

2021 ◽  
Author(s):  
K. D. Rybakov ◽  
G. S. Sednev ◽  
E. M. Askerov ◽  
A. M. Morozov ◽  
A. N. Pichugova ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Small Intestine ◽  
Small Bowel ◽  
Intestinal Obstruction ◽  
Resonance Imaging ◽  
X Ray ◽  
Modern Methods ◽  
Partial Colectomy ◽  
Adhesive Intestinal Obstruction

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. 

scholarly journals About criteria of X-Ray study in chronic palace disease of Bruceur

2018 ◽  
Vol 11 (2) ◽  
pp. 97-100
Author(s):  
Marat A Nurtdinov ◽  
Ildar F Sufiayrov ◽  
Gusel R Yamalova ◽  
Aiaz A Shakirianov
Keyword(s):  
Small Intestine ◽  
Surgical Treatment ◽  
Intestinal Obstruction ◽  
Intestinal Wall ◽  
Virtual Model ◽  
Peritoneal Adhesion ◽  
Peritoneal Disease ◽  
X Ray ◽  
Pearson Criterion ◽  
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.

scholarly journals SURGICAL TREATMENT OF ACUTE INTESTINAL OBSTACLATION CONDITIONED BY A NEUROENDOKRIN TUMOR OF THE THIN INTESTINE, ON THE BACKGROUND OF THE PATIENT INFECTION OF A NEW CORONOVIRUS INFECTION COVID-19

2020 ◽  
Vol 24 (2) ◽  
pp. 37-45
Author(s):  
Ildar Mugallimovich Sharafutdinov ◽  
◽  
Marat Faritovich Minniakhmetov ◽  
Vladimir Petrovich Ionin ◽  
Keyword(s):  
Small Intestine ◽  
Surgical Treatment ◽  
Intestinal Obstruction ◽  
Neuroendocrine Tumor ◽  
Clinical Case ◽  
Acute Intestinal Obstruction ◽  
Patient Infection

A clinical case of successful surgical treatment of acute intestinal obstruction due to a neuroendocrine tumor of the small intestine in a patient against a new coronovirus infection COVID-19 is described.

scholarly journals TRICHOBEZOAR OF A SMALL INTESTINE IN A 10 YEAR OLD FEMALE

2018 ◽  
Vol 6 ◽  
pp. 986-989
Author(s):  
Ievgen Mozhaiev ◽  
Natalia Mozhaieva ◽  
Yuliya Modna ◽  
Daniel Khashchuk
Keyword(s):  
Small Intestine ◽  
Intestinal Obstruction ◽  
Clinical Picture ◽  
Pediatric Surgery ◽  
Clinical Case ◽  
Practical Interest

The majority of items which accidentally enter the organism significantly threaten the health and life of a child. The problem of bezoars in the practice of pediatric surgeons and emergency pediatric surgery remains relevant, as evidenced by this clinical case. As a clinical picture of bezoars is diverse and this pathology is quite rare in childhood each case with a bezoar represents a practical interest for pediatric surgeons. This case is interesting because it describes a clinical case involving a bezoar of a child’s small intestine with the clinical picture of an acute mechanical (obstructive) intestinal obstruction.

scholarly journals Rare Forms of Intestinal Obstruction in Children

2019 ◽  
Vol 4 (2) ◽  
pp. 144-147 ◽  
Author(s):  
V. N. Stalmakhovich ◽  
I. N. Kaigorodova ◽  
A. S. Strashinsky ◽  
I. B. Li ◽  
E. V. Sapukhin
Keyword(s):  
Small Intestine ◽  
Intestinal Obstruction ◽  
Abdominal Cavity ◽  
Clinical Signs ◽  
Pancreatic Injury ◽  
Esophageal Stenosis ◽  
X Ray ◽  
First Child ◽  
Omental Bursa ◽  
Adhesive Intestinal Obstruction

The article analyzes two rare cases of acquired intestinal obstruction in children. In the first child at the age of 2 years, who suffered a retrosternal total coloesophagoplasty for extended post-burn chemical esophageal stenosis, early postoperative adhesive intestinal obstruction appeared on the 8th day of the postoperative period, which was eliminated laparoscopically. The next day, against the background of drug stimulation of the intestine, a small intestinal invagination developed, diagnosed with ultrasound examination. Relaparotomy and disinvagination were performed.The second patient, the 15 years old girl, who had suffered from closed abdominal injury and a pancreatic injury, manifested the signs of high partial intestinal obstruction a day after the trauma occurred. Initially, its cause was considered to be hematoma of the omental bursa. Fibrogastroduodenoscopy (FGDS) and X-ray diagnostics did not reveal the cause of intestinal obstruction, but after FGDS procedure the patient’s condition improved within 3–4 days, and then the clinical signs of small bowel obstructive adhesion confirmed by X-ray and laparoscopy. With laparoscopy in the middle section of the small intestine, a hyperinflate “whitish” section about 12 cm long, dense in palpation, was identified, which was the cause of obstruction. Through minilaparotomic umbilical access from the abdominal cavity, a loop of the jejunum with a foreign body inside was exteriorized. With transverse enterotomy trihobezoar 10×4×4 cm was removed from the lumen, which moved from the stomach and led to obstruction of small intestine. The outcome of the treatment was good in both cases.

Clinical case of invasive aspergillosis in child after kidney transplantation

2019 ◽  
Vol 21 (1) ◽  
pp. 78-83
Author(s):  
I.V. Sheuchuk ◽  
◽  
S.V. Baiko ◽  
A.V. Sukalo ◽  
◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Invasive Aspergillosis ◽  
Clinical Case

CHANGES IN SMALL INTESTINE MICROFLORA IN PATIENTS WITH ACUTE INTESTINAL OBSTRUCTION

2020 ◽  
pp. 16-18
Author(s):  
V. M. Lykhman ◽  
O. M. Shevchenko ◽  
Ye. O. Bilodid ◽  
Igor Vladimirovich Volchenko ◽  
I. A. Kulyk ◽  
...  
Keyword(s):  
Small Intestine ◽  
Gastrointestinal Tract ◽  
Species Composition ◽  
Intestinal Obstruction ◽  
Bacterial Flora ◽  
Anaerobic Bacteria ◽  
Acute Intestinal Obstruction ◽  
Gram Positive ◽  
Mechanical Intestinal Obstruction ◽  
Facultative Anaerobic Bacteria

Among urgent surgical diseases of abdominal cavity, an acute intestinal obstruction is the most difficult to be diagnosed and treated. Leading factor, determining the development of pathophysiological processes is considered to be the progressive manifestations of enteric insufficiency syndrome, resulting in intestinal barrier impairment, negative changes in ecology of intestinal flora, increased endotoxins. To identify the small intestine microflora in acute intestinal obstruction and determine the role of dysbiotic disorders in clinical manifestations of main pathological process, a study was conducted in 60 patients with mechanical intestinal obstruction. The small intestine has a relatively rare microflora, consisting mainly of gram−positive facultative aerobic microorganisms, streptococci, lactobacilli. The distal ileum in nearly 30−55 % of healthy people contains scanty microflora, and yet the flora of this area differs from the microbial population of the higher gastrointestinal tract due to higher concentration of gram−negative bacteria. Optional−anaerobic coliform bacilli, anaerobic bifidobacteria and fusobacteria, bacteroids, the number of which starts exceeding the one of gram−positive species, are presented in significant quantities. Distal to the ileocecal valve there are significant changes in the microflora quantitative and species composition. Obligatory anaerobic bacteria become the predominant part of microflora, exceeding the number of aerobic and facultative anaerobic bacteria. The bacterial flora in different parts of gastrointestinal tract has its own specifics and is quite constant, as a result of the interaction of many factors, regulating the bacterial population in small intestine. The most important among them are: acidity of gastric juice, normal peristaltic activity of the intestine, bacterial interactions and immune mechanisms. Disorders of the intestine motor and evacuation function with its obstruction lead to slow passage of the chyme and contamination of the upper gastrointestinal tract with new types of microbes. There is a syndrome of small intestine excessive colonization, which means an increased concentration of bacterial populations in it, similar in species composition to the colon microflora. Pathological intra−intestinal contents become a source of endogenous infection and re−infection of the patient, leads to internal digestive disorders, which is manifested by syndrome of malabsorption of proteins, carbohydrates and vitamins. Key words: acute intestinal obstruction, small intestinal microflora, conditionally pathogenic microorganisms, intestinal biocenosis.

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