scholarly journals Results Of Treatment Of Acute Diffuse Purulent Peritonitis Using Laparostomy

2020 ◽  
Vol 02 (11) ◽  
pp. 66-71
Author(s):  
S. A. Ruziboev ◽  
◽  
A. A. Avazov ◽  
Sh. Kh. Sattarov ◽  
A. N. Elmuradov ◽  
...  
Keyword(s):  
Bacterial Translocation ◽  
Abdominal Cavity ◽  
Multiple Organ ◽  
The Body ◽  
Abdominal Pressure ◽  
Results Of Treatment ◽  
Abdominal Hypertension ◽  
Purulent Peritonitis ◽  
Intractable Problems ◽  
Cause Of Deaths

Currently, despite significant achievements in the field of surgery, anesthesiology and resuscitation, the results of treatment of patients with advanced purulent peritonitis remain one of the most intractable problems, almost every sixth patient with acute surgical diseases and injuries of the abdominal cavity is admitted to medical institutions with peritonitis [1,3] Common peritonitis in 17-29% complicates the course of most acute surgical diseases and is the main cause of deaths in surgical hospitals [3,7]. Lethality in advanced peritonitis remains extremely high and reaches 20-39% [1,2,4,5]. In recent decades, great importance has been attached to recording intra-abdominal pressure in purulent pathology of the abdominal cavity. It was found that intra-abdominal hypertension occurs in every third patient with acute surgical pathology and negatively affects the functioning of all organs and systems of the body [1,6,8]. Pathological changes that occur with acute and excessive increase in intra-abdominal pressure (IAP) are manifestations of abdominal compartment syndrome (ACS) with disorders of the cardiovascular system; urinary disorders, disorders of perfusion of internal organs and the development of intestinal ischemia, which contributes to bacterial translocation and endogenous infection [2,7,8]. Ischemic blood flow disorders of the splanchnic zone are fraught with the development of bacterial translocation and the development of systemic inflammatory response syndrome and multiple organ failure (PON). Unsatisfactoriness with such results gave rise to a fundamentally different approach to the surgical treatment of common forms of peritonitis-the introduction of an open abdominal management method based on the ideas of I. Mikulich (1881), Jean-Louis Faure (1928), N. S. Makoch (1984) and D. Steinberg (1979).

scholarly journals Prediction of kidney damage in the syndrome of intra-abdominal hypertension

2018 ◽  
Vol 22 (4) ◽  
pp. 669-673
Author(s):  
A.I. Suchodolia ◽  
K.Yu. Krenov ◽  
I.V. Loboda ◽  
V.M. Monastyrskiy
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Perfusion Pressure ◽  
Blood Pressure Measurement ◽  
Abdominal Cavity ◽  
Multiple Organ ◽  
Intraabdominal Pressure ◽  
Abdominal Pressure ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

The syndrome of intra-abdominal hypertension and abdominal compartment syndrome can complicate the course of many surgical abdominal diseases and lead to the development and progression of multiple organ failure. In particular, impaired renal blood flow is an early and significant pathogenetic link of thanatogenesis in such patients. Mortality at an abdominal compartment syndrome reaches very significant figures — 42–68% and without treatment approaches 100%. The purpose of the work is to predict renal failure in patients with intra-abdominal hypertension syndrome and abdominal compartment syndrome. A survey of 40 patients with acute surgical abdominal pathology and signs of intra-abdominal hypertension was performed. Blood pressure measurement was performed according to the recommendations of the conciliation commission on the problem of intra-abdominal hypertension syndrome (SIGA) from 2004. Also, the calculation of perfusion pressure of the abdominal cavity was performed, which is the difference between mean arterial pressure and intraabdominal pressure. The level of perfusion pressure is less than 60 mm Hg. Art. correlates with survival of patients. Determination of cystatin C was performed in the first 48 hours after hospitalization of patients in VAIT. The calculation of the results was carried out according to the standard t-criterion calculation formulas in the Exel tables. It was found that of 40 patients died — 13, and survived — 27. The reliable difference between the indicators of intra-abdominal pressure in surviving and deceased patients was acquired only at the end of the third day of observation, whereas the abdominal perfusion pressure indices significantly differed already in the first day. In the analysis of cytatine C in surviving patients, the biomarker values were 1,299±0.827, whereas in those who died 1,882±0.828, the statistical deviation was significant at p≤0.05. Thus: the cytosine C score, in combination with the dynamics of abdominal perfusion tick, can be considered as a marker that may predict the development of renal insufficiency in patients with SIGA-AKS.

scholarly journals Change of Intestinal Microbiome in Patients with Coronavirus Infection

2021 ◽  
Vol 6 (5) ◽  
pp. 22-27
Author(s):  
M. M. Mishina ◽  
◽  
O. V. Kotsar ◽  
Pochernina M. H. ◽  
O. V. Kochnieva ◽  
...  
Keyword(s):  
Bacterial Translocation ◽  
Intestinal Barrier ◽  
Multiple Organ ◽  
Infection Process ◽  
The Body ◽  
Intestinal Microbiome ◽  
Intestinal Lumen ◽  
Treatment Regimens ◽  
Analysis And Synthesis ◽  
Coronavirus Infection

The purpose of the study was to analyze modern literature on the problems of dysbiosis in patients with COVID-19, to study the main mechanisms of systemic interaction between the intestine and lungs, as well as changes in the microbiota that occur under the influence of coronavirus infection. Materials and methods. A comprehensive selection of research methods was used for the work: systematization of the material, the method of generalization, methods of analysis and synthesis. Scientific works in the field of microbiology, epidemiology and infectious diseases were studied. Literature data for the last 2 years (2019-2021) were considered. The results of bacteriological studies from patients with COVID infection were described. The data obtained were processed using information-analytical and statistical-analytical methods. Results and discussion. As a result of this work, a complex of connections between intestine and lungs, which is called the "intestinal-lung axis", was considered. It is known that the interaction between these two biotopes occurs with the participation of microflora and its metabolites. Dysfunction of the intestinal barrier is accompanied by bacterial translocation. Bacteria from the intestinal lumen enter the liver through the portal vein system. The lymphatic pathway of bacterial translocation from the intestine to the lungs is also possible, which causes multiple organ failure syndrome in coronavirus infection. The COVID-19 virus is able to reduce the number of ACE2 receptors in the gastrointestinal tract, which leads to an imbalance in the intestines. At the same time, the infection process in the lungs promotes the growth of bacteria of the Enterobacteriacae family in the intestine, which also leads to dysbiotic disorders. The use of probiotics is an effective tool in the complex treatment of this infection, which facilitates the general condition of patients. In the course of treatment, it is important not only to eliminate the virus from the body, but also to restore normal intestinal microbiota after an infection. Conclusion. Thus, the use of probiotic drugs for the treatment of patients with coronavirus infection can significantly reduce the risk of developing dysbiosis and improve the condition of patients. A perspective direction is the development of new treatment regimens for dysbiotic conditions using probiotics, eubiotics, synbiotics and postbiotics to prevent the development of severe complications in COVID infection

scholarly journals The Results of Duodenum-Preserving Resections of the Pancreas in Chronic Pancreatitis Using the Technology of Sealing the Pancreatic-Intestinal Anastomosis

2019 ◽  
Vol 4 (2) ◽  
pp. 122-126
Author(s):  
V. G. Lubyanskiy ◽  
V. V. Seroshtanov
Keyword(s):  
Chronic Pancreatitis ◽  
Intestinal Anastomosis ◽  
Abdominal Cavity ◽  
Main Group ◽  
Control Group ◽  
Cervical Anastomosis ◽  
Pancreatic Anastomosis ◽  
Drainage Fluid ◽  
Results Of Treatment ◽  
Cause Of Deaths

Background. The problem of chronic pancreatitis in recent years is acute, primarily due to the occurrence of complications and pain that forces you to turn to a surgeon. The main cause of deaths is the failure of the pancreatic anastomosis and the occurrence of bleeding into the cavity of the pancreatic intestinal anastomosis (40 %).Aims: to improve the results of duodenum-preserving resections by introducing the technology of sealing the pancreaticintestinal anastomosis.Materials and methods. The clinic operated 225 patients with chronic pancreatitis. All patients before the operation and in the postoperative period were carried out clinical and biochemical studies, the Frey operation was performed. Patients were divided into two groups. The first group, the group of comparison, included 184 (81.8 %) patients with pancreatoenteroanastomosis formed without additional sealing methods. The second group – the main one – consisted of 41 (18.2 %)patients in which the suture of the pancreatic anastomosis was strengthened with an adhesive composite or with the loop of the small intestine.Results. After the surgery, complications in the control group were recorded in 19 (8.4 %) patients: failure – in 6 (3 %), bleeding into the lumen of pancreatoenteroanastomosis – in 9 (4 %), mortality was 1.8 % (4 persons). There were no complications in the main group. The analysis of the amylase content in the drainage fluid revealed high values in the control group on the 3rd day – 916 ± 15 U/l, in comparison with the main group – 437 ± 16 U/l (p < 0.05). The data obtained indicate that the cause of insolvency of the pancreatic-intestinal anastomosis is the penetration of enzymes through the pancreatic-cervical anastomosis zone into the abdominal cavity. When analyzing the results, it turned out that the failure of the pancreatic-intestinal anastomosis was not detected in any case in patients with sealing.Conclusion. The escape of enzymes destroys the tightness of the superimposed fistula and is characterized by an increase in the level of amylase in the drainage fluid. The proposed sealing technologies decrease the number of postoperative complications and improve the results of treatment.

scholarly journals The Role of Presepsin in Patients with Acute Surgical Diseases

2019 ◽  
Vol 7 (8) ◽  
pp. 1282-1286
Author(s):  
Miras Mugazov ◽  
Yermek Turgunov ◽  
Dinar Kaliyeva ◽  
Dmitriy Matyushko ◽  
Zhandos Koishibayev ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Bacterial Flora ◽  
Abdominal Cavity ◽  
Bladder Tumour ◽  
Abdominal Pressure ◽  
Normative Documents ◽  
Abdominal Hypertension ◽  
Prothrombin Index ◽  
The Republic ◽  
Critical Patients

AIM: The purpose of this study was to determine the level of significance of markers in the development of intra-abdominal hypertension in patients with acute surgical diseases of the abdominal cavity. METHODS: The authors surveyed 100 patients who were monitored at the Regional Clinical Hospital, Karaganda. The criterion for inclusion in the study was the informed consent of patients to participate in the study, the presence of acute surgical pathology, and the monitoring of intra-abdominal pressure over time. The exclusion criteria for patients from the study is the presence of sub and decompensation of associated diseases: trauma (hematoma of the bladder), bladder tumour and impaired integrity of the pelvic ring. The design of the study was by the legislation of the Republic of Kazakhstan, international ethical norms and normative documents of research organizations, approved by the ethics committee of the Karaganda State Medical University. RESULTS: According to the world scientific literature, there are 4 indicators that change their value in response to increases in pressure in the abdominal cavity: fibrinogen and prothrombin index (the main indicators of the coagulogram); marker of blood clots D-dimer; early marker of translocation of bacterial flora into the bloodstream sCD14 (presepsin). CONCLUSION: The authors concluded that the obtained data indicate that an increase in intra-abdominal pressure in acute surgical diseases of the abdominal cavity causes hypercoagulation and an increase in presepsin. Monitoring IAP with simultaneous measurement of the level of presepsin significantly improves the stratification of critical patients in need of emergency surgery.

scholarly journals Effect of intra-abdominal hypertension on the strength of the postoperative scar of a laparotomic wound

2020 ◽  
Vol 24 (2) ◽  
pp. 223-226
Author(s):  
I. K. Morar
Keyword(s):  
Mechanical Strength ◽  
Negative Impact ◽  
Abdominal Cavity ◽  
Study Groups ◽  
Laboratory Animals ◽  
Abdominal Pressure ◽  
Abdominal Hypertension ◽  
Laparotomy Wound ◽  
The Impact ◽  
Postoperative Scar

Annotation. One of the main factors of postoperative eventration is intra-abdominal hypertension, which occurs in various surgical pathologies of the abdominal cavity. Despite the presence of a large number of scientific papers on the negative effect of intra-abdominal hypertension on the morphological state of granulation tissue in the area of the laparotomy wound, there are no publications on the impact on the strength of the postoperative scar. Therefore, the study aimed to investigate in an experiment on small laboratory animals the effect of intra-abdominal hypertension on the mechanical strength of the postoperative scar of a laparotomy wound. The experiment was performed on 120 laboratory rats, which underwent a median laparotomy and brought together the edges of the musculoaponeurotic layer of the anterior abdominal wall with simple nodal sutures. The main group consisted of 72 animals who developed intra-abdominal hypertension by inserting a container (condom) with a certain amount of Furacilin into the abdominal cavity. The comparison group consisted of 48 animals who had an empty condom inserted into the abdominal cavity after laparotomy. The mechanical strength of the postoperative scar of the laparotomy wound was determined by the method of G. V. Petrovich (2010) on the 1st, 3rd, and 5th day after the creation of intra-abdominal hypertension, by measuring the level of intra-abdominal pressure at the time of rupture of the postoperative scar of the laparotomy wound. Statistical analysis of the results was performed using Microsoft Excel spreadsheets and a package of statistical processing software PAST. Differences between study groups were determined using Mann-Whitney criteria. The results of the study indicate that the created intra-abdominal hypertension leads to a decrease in the mechanical strength of the postoperative scar of the laparotomy wound. The degree of the negative impact of intra-abdominal hypertension on the strength of the postoperative scar is inversely proportional to the level of intra-abdominal pressure.

scholarly journals INTRAABDOMINAL HYPERTENSION SYNDROME: CURRENT STATE OF THE PROBLEM

2020 ◽  
pp. 35-42
Author(s):  
V. A. Samartsev ◽  
V. A. Gavrilov ◽  
B. S. Pushkarev
Keyword(s):  
Abdominal Cavity ◽  
Abdominal Pressure ◽  
Current Trends ◽  
Current State ◽  
Abdominal Hypertension ◽  
Practical Research ◽  
Intraabdominal Hypertension ◽  
Therapeutic Measures ◽  
Methods Of Treatment ◽  
Extensive Surgery

Syndrome of intra-abdominal hypertension (SIAH) is a dangerous complication that can occur in patients with a surgical profile after surgery in the abdominal cavity. Only in the past 25 years has the SIAH been recognized. According to W. Ertel et al., In one third of patients with peritonitis, pancreatic necrosis, injuries of the abdominal cavity and after extensive surgery, there is an increase in intra-abdominal pressure (IAP), while SIAH develops in 5.5% of such patients. Mortality in SIAH is 42–68%. The reason for the development of so many deaths is the presence of diagnostic, preventive and therapeutic measures, as well as differences in the interpretation of terms. Today, much attention is paid to the study of SIAH, official attempts are being made to standardize and define terms and recommended methods of treatment, but this problem needs further study. The review presents data on the current state of the problem, current trends in the diagnosis, prevention and treatment of patients with IAP and SIAH, their use in practical research.

scholarly journals SANITATION OF THE ABDOMINAL CAVITY IN WIDESPREAD PERITONITIS

2020 ◽  
pp. 37-42
Author(s):  
V. N. Lykhman ◽  
A. N. Shevchenko ◽  
A. O. Merkulov ◽  
D. A. Myroshnychenko ◽  
S. V. Tkach ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Postoperative Period ◽  
Absolute Risk ◽  
Multiorgan Failure ◽  
Abdominal Cavity ◽  
Average Degree ◽  
Average Weight ◽  
Results Of Treatment ◽  
Dialysis Solution ◽  
Purulent Peritonitis

Summary. Purpose. Study of the effectiveness of permanent transmembrane peritoneal dialysis in “semi-closed” management of the abdominal cavity (BP) in patients with advanced purulent peritonitis (APP). Materials and methods. The results of treatment of 63 patients with APP with “semi-closed” administration in the abdominal cavity (BP) were analyzed. Depending on the features of BP drainage, patients with RGP were divided into two groups: comparison group (CG) — 31 patients who used traditional methods of abdominal drainage and the main group (MG) — 32 patients who underwent permanent peritoneal surgery in the postoperative period. dialysis through an artificial semipermeable membrane. Results and discussion. A study of the relationship between the levels of molecules of average weight in spent dialysis solution with the severity of multiorgan failure (MF) on the SOFA scale using Spearman’s correlation analysis revealed an average degree of correlation: 1 day after surgery - r = 0.63 (p = 0.01), for 3 days — r = 0.75 (p = 0.001). The average degree of correlation between these indicators can be explained by the fact that in addition to endotoxicosis, the severity of MF in the next day after surgery also affects surgery. This is also confirmed by the increase in the correlation coefficient by 3 days, when the degree of influence of the operating aid on the severity of MF decreases. The postoperative period was complicated in 14 (22.2 ± 5.2 %) patients with APP: in CG in 10 (32.3 ± 8.4 %) cases in MG - in 4 (12.5 ± 5.8 %) p = 0.059). Mortality of patients with APP at “semi-closed” management of an abdominal cavity made 19,0 ± 4,9 %: in MG — (25,8 ± 7,9) %, in MG — (12,5 ± 5,8) % (p = 0,179). Conclusions. The proposed method of peritoneal dialysis reduced the absolute risk of postoperative complications in patients with advanced purulent peritonitis by 19.8 %.

scholarly journals Diagnosis and treatment of destructive forms of acute pancreatitis

2019 ◽  
Vol 41 part 1 (2) ◽  
pp. 65-70
Author(s):  
V. V. Mishchenko ◽  
V. V. Hrubnyk ◽  
P. I. Pustovoyt ◽  
V. V. Horyachyy ◽  
V. V. Velychko ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Cavity ◽  
Secretory Activity ◽  
Multiple Organ ◽  
Diagnosis And Treatment ◽  
Infusion Therapy ◽  
Surgical Interventions ◽  
Purulent Peritonitis ◽  
Peridural Anesthesia ◽  
Complete Cell

Purpose of the study. The study of the diagnosis and treatment of destructive forms of acute pancreatitis and the identification of possible ways to optimize them. Materials and methods. Destructive forms of acute pancreatitis were found in 16,8%. The algorithm for treating acute destructive pancreatitis consisted in artificial ventilation of the lungs, adequate infusion therapy, peridural anesthesia, setting up a nasoenteric probe, stimulating the bowels, correcting hemodynamics, intra- and extracorporal detoxification, antisecretory, anti-bacterial, hepatoprotective, cerebroprotective, antioxidant therapy, directed immune correction, use of anti-enzyme drugs, suppression of the release of mediators inflammation, external secretory activity of the pancreas. Medical video laparoscopy and puncture interventions under the control of ultrasound were used as the first stage of surgical treatment. The indications for traditional surgical interventions are large areas of aseptic destruction, unlimited infected pancreatic necrosis, infection of necrotic areas with complete cell sequestration, abscesses with large sequesters, abdominal phlegmon, signs of progressive multiple organ failure and the development of arousal hemorrhage, perforation of cystic formations in the abdominal cavity, perforation of a hollow organ, purulent peritonitis. Results. The developed therapeutic tactics allowed, in destructive forms of acute pancreatitis, to achieve a reduction in overall mortality to 23,4%. Conclusion. Diagnostic and treatment tactics for destructive forms of acute pancreatitis should be standardized depending on the timing, severity of the disease, localization and prevalence of the destructive process, systemic and local complications. Keywords: acute, destructive, pancreatitis, diagnosis, treatment.

scholarly journals Case report of a giant inguinal hernia causing intestinal obstruction

2021 ◽  
Vol 8 (8) ◽  
pp. 2463
Author(s):  
R. Sanjay ◽  
Farukh Khan ◽  
Shalu Gupta ◽  
Prashant . ◽  
Akash .
Keyword(s):  
Inguinal Hernia ◽  
Abdominal Cavity ◽  
Standing Position ◽  
Abdominal Pressure ◽  
Hernia Sac ◽  
Modern Times ◽  
The Past ◽  
Abdominal Hypertension ◽  
History Of ◽  
Abdominal Compartment

Inguinal hernia is one of the ancient diseases that haunted the humanity from its very beginning to the modern times. Giant inguinal hernia is defined as an inguinal hernia that extends below the midpoint of inner thigh when the patient is in standing position. A 43 years old healthy male was affected by long standing, progressively enlarging right sided inguinal hernia for the past 21 years. His symptoms of abdominal discomfort and pain in lower abdomen after meal had worsened over time and he had lost 13 kg of weight in past 2 years. He had difficulty in micturition and gave history of constipation. Giant inguinal hernia is a type of hernia with massive contents inside the hernia sac and limited domain of abdominal cavity. The surgeon’s decision regarding the prevention of intra-abdominal hypertension is a crucial stage of overall management. Giant inguinal hernia is a very rare. It is defined as hernia sac extending below mid inner thigh in the standing position. Surgical repair is very challenging and has significant morbidity and mortality due to increased intra-abdominal pressure and abdominal compartment syndrome.

The IN-PANCIA Study: Clinical Evaluation of Gastrointestinal Dysfunction and Failure, Multiple Organ Failure, and Levels of Citrulline in Critically Ill Patients

2017 ◽  
Vol 35 (3) ◽  
pp. 279-283 ◽  
Author(s):  
Nazzareno Fagoni ◽  
Simone Piva ◽  
Rosella Marino ◽  
Giovanni Chiarini ◽  
Daniela Ferrari ◽  
...  
Keyword(s):  
Multiple Organ Failure ◽  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bowel Dysfunction ◽  
Multiple Organ ◽  
Abdominal Pressure ◽  
Gastrointestinal Dysfunction ◽  
Abdominal Hypertension ◽  
Patient Groups

Purpose: Gastrointestinal dysfunction and failure (GID and GIF) in critically ill patients are a common, relevant, and underestimated complications in ICU patients. The aims of this study were (1) to determine plasmatic levels of citrulline, glutamine, and arginine as markers of GID/GIF in critically ill patients with or without GID/GIF with or without multiple organ failure (MOF) and (2) to assess the role of intra-abdominal hypertension in these patient groups. Materials and Methods: This is a 1-year, monocentric (Italian hospital), prospective observational study. Inclusion criteria were adult patients with GID/GIF, with or without MOF. The GIF score was daily evaluated in 39 critically ill patients. Amino acids were measured at the time of GID or GIF. Results: We enrolled 39 patients. Nine patients developed GID and 7 GIF; 6 of patients with GID/GIF developed MOF. Citrulline was lower ( P < .001) in patients with GID/GIF (11.3 [4.4] µmol/L), compared to patients without GID/GIF (22.4 [6.8] µmol/L); likewise, glutamine was lower in patients with GID/GIF, whereas arginine was nonstatistically different between the 2 groups. Intra-abdominal pressure was higher in patients affected by MOF (13.0 [2.2] mm Hg) than in patients with GIF/GID without MOF (9.6 [2.6] mm Hg) and compared to patients without GID/GIF (7.2 [2.1] mm Hg). Conclusions: Both GID and GIF in critically ill patients are associated with low levels of citrulline and glutamine, which could be considered as markers of small bowel dysfunction. The higher the GIF score, the lower the citrulline levels. Patients affected by MOF had higher levels of intra-abdominal pressure.

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