Acute obstruction of the small intestine. Controversial and unresolved issues of the digestive decompression in the light of successes and failures of surgical treatment

Authors

  • I. Ya. Dziubanovskyi I. Horbachevsky Ternopil National Medical University
  • V. V. Benedykt I. Horbachevsky Ternopil National Medical University
  • V. Ya. Danchak Department of Health and Medical Supply of Ternopil City Council
  • A. M. Prodan I. Horbachevsky Ternopil National Medical University

DOI:

https://doi.org/10.11603/2414-4533.2020.1.10750

Keywords:

acute small intestine obstruction, decompression methods

Abstract

The aim of the work: to improve the results of surgical treatment of patients with acute obstruction of the small intestine (AOSI) by identifying indications for the implementation of various methods of decompression of the digestive canal and improving its known methods.

Materials and Methods. 221 patients with AOSI were examined, who were divided into four groups: 1 – (67 (30.32 %)) – operated patients without digestive canal decompression; 2 – (107 (48.42 %)) – operated patients with decompression of the digestive canal; 3 – (22 (9.95 %)) – operated patients who underwent resection of necrotized tissue area; 4 – (25 (11.31 %)) – patients operated using laparoscopic technologies. A retrospective analysis of 30 medical records of inpatient deceased patients with AOSI was also performed.

Results and Discussion. Retrospective analysis showed that the choice of inadequate method of decompression of the digestive canal was in 28 (93.34 %) patients. The comorbidity index was 5.5–6.07 and operative anesthesia risk for ASA (IV–V classes) was observed in 24 (80.01 %) cases. In 67 patients, obstruction was eliminated by dissecting adhesions and restoring the passage through the digestive canal. In 107 patients was performed nasogastrointestinal intubation. In 22 patients, obstruction was eliminated by resection of the SI area. Single-stage intraoperative decompression of SI in this subgroup of patients was performed in all patients. In 8 (36.36 %) patients the operation was completed with the imposition of terminal enterostomy ileostomy, in 9 patients primary entero-enteroanastomosis with laparostomy was formed. In 5 (22.73 %) patients the operation was completed with the formation of direct entero-enteroanastomosis. Minimally invasive interventions in the volume of laparoscopic adhesiotomy were performed in 25 cases in 1–2 stages of the disease, with compensated functional condition of patients in the absence of pronounced local changes and disorders of SI during surgery. In such cases, SI decompression was not performed.

Using the proposed algorithms using methods and techniques of decompression of SI allowed to accelerate the recovery of motor-evacuation function of the digestive canal after surgical treatment for 2–3 days, to reduce the time of inpatient treatment of patients by an average of 3–4 days.

References

Benedykt, V.V. (2005). Osoblyvosti likuvalnoi taktyky v pisliaoperatsiinomu periodi u khvorykh na hostru neprokhidnist kyshky v zalezhnosti vid klinichnoho perebihu zakhvoriuvannia [Features of therapeutic tactics in the postoperative period in patients with acute bowel obstruction depending on the clinical course of the disease]. Khirurhiia Ukrainy – Journal of Surgery, 1 (13), 147-151 [in Ukrainian].

Benedykt, V.V. (2017). Pro znachennia monitorynhu stanu nespetsyfichnoi rezystentnosti orhanizmu u khvorykh na hostru neprokhidnist kyshky [On the importance of monitoring the state of nonspecific resistance of the body in patients with acute bowel obstruction]. Zbirnyk materialiv XVI zizdu Vseukrainskoho likars­koho tovarystva – Collection of Materials of XIV Congress of All-Ukrainian Doctor’s Society. Kamianets-Podilskyi [in Ukrainian].

Gain, Yu.M., Leonovich, S.I., & Alekseev, S.A. (2000). Sindrom enteralnoy nedostatochnosti pri peritonite: teoreticheskie i prakticheskie aspekty, diagnostika i lechenie [Enterior insufficiency syndrome in peritonitis: theoretical and practical aspects, diagnosis and treatment]. Minsk [in Russian].

Gabrielyan, N.I., Dmitriev, A.A., & Kulakov, G.P. (1981). Diagnosticheskaya tsennost opredeleniya srednikh molekul v plazme krovi pri nefrologicheskikh zabolevaniyakh [Diagnostic value of determination of average molecules in blood plasma in nephrological diseases]. Klinicheskaya meditsina – Clinical Medi­cine, 10, 38-42 [in Russian].

Hrubnyk, V.V., Mishchenko, V.V., & Koshel, Yu.M. (2014). Taktychni pidkhody do likuvannia hostroi kyshkovoi nepro­khidnosti – rol i mistse nazointestynalnoi inkubatsii [Tactical approaches to the gastro-intestinal impairment – the role of the nasal interstitial іncubation]. Kharkivska khirurhichna shkola – Kharkiv Surgical School, 1 (64), 129-131 [in Ukrainian].

Danylenko, I.A., Kononenko, M.H., & Kashchenko, L.H. (2014). Mistse intubatsii tonkoi kyshky v likuvanni patsiientiv z hostroiu zlukovoiu kyshkovoiu neprokhidnistiu [The place of incubation of the small intestine in the treatment of patients with acute connective bowel obstruction]. Kharkivska khirurhichna shkola – Kharkiv Surgical School, 2 (65), 56-58 [in Ukrainian].

Tamm, T.I., Bardiuk, O.Ya., & Datsenko, O.B. (2003). Diah­nostyka i taktyka likuvannia khvorykh na hostru kyshkovu neprokhidnist [Diagnosis and tactics of treatment of patients with acute intestinal obstruction]. Kharkiv [in Ukrainian].

Eryukhin, I.A., Petrov, V.P., & Khanevich, M.D. (1999). Kishechnaya neprokhodimost [Intestinal obstruction]. Saint-Petersburg: Piter [in Russian].

Zaporozhchenko, B.S., Borodaev, I.E., & Zubkov, O.B. (2014). Metodicheskie aspekty nazogastrointestinalnoy intuba­tsii pri ostroy khirurgicheskoy patologii [Methodological aspects of nasogastrointestinal intubation in acute surgical pathology]. Kharkіvska khіrurhіchna shkola – Kharkiv Surgical School, 2 (65), 66-68 [in Russian].

Kalf-Kalif, Ya.Ya. (1947). O gematologicheskoy differentsia­tsii razlichnykh form i faz ostrogo appenditsita [On the hematological differentiation of various forms and phases of acute appendicitis]. Khirurgiya – Surgery, 7, 40-43 [in Russian].

Komorvskiy, Yu.T., & Korchinskiy I.Yu. (1969). Spornye voprosy spayechnoy bolezni bryushiny v svete uspekhov i neudach operativnogo lecheniya [Controversial issues of adhesive disease of the peritoneum in the light of the successes and failures of surgical treatment]. Vestnik khirurgii – Herald of Surgery, 1, 89-94 [in Russian].

Mendel, M.A., Volostnykov, Ye.V., & Plotnikov, Yu.V. (2014). Intubatsiia kyshechnyku: krytychnyi pohliad [Intubation of the intestine: a critical view]. Kharkivska khirurhichna shkola – Kharkiv Surgical School, 1 (64), 91-97 [in Ukrainian].

Moshe Shain. (2003). Zdravyy smysl v neotlozhnoy abdominalnoy khirurgii [Common sense in emergency abdominal surgery]. Moscow: GEOTAR-MED [in Russian].

Rusyn, V.I., & Chavarha, M.I. (2012). Dekompresiia travnoho kanalu pry spaikovii kyshkovii neprokhidnosti u ditei [Decompression of the digestive canal with adhesive intestinal obstruction in children]. Halytskyi likarskyi visnyk – Galician Medical Journal, 3 (2), 104-105 [in Ukrainian].

Charlson, M.E., Pompei, P., Ales, K.L., & McKenzie, C.R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chron. Dis., 40 (5), 373-383. DOI: https://doi.org/10.1016/0021-9681(87)90171-8

Little, J.P. (1995). Consistency of ASA grading. Anaesthesia, 50 (7), 658-659.

Downloads

Published

2020-01-17

How to Cite

Dziubanovskyi, I. Y., Benedykt, V. V., Danchak, V. Y., & Prodan, A. M. (2020). Acute obstruction of the small intestine. Controversial and unresolved issues of the digestive decompression in the light of successes and failures of surgical treatment. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (1), 130–136. https://doi.org/10.11603/2414-4533.2020.1.10750

Issue

No. 1 (2020)

Section

EXPERIENCE OF WORK

License

Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  
  2. Лицензия Creative Commons
  3. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  4. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)