FEATURES OF THE CYTOLOGICAL COMPOSITION OF PERITONEAL EXUDATE IN PATIENTS WITH ACUTE ADHESIVE SMALL BOWEL OBSTRUCTION IN THE STAGE OF DECOMPENSATION
DOI:
https://doi.org/10.11603/2414-4533.2025.4.15743Keywords:
acute adhesive small bowel obstruction, cytological composition of peritoneal exudate, postoperative treatmentAbstract
The aim of the work: to evaluate the effect of the proposed method of postoperative treatment using nasogastric intubation with lavage, oxygen therapy and early enteral nutrition on the cellular composition of peritoneal exudate in patients with acute adhesive small bowel obstruction in the stage of decompensation, and to compare these changes with the indicators of traditional treatment.
Materials and Methods. The paper analyses the results of clinical examination and surgical treatment of 52 patients with acute adhesive small bowel obstruction in the stage of decompensation. Material for cytology was obtained from drainages from the abdominal cavity. The study was conducted dynamically — on the 1st, 3rd, and 5th days after surgery. The smears were stained according to Pappenheim, and microscopic evaluation was performed at ×200 magnification.
Results. In patients with acute adhesive small bowel obstruction in the stage of decompensation, cytological examination of peritoneal exudate showed a pronounced inflammatory response, manifested by massive neutrophilic infiltration already on the first day after surgery. The majority of neutrophilic granulocytes were in a state of lysis, indicating a high intensity and duration of the inflammatory process. At the same time, a significant decrease in the number of lymphocytes and macrophages was recorded, as well as pronounced dystrophic changes in mesothelial cells (vacuolisation, fragmentation, desquamation), indicating damage to the peritoneal barrier.
Conclusions. The use of the proposed method of postoperative treatment in patients with acute adhesive small bowel obstruction in the stage of decompensation provides more favourable dynamics of cytological indicators of peritoneal exudate. A marked decrease in the proportion of neutrophils in a state of lysis was noted, indicating suppression of excessive acute inflammatory response. At the same time, an increase in the number of lymphocytes and macrophages was observed, as well as a decrease in signs of mesothelial cell damage, indicating restoration of the barrier function of the peritoneum. The combination of these changes demonstrates the activation of local tissue immunity, acceleration of reparative processes, and a less intense course of postoperative peritoneal inflammation compared to traditional treatment.
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