Rectal stump mucocele after a Hartmann’s procedure causing mechanical ileus

Two years after a Hartmann’s procedure, an 85-year-old woman was admitted at our emergency department with abdominal bloating and severe constipation for 5 days. Abdominal CT showed a large rectal stump mucocele associated with compression of surrounding structures, causing a mechanical ileus and a bilateral pyelocaliceal dilatation. Successful transanal drainage with a rectal catheter allowed rapid recovery.

Intestine wall histostructure peculiarities with peritonitis and mechanical intestine obstruction (experimental study)

Today, the histological criteria for differential diagnosis of dynamic ileus due to peritonitis and mechanical obstruction of the intestine remain undeveloped. In this regard, the aim of the work was to establish the difference in morphological changes occurring in the intestinal wall during dynamic and mechanical ileus in the experiment. The experiment was conducted on 33 sexually mature Wistar rats. In 15 animals of the first group, mechanical ileus was modeled by ligation of the lumen of the small intestine at the middle of the distance between the duodenojejunal junction and the ileocecal angle. In 15 rats of the second group, a dynamic ileus model was formed in the form of peritonitis by introducing fecal suspension into the lumen of the abdominal cavity. The control group included 3 animals who underwent laparotomy without the formation of mechanical ileus and peritonitis. For histological examination, fragments of the intestinal wall were sampled 1 cm above the site of the obstruction with mechanical ileus and the portion of the small intestine with peritonitis. Statistical processing was performed in an Excel package using parametric statistics methods. It was stated that with mechanical ileus purulent inflammation develops in the intestine wall beginning from the mucous membrane spreading over wall thickness which can cause its destruction within 48 hours; with dynamical ileus purulent inflammation develops in the intestine wall, it captures particularly serous and muscle layers without causing violations of mucosa cover structure and without intestine wall destruction within 48 hours. Under experimental dynamic ileus, changes in the mucous membrane were reactive in nature and consisted of manifestations of compensatory-adaptive and regenerative processes in response to a violation of the trophism of various structures of the intestinal wall.

Studying of capacity of the inflamed intestinal wall to accumulate tienam preparation in experiment

Objective. Using experimental pattern of mechanical ileus, to study the capacity of nonchanged and inflamed intestine to accumulate a tienam preparation. Materials and methods. The experiment was conducted on 60 laboratory animals in two stages. On the first stage the content of tienam in the blood, parenchymatous organs and in the nonchanged intestinal wall was determined. On the second stage the content of the tienam components was determined in the blood, parenchymatous organs and in the wall of inflamed suprastenotic part of intestine. In both series the preparation was injected intravenously in accordance to scheme, calculated for the animals body mass. The quantity of tienam preparation in the investigated material was determined, using the method of a highly effective liquid chomatography. Results. The experimental investigation conducted have shown, that the tienam preparation components in nonoperated animals are accumulated in therapeutic doses in the blood, liver and kidneys. In the animals, in whom mechanical ileus was simulated, he tienam components were revealed only in parenchymatous organs and in the blood. In the inflamed intestinal wall the tienam components were not revealed even while injection of a dose, prevailing a middle therapeutic one in 2.5 times. Conclusion. Imipenem and cilastatin, which are included into tienam preparation, while secondary injections in a dose, prevailing a middle therapeutic one in 2.5 times, were not revealed in the wall of the inflamed intestine in experimental mechanical ileus.

A large superior mesenteric artery aneurysm and ileal obstruction: a rare presentation of polyarteritis nodosa in an infant

Polyarteritis nodosa (PAN) is a rare form of vasculitis that occurs in childhood and affects small- and medium-sized arteries. Large aneurysms due to PAN can induce fatal complications like rupturing or occlusion of the affected arteries. Here, we report a case of a 4-month-old girl with PAN complicated by a large superior mesenteric artery aneurysm and ileal obstruction. We controlled her blood pressure to prevent the artery from rupturing. A combination of prednisolone, intravenous cyclophosphamide, and plasma exchange reduced the inflammation. She developed mechanical ileus due to ileum stricture and underwent bowel resection. Histopathological examinations revealed reparative arteritis around the healed ulcer. Her postoperative course was uneventful without further dilatation of the aneurysm. This case highlights the importance of intensive immunosuppressive therapy and appropriate blood pressure control in pediatric patients with PAN complicated by large aneurysms. Mechanical ileus can develop and may require surgical management even after remission of vasculitis.

One-Layer Sutures in Abdominal Cavity Surgery

The aim of our study was to evaluate of short-term outcomes of 4210 patients underwent open abdominal open surgery with used either single absorbable or continuous layer sutures. Anastomosis were made by seromuscolar layer without mucosa. Fluid therapy: GDT and zero-balance GDT was also discussed. Anastomosis leakage developed in 6 patients. They were treated by creating the stomia. Septic shoc was treated in the same time. Re-anastomosis were made in delayed time. Re-anastomosis was performer after septic shoc treatment. Results of treatment with use of two-layer sutures, which was used before 1978. Analysis of 536 patients treated in the same time, in this group 53 patients developed anastomosis leakage. In this group 2 patients survived. The mode of anastomosis in the literature review was discussed. Attention was payed on advantage one-layer sutures under multi-layer sutures: Effectivness, simplicity and lower cost of treatment. Mechanical ileus was rarely observed since ceasing peritonisation abdominal cavity and softening after-operative course with patients with preoperative prepered intestinal track. Post-operetive complications were discussed. TC and MRI were the main tests of diagnosis of post-operetive complications. The main attention was focused on medical observation and clinical examination by experienced surger In order to serach post-operative complications. Antybiotic treatment in post-operation complications was presented and fluid therapy: GDT, zero-balance GDT and medical treatment of complication, such as: anastomosis leakage, mechanical ileus, inter-peritoneal abscess. Anastomotic stenosis was not observed in this group of patients.