scholarly journals Advantages of computer tomography in the diagnosis of acute adhesive intestinal obstruction after gynecologic operations

2019 ◽  
pp. 119-126
Author(s):  
F. F. Mufazalov ◽  
I. F. Sufiyarov ◽  
G. R. Yamalova ◽  
A. G. Hasanov
Keyword(s):  
Mortality Rate ◽  
Intestinal Obstruction ◽  
Postoperative Mortality ◽  
Abdominal Hysterectomy ◽  
Intestinal Wall ◽  
Free Fluid ◽  
Adhesive Small Bowel Obstruction ◽  
Peritoneal Disease ◽  
Computer Tomographic ◽  
Adhesive Intestinal Obstruction

Adhesive intestinal obstruction is one of the most common and potentially fatal complications after abdominal surgery. Among gynecological operations, leading to the development of adhesive intestinal obstruction, abdominal hysterectomy is the most common cause of emergency intervention. At the same time, in the recent past, mortality was observed from 40% to 60%. Currently ,due to the development of endovideosurgery, it was possible to reduce the postoperative mortality rate however, the mortality rate remains between 10% and 20% in all patients with adhesive small bowel obstruction. The cornerstone in the improvement of treatment results is the timely diagnosis of this complication. We have developed criteria for early computer tomographic diagnosis of adhesive intestinal obstruction in patients after gynecological surgery (patent No. 2669729). These include: free fluid in the lumen of the small intestine more than 200.0 ml, in two or more areas, pneumatized intestinal loops, expansion of the intestinal wall by 2.1 mm or more. The study was conducted in two groups of patients with adhesive peritoneal disease with intestinal obstruction, which included computed tomography (104 patients) and examined according to the traditional method (60 people). The validity of the diagnostic computer tomographic criteria of the study leaves no doubt about the need for their use in the preoperative prediction of access and the volume of surgery.

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 Early diagnostics of acute honestious intestinal incapability with help of X-ray tomography

2018 ◽  
pp. 55-59
Author(s):  
I. F. Sufiyarov ◽  
F. F. Mufazalov ◽  
G. R. Yamalova
Keyword(s):  
Intestinal Obstruction ◽  
Surgical Intervention ◽  
Abdominal Cavity ◽  
Intestinal Wall ◽  
Peritoneal Adhesion ◽  
Peritoneal Disease ◽  
X Ray ◽  
Pearson Criterion ◽  
X Ray Computed ◽  
Adhesive Intestinal Obstruction

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.

scholarly journals The Point-Rating Scale for Determining Treatment Tactics in Patients With Adhesive Small Bowel Obstruction

2021 ◽  
Vol 10 (2) ◽  
pp. 303-308
Author(s):  
B. V. Sigua ◽  
V. P. Zemlyanoy ◽  
B. P. Filenko ◽  
P. A. Kotkov ◽  
D. Kh. Kalandarova ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Conservative Therapy ◽  
Rating Scale ◽  
Negative Impact ◽  
Morphological Changes ◽  
Abdominal Cavity ◽  
Adhesive Small Bowel Obstruction ◽  
Point Rating Scale ◽  
Adhesive Intestinal Obstruction ◽  
Therapy Success

Relevance. The most practiced method of treating patients with acute intestinal obstruction - urgent surgical intervention - does not guarantee remission, contributing to the progression of morphological changes in the abdominal cavity. From this perspective, a shift in emphasis towards the planned surgical treatment of patients with adhesive disease with the use of the existing anti-adhesive methods after conservative resolution of the intestinal passage disorders looks like a promising direction.Aim of the study. Improving the results of patients with acute adhesive intestinal obstruction treatment by developing a point-rating scale that allows to highlight groups of patients who are prone to conservative resolution of intestinal passage disorders episode, and, thereby, reduces the proportion of urgent interventions.Material and methods. The analysis of the 125 patients treatment results (retrospective group) admitted with symptoms of acute adhesive intestinal obstruction was carried out. On this basis, the point-rating scale was developed including a number of factors that have certain value in terms of predicting the probability of conservative therapy success. Subsequently the developed scale was applied in 170 patients (prospective group) as part of treatment tactics implementation aimed at maximally conservative resolution of adhesive intestinal obstruction without negative effect on the immediate results of patients operated in later periods.Results. The developed point-rating scale made it possible to reduce the frequency of urgent interventions among patients with signs of acute adhesive intestinal obstruction (from 79.2% to 57.6%) due to longer conservative measures — 18.1±17.2 and 11,2±8.7 hours in prospective and retrospective groups, respectively). There was no negative impact on the frequency of resection interventions (12.2 and 16.1% in the prospective and retrospective groups) as well as postoperative complications and overall mortality.Conclusions. The developed point-assessment scale made it possible to stratify patients in accordance with the probability of conservative therapy success and to justify its continuation for more than 12 hours in low-risk patients. The obtained results allow us to recommend the proposed scale for use in clinical practice. 

scholarly journals Possibilities of CT in the diagnosis of complications of intestinal diverticulosis (clinical observation)

2019 ◽  
pp. 54-65
Author(s):  
E. P. Korneva ◽  
M. V. Rostovtsev ◽  
N. V. Nudnov ◽  
T. M. Rostovtseva ◽  
E. V. Pronkina
Keyword(s):  
Abdominal Pain ◽  
Intestinal Obstruction ◽  
Abdominal Cavity ◽  
High Sensitivity ◽  
Intestinal Wall ◽  
Free Fluid ◽  
Abdominal Organs ◽  
Multiplanar Reformatting ◽  
Detection And Diagnosis ◽  
The Right

Purpose. To determine the possibility of MSCT in the detection and diagnosis of complications of diverticulosis.Materials and methods. MSCT was performed in the apparatus Aqullion Toshiba 64 with collimation of 0.5–1 mm with the multiphase contrast-enhanced and further multiplanar reformatting. The results of MSCT of abdominal organs in 2082 (100%) patients for 2016–2018 in GBUZ GKB im were analyzed. M.E. Zhadkevich, 841 (40%) – for emergency indications.Results. Intestinal diverticula was detected in 239 (11%) patients. CT-signs of diverticulitis were found in 36 (1.7%) subjects: 19 (0.9%) women aged 54 years to 91 years and 17 (0.8%) men aged 27 to 88 years. When admitted to the hospital, all patients (36 people – 100%) with CT signs of diverticulitis complained of severe abdominal pain: with localization in the left iliac and suprapubic areas of 22 (61%) patients, 2 (5.5%) – in the right iliac and suprapubic areas, the remaining 12 (33.5%) patients complained of abdominal pain without a clear localization. Localization of diverticulitis in the sigmoid colon occurred in 22 (61%) cases, in the descending part of the colon – in 13 (36%). In 1 (3%) observation diverticulitis was detected in the terminal part of the jejunum.The presence of perianth infiltrate took place – in 16 (44%) cases, with signs of abscedding – in 4 (11%), peritonitis was observed in 2 (5.5%) examined in combination with signs of intestinal obstruction. Perforation with the presence of a large amount of free gas was detected in 1 (3%) case, microperforation – in 12 (33.5%). A small amount of free fluid in the abdominal cavity was found in 18 (50%) patients. Conclusion. Timely diagnosis of complicated diverticular disease is crucial. MSCT has high sensitivity and specificity in the diagnosis of phlegmon and abscesses of the abdominal cavity, perforation of the intestinal wall, peritonitis, bleeding and intestinal obstruction.

scholarly journals STRANGULATION PREDICTION FACTORS IN CHILDREN WITH ADHESIVE INTESTINAL OBSTRUCTION

2020 ◽  
Vol 10 (4(38)) ◽  
pp. 41-45
Author(s):  
M. Melnychenko ◽  
A. Kvashnina
Keyword(s):  
Prognostic Value ◽  
Abdominal Cavity ◽  
Laboratory Data ◽  
Clinical Decision ◽  
Intestinal Wall ◽  
Free Fluid ◽  
Adhesive Small Bowel Obstruction ◽  
Intestinal Damage ◽  
Initial Examination ◽  
Ultrasound Monitoring

Introduction. Adhesive small bowel obstruction (ASBO) remains one of the leading causes of emergency surgery in children. According to various authors, the incidence of ASBO remains high (in 2-6% of children after abdominal surgery), despite the introduction of minimally invasive technologies and modern means of prevention.        Objective: To improve the treatment outcomes of patients with ASBO by identifying strangulation prediction factors to determine the indications for urgent surgery.        Material and methods. We have analyzed the prognostic value of clinical-anamnestic and paraclinical features in 89 children with ASBO which may be pathogenetically associated with the presence of strangulation. 75.3% of them (67 patients) had obstructive ASBO nature, and 24.7% (22) had strangulation. The analysis was performed using conjugation tables and Pearson's χ2 criteria. The connection was considered reliable at p <0,05.        Results. We have determined 8 signs which demonstrated the presence of a statistically significant connection with the strangulation nature of obstruction, among which the greatest prognostic value (p≤0.001) had positive peritoneal signs (χ2 = 15.256), free fluid in the abdominal cavity during ultrasound monitoring of the pelvis (χ2 = 13.777) and in the form of inter-loop effusion (χ2 = 6.473). From laboratory data it is necessary to pay attention to the existence of a hyperleukocytosis (52,6%). These signs, identified as a result of the study, can be obtained quickly and easily at the initial examination of a patient and allow to effectively assess the likelihood of strangulation obstruction and, accordingly, to assist in making a clinical decision.        Conclusion. For timely diagnosis of irreversible intestinal wall changes at strangulation obstruction, ultrasound examination of abdominal organs should be performed immediately upon treatment or hospitalization of a child with ASBO to avoid intestinal damage due to strangulation and development of peritonitis. The presence of 2 or more of the identified prognostic factors (89.5%) in children with ASBO means a "strong" connection with the presence of strangulation (PCC = 0.627), which can be considered as an indication for the urgent surgical treatment.

scholarly journals Method of selective resonance stimulation in the treatment of acute adhesive small bowel obstruction.

2018 ◽  
Vol 96 (4) ◽  
pp. 348-353
Author(s):  
V. I. Pikuza ◽  
O. Kh. Khalidov ◽  
Vladimir Sergeevich Fomin ◽  
V. N. Yakovenko ◽  
V. M. Fomina
Keyword(s):  
Intestinal Obstruction ◽  
Standard Therapy ◽  
Mean Value ◽  
Abdominal Pressure ◽  
Adhesive Small Bowel Obstruction ◽  
Peristaltic Activity ◽  
Group 2 ◽  
Adhesive Intestinal Obstruction ◽  
Stimulation Of ◽  
Group 1

Aim. Demonstration of the technique of resonant stimulation of peristaltic activity in patients with acute adhesive intestinal obstruction with the aim of correcting enteral insufficiency. Material and methods. The outcome of treatment of 46 patients with adhesive intestinal obstruction (2015-2016) is analyzed. The 1st group (21 patients - prospectively) and the 2nd group (25 patients - retrospectively) are fully commensurable. In the 2nd group - standard therapy. Patients of group 1 for the correction of enteral insufficiency, prevention of progression of intraperitoneal hypertension, stimulation of peristaltic activity, in addition to standard therapy, sessions of resonant stimulation were conducted. Results. By the end of the first session (about 70% of patients), and at the 2 nd session in group 1, responses of all stimulated departments were obtained, with synchronization of sensitivity and preservation of activity in background stimulation regimes. The maximum sensitivity increased to M110 ± 13 mcV. In the course of enterography, the passage to the distal ileum was 6.2 ± 2.1 hours in Group 1 and 8.1 ± 2.3 hours (p≤0.05) in Group 2. By the end of the second day of treatment, by all patients in 1 Group the transvesical-measured pressure was 5.8 ± 1.3 mm Hg, while the mean value of abdominal pressure in group 2 was 10.3 ± 3.9 mm Hg (р≤0,05), and 7 patients showed signs of grade 1 hypertension. Conclusion. These data allow us to look optimistically at the improvement of the results of surgical treatment of acute adhesive intestinal obstruction, avoiding excessive and sometimes vain surgical activity, reducing the risk of further trauma to the peritoneum and the formation of adhesions.

Pylorus-Preserving Pancreaticoduodenectomy: Evaluation of 50 Cases

2017 ◽  
Vol 13 (1) ◽  
pp. 42-45
Author(s):  
SM Shakhwat Hossain ◽  
Ferdous Rahman
Keyword(s):  
Gastric Emptying ◽  
Mortality Rate ◽  
Wound Infection ◽  
Postoperative Mortality ◽  
Operation Time ◽  
Armed Forces ◽  
Military Hospital ◽  
Morbidity Rate ◽  
Proper Patient Selection ◽  
Periampullary Neoplasms

Introduction: Pancreaticoduodenectomy is the procedure of choice for periampullary neoplasms. It is considered as a major surgical procedure. It is associated with relatively higher postoperative mortality and morbidity rate, however, with development of technology, proper patient selection, meticulous operative technique, appropriate postoperative care, morbidity and mortality rate has decreased subsequently. Up to the 1970s, the operative mortality rate after pancreaticoduodenectomy approached 20% but it has been reduced to less than 5% in recent reports. This study is designed to evaluate the postoperative outcomes of pylorus-preserving pancreaticoduodenectomy procedure in our set up. Objective: To evaluate the outcome of the pylorus-preserving pancreaticoduodenectomy procedure with the intention to measure operation time and per-operative bleeding, observing postoperative anastomotic leakage and gastric emptying time. To find out postoperative wound infection and complications to detect the dumping syndrome. Materials and Methods: A prospective observational study was carried out in the Department of Hepatobiliary Surgery, Combined Military Hospital, Dhaka from July 2013 to January 2017. Fifty patients who underwent pylorus-preserving pancreaticodudenectomy procedure were included in this study. Results: Out of 50 postoperative patients, 12(24%) patients developed complications. Of these patients, 3(6%) developed wound infection, 2(4%) developed bile leakage and 2(4%) developed postoperative haemorrhage. Pancreatic fistula, vomiting, delayed gastric emptying and abdominal collection all were 1(2%) each. Postoperative mortality was 3(6%). Conclusion: The present study demonstrated the development of postoperative complications after pylorus-preserving pancreaticoduodenectomy is as similar as published in different studies. Better outcome can be achieved with meticulous pre-operative evaluation of risk factors and per-operative skill maneuvering. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 42-45

scholarly journals NCOG-65. MR-GUIDED LASER INTERSTITIAL THERMAL THERAPY FOR BRAIN TUMORS IN GERIATRIC PATIENTS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii144-ii144
Author(s):  
Elizabeth Ginalis ◽  
Shabbar Danish
Keyword(s):  
Mortality Rate ◽  
Neurological Symptom ◽  
Geriatric Patients ◽  
Age Groups ◽  
Postoperative Mortality ◽  
Thermal Therapy ◽  
Partial Recovery ◽  
Intracranial Tumors ◽  
Laser Interstitial Thermal Therapy ◽  
Significant Difference

Abstract INTRODUCTION There is a paucity of studies assessing the use of magnetic resonance-guided laser interstitial thermal therapy (LITT) in the elderly population. METHODS Geriatric patients (≥65 years) treated with LITT for intracranial tumors at a single institution from January 2011 to November 2019 were retrospectively identified. We grouped patients into two cohorts: 65-74 years (group 1) and 75 years or older (group 2). Baseline characteristics, operative parameters, postoperative course, and morbidity were recorded. RESULTS There were 55 patients who underwent 64 distinct LITT procedures. The majority of tumors (62.5%) treated were recurrent brain metastasis/radiation necrosis. The median hospital length of stay was 1 day, with no significant difference between age groups. Hospital stay was significantly longer in patients who presented with a neurological symptom and in those who experienced a postoperative complication. The majority of patients (68.3%) were discharged to their preoperative accommodation. Rate of discharge to home was not significantly different between age groups. Those discharged to rehabilitation facilities were more likely to have presented with a neurological symptom. Nine patients (14.1%) were found to have acute neurological complications, with nearly all patients showing complete or partial recovery at follow-up. The 30-day postoperative mortality rate was 1.6% (n = 1). The complication and 30-day postoperative mortality rate were not significantly different between age groups. CONCLUSIONS LITT can be considered as a minimally invasive and safe neurosurgical procedure for treatment of intracranial tumors in geriatric patients. Careful preoperative preparation and postoperative care is essential as LITT is not without risk. Appropriate patient selection for cranial surgery is essential as neurosurgeons treat an increasing number of elderly patients, but advanced age alone should not exclude patients from LITT.

scholarly journals Mortality in Patients with Brainstem Cavernous Malformations

2021 ◽  
pp. 1-7
Author(s):  
Julia Velz ◽  
Marian Christoph Neidert ◽  
Yang Yang ◽  
Kevin Akeret ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Postoperative Mortality ◽  
Mortality Rates ◽  
Cavernous Malformations ◽  
Patient Cohort ◽  
Actual Risk ◽  
Single Center Study

<b><i>Objective:</i></b> Brainstem cavernous malformations (BSCM)-associated mortality has been reported up to 20% in patients managed conservatively, whereas postoperative mortality rates range from 0 to 1.9%. Our aim was to analyze the actual risk and causes of BSCM-associated mortality in patients managed conservatively and surgically based on our own patient cohort and a systematic literature review. <b><i>Methods:</i></b> Observational, retrospective single-center study encompassing all patients with BSCM that presented to our institution between 2006 and 2018. In addition, a systematic review was performed on all studies encompassing patients with BSCM managed conservatively and surgically. <b><i>Results:</i></b> Of 118 patients, 54 were treated conservatively (961.0 person years follow-up in total). No BSCM-associated mortality was observed in our conservatively as well as surgically managed patient cohort. Our systematic literature review and analysis revealed an overall BSCM-associated mortality rate of 2.3% (95% CI: 1.6–3.3) in 22 studies comprising 1,251 patients managed conservatively and of 1.3% (95% CI: 0.9–1.7) in 99 studies comprising 3,275 patients with BSCM treated surgically. <b><i>Conclusion:</i></b> The BSCM-associated mortality rate in patients managed conservatively is almost as low as in patients treated surgically and much lower than in frequently cited reports, most probably due to the good selection nowadays in regard to surgery.

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