FEATURES OF DIAGNOSIS AND TREATMENT OF ELDERLY AND SENILE PATIENTS WITH ADHESIVE SMALL BOWEL OBSTRUCTION

Спаечная тонкокишечная непроходимость является часто встречающейся патологией с тенденцией к нарастанию, характеризуется сложным патогенетическим течением, с высоким процентным соотношением осложнений и летальных исходов. Среди форм кишечной непроходимости, обусловленных механическим препятствием, острая тонкокишечная непроходимость составляет 64,3-80 % с летальностью 5,1-8,4 % в структуре ургентных заболеваний. Сложность ранней диагностики наряду со стертой клинической картиной, тяжелым течением на отягощенном фоне у лиц пожилого и старческого возраста ведет к поиску новых оптимизированных лечебнодиагностических протоколов. Цель исследования - изучение характера течения спаечной тонкокишечной непроходимости у лиц пожилого и старческого возраста, установление информативности различных методов диагностики, определение показаний к выбору оптимального срока и метода лечения. Проведен сравнительный анализ по результатам лечения 191 пациента 60-90 лет и старше, получавших лечение в хирургических отделениях Елизаветинской больницы (Санкт-Петербург) в период 2016-2019 гг. Все пациенты были разделены на две группы: основную составили 106 пациентов (2018-2019 гг.), группу сравнения - 85 пациентов (2016-2017 гг.). Для всех пациентов основной группы использован усовершенствованный лечебно-диагностический алгоритм с применением оригинальной балльно-оценочной шкалы, который позволил оптимизировать диагностику и улучшить результаты лечения. Пациенты группы сравнения были обследованы в соответствии со стандартными протоколами, оперативное лечение осуществляли исключительно традиционными методами. Применение предложенного лечебно-диагностического алгоритма позволило увеличить вероятность консервативного разрешения острой спаечной тонкокишечной непроходимости с 20 % (17) до 33 % (35), снизить частоту послеоперационных осложнений с 60,2 % (41) до 25,3 % (18), р<0,01, а уровень летальности - с 23,5 % (16) до 7 % (5), р<0,05. Adhesive small bowel obstruction is a common pathology with a tendency to increase characterized by a complex pathogenetic course with a high percentage of complications and deaths. Among the forms of intestinal obstruction caused by mechanical obstacles acute small bowel obstruction ranges from 64,3 to 80 % with a mortality rate of 5,1 to 8,4 % in the structure of urgent diseases. The complexity of early diagnosis along with an erased clinical picture severe course against a burdened background as well as age - in elderly and senile people leads to the search for new optimized treatment and diagnostic protocols. The purpose of this study was to study the nature of the course of adhesive small bowel obstruction in elderly and senile people to establish the information content of various diagnostic methods to determine the indications for the choice of the optimal period and method of treatment. A comparative analysis of 191 patients aged 60 to 90 years and older who received treatment in the surgical departments of St. Elizabeth Hospital (St. Petersburg) in the period from 2016-2019 was carried out. All patients were divided into 2 groups: the main group consisted of 106 patients (2018-2019) the comparison group included 85 patients (2016-2017). All patients of the main group used an improved diagnostic and treatment algorithm with the use of an original point-assessment scale which made it possible to optimize diagnostics and improve treatment results. Patients in the comparison group were examined in accordance with standard protocols and surgical treatment was carried out exclusively by traditional methods. The use of the proposed therapeutic and diagnostic algorithm made it possible to increase the probability of conservative resolution of acute adhesive small bowel obstruction from 20 % (17) to 33 % (35) and to reduce the incidence of postoperative complications from 60,2 % (41) to 25,3 % (18), p<0,01, and the mortality rate from 23,5 % (16) to 7 % (5), p<0,05.

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Modern aspects of surgical treatment of patients with adhesive small bowel obstruction

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

10.17816/mechnikov49895 ◽

2021 ◽

Vol 12 (4) ◽

pp. 47-54

Author(s):

Badri V. Sigua ◽

Vyacheslav P. Zemlyanoy ◽

Sergey V. Petrov ◽

Diyora H. Qalandarova

Keyword(s):

Small Intestine ◽

Surgical Treatment ◽

Small Bowel ◽

Mortality Rate ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Diagnostic Algorithm ◽

Diagnostic Methods ◽

Adhesive Small Bowel Obstruction ◽

Surgical Interventions

Despite the ongoing preventive measures aimed at reducing the formation of adhesions in the abdominal cavity with an increase in the number of surgical interventions on the abdominal organs, the number of patients admitted to surgical hospitals with adhesions of the small intestine is also increasing. It should be noted that annually about 12% of previously operated patients undergo treatment in surgical departments while the exceptional fact is that 5070% are patients with acute adhesive ileus of the small intestine and the mortality rate in this group ranges from 13 to 55%. In recent years the literature has been actively discussing the advantages of minimally invasive technologies in the treatment of adhesive small bowel obstruction since the use of traditional methods often leads to the development of complications with repeated (in 60% of cases) surgical interventions. The purpose of this study was the development and implementation of an improved therapeutic and diagnostic algorithm in patients with adhesive small bowel obstruction which made it possible to improve the results of treatment. A comparative analysis of 338 patients with adhesive small bowel obstruction who were treated in the surgical departments of the St. Elizabeth Hospital in St. Petersburg in the period from 2016-2019 was carried out. All the patients were divided into 2 groups: the main (I) group (2018-2019), which consisted of 198 patients who received the improved diagnostic and treatment algorithm as well as the comparison group (II) (2016-2017) which included 140 cases these are patients examined according to the standard protocol and operated on in the traditional way. Moreover, in 98 cases, it was possible to resolve acute adhesive small intestinal obstruction in a conservative way, and 240 patients underwent surgical treatment. The developed diagnostic algorithm is based on the consistent application of the most informative diagnostic methods. At the same time the indications and the sequence of their application were established which ultimately made it possible to shorten the preoperative time interval as well as to determine the optimal treatment strategy with the choice of the type of surgical treatment (laparotomy or laparoscopy). The proposed treatment and diagnostic algorithm allowed to reduce the complication rate from 46.5% (53) to 22.2% (28) (р 0,001), and the mortality rate from 14.9% (17) to 3.9% (5) (p 0,01).

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Value of the ultrasound research in the diagnostic of acute strangulated small bowel obstruction

Medical Visualization ◽

10.24835/1607-0763-875 ◽

2021 ◽

Vol 25 (3) ◽

pp. 31-42

Author(s):

N. V. Shavrina ◽

P. A. Yartsev ◽

A. G. Lebedev ◽

V. D. Levitsky ◽

M. N. Drаyer ◽

...

Keyword(s):

Blood Flow ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Intestinal Ischemia ◽

Comparison Group ◽

Abdominal Cavity ◽

Intestinal Wall ◽

Adhesive Small Bowel Obstruction ◽

Intestinal Necrosis

Purpose. To identify and evaluate the effectiveness of sonographic signs of intestinal ischemia in patients with strangulated small bowel obstruction.Materials and methods. For the period 2017–2019, 115 patients with SIO were treated at the N.V. Sklifosovsky Federal Research Institute of Emergency Medicine. There were 64 women (55.6%) and 51 men (44.4%). The mean age was 62 ± 15 years. In all patients, the diagnosis was verified intraoperatively. All patients underwent ultrasound examination of the abdominal cavity in B-mode with the assessment of blood flow of the intestinal wall in the mode of CDI. Patients were divided on the basis of intraoperative data into 2 groups. The first group: 63 (54.8%) patients with signs of ischemia of the strangulated loop of the intestine. The second group consisted of 21 (18.1%) patients in whom intestinal necrosis was detected. The comparison group included 31 (26.7%) patients with adhesive small bowel obstruction without intestinal strangulation.Results. The most informative signs of ischemia of the strangulated intestine of the loop are infiltrative changes of its mesentery. In the second and third groups 9 (14.3%) and 12 (57.1%) participants, respectively, showed severity of intestinal ischemia, compared with 1 participant (3.2%) in the first group. The next informative criterion is the thickening of more than 0.4 cm and edema of the intestinal wall. In the second and third groups 30 (47.6%) and 14 (66.6%), in the comparison group 4 (12.9%), akinesis of the strangulated loop and paresis of the entire small intestine also directly correlated with intestinal ischemia. The absence of differentiation of intestinal wall layers occurs in (23.8%), the absence of blood flow in the intestinal wall in the CDI mode (19%), gas inclusions in the intestinal wall (4.3%).Conclusion. The assessment of sonographic symptoms allows to diagnose the presence of ischemic changes in the intestinal wall and perform surgery before the development of necrosis in the early period. In cases of late admission of the patient to the hospital, with the onset of intestinal necrosis and the associated erased clinical picture, ultrasound allows to establish indications for surgery before the development of peritonitis.

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Acute adhesive small-bowel obstruction: laparotomy or laparoscopy

Kazan medical journal ◽

10.17816/kmj2018-508 ◽

2018 ◽

Vol 99 (3) ◽

pp. 508-514

Author(s):

I S Malkov ◽

E B Bagautdinov ◽

I F Sharafislamov ◽

S R Zogot ◽

Dz Kh Misiev

Keyword(s):

Computed Tomography ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Diagnostic Methods ◽

Abdominal Pressure ◽

Adhesive Small Bowel Obstruction ◽

Diffuse Peritonitis ◽

Laparoscopic Adhesiolysis ◽

Radiological Methods

Aim. To determine the capabilities of complex preoperative examination of patients with acute adhesive small-bowel obstruction for the choice of the method of surgical treatment. Methods. The diagnostic significance was studied for clinical and radiological methods in assessment of the prevalence of adhesive process in the abdominal cavity in 354 patients with acute adhesive small-bowel obstruction. Patients were divided into two groups: (1) a comparison group of 204 subjects examined by the standard protocol without the use of computed tomography and ultrasound without mapping of adhesions operated by an open procedure, and (2) the study group of 150 patients who underwent the modified diagnostic algorithm and laparoscopic adhesiolysis. To clearly understand the spread of adhesive process, on ultrasound examination the anterior abdominal wall was divided into four sectors. The severity of pathological process was assessed by enteral index and intra-abdominal pressure reflecting the degree of morphofunctional disorders. Results. The highest sensitivity (92%) among diagnostic methods was observed for X-ray contrast-enhanced computed tomography. The objective severity criteria for the patients with acute adhesive small-bowel obstruction are enteral index, intra-abdominal pressure, signs of diffuse peritonitis. The developed complex diagnostic program, presented in the form of an algorithm, was of decisive importance for the choice of the method of surgical intervention (laparotomy or laparoscopy). Conclusion. The optimal treatment option for patients with acute adhesive small-bowel obstruction is laparoscopic adhesiolysis, which should be regulated by the severity of the patient's condition and spread of the adhesion process; to determine the spread of adhesive process, a complex diagnostic program should be used, in which radiological methods take the lead.

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Adhesive Small Bowel Obstruction Protocol in Geriatric Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.200 ◽

2019 ◽

Vol 229 (4) ◽

pp. S87

Author(s):

Jose A. Aldana ◽

Javier E. Rincon ◽

Ricardo A. Fonseca ◽

Rohit K. Rasane ◽

Christina X. Zhang ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Geriatric Patients ◽

Adhesive Small Bowel Obstruction

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Sex differences in non‐strangulated postoperative adhesive small bowel obstruction: A retrospective cohort study

ANZ Journal of Surgery ◽

10.1111/ans.17103 ◽

2021 ◽

Author(s):

Yuta Yamamoto ◽

Yusuke Miyagawa ◽

Masato Kitazawa ◽

Makoto Koyama ◽

Satoshi Nakamura ◽

...

Keyword(s):

Sex Differences ◽

Cohort Study ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Adhesive Small Bowel Obstruction

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Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

Scandinavian Journal of Surgery ◽

10.1177/1457496920982763 ◽

2021 ◽

pp. 145749692098276

Author(s):

M. Podda ◽

M. Khan ◽

S. Di Saverio

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Conservative Management ◽

Bowel Ischemia ◽

Current Evidence ◽

First Episode ◽

Adhesive Small Bowel Obstruction ◽

Highly Effective

Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies. Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction. Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8–24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries. Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.

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