PECULIARITIES OF DIAGNOSTIC CRITERIA AT DIFFERENT STAGES OF ACUTE ADHESIVE SMALL BOWEL OBSTRUCTION
DOI:
https://doi.org/10.11603/1811-2471.2022.v.i2.13131Keywords:
acute adhesive small bowel obstruction, intra-abdominal pressure, diagnostic criteriaAbstract
SUMMARY. The frequency, specificity, diagnostic accuracy of intra-abdominal pressure (IAP) indicators, sonographic and radiological diagnostic criteria at different stages of acute adhesive small bowel obstruction (AASBO) are studied in the work.
The aim – to study the value of diagnostic criteria at different stages of acute adhesive small bowel obstruction.
Material and Methods. The results of a clinical examination of 182 patients with acute adhesive small bowel obstruction, who were treated in the Department of Surgery No.1 on the basis of Ternopil Regional Clinical Hospital for the period from 2014 to 2021 were analyzed. Intra-abdominal pressure measurements, sonographic and X-ray examinations were performed in the complex of the diagnostic program.
Results Among the examined patients in the compensation stage in 73.9 %, the first of stage increase IAP was found, which has the highest sensitivity and diagnostic accuracy in this stage. While in the stage of decompensation in 79.8 % of patients there was a second stage of increase IAP, which has the highest sensitivity and diagnostic accuracy in this stage. 13.8 % of patients in the stage of decompensation were diagnosed with stage III of increase IAP. Sonographically, in the compensation stage of AASBO, dilatation of the intestinal lumen >30 mm and “sequestration of fluid” in its lumen were detected in 76.1 %, increase in the height of Kercking folds >10 mm in 44.6 % of patients and intestinal hyperpneumatization in 88.6 % of patients. At that time, in the stage of decompensation, these sonographic features of AASBO were detected with 100 % frequency. Under conditions of compensated AASBO thickening of the intestinal wall >4 mm occurred in 25.5 % of patients, pendular peristalsis – in 64.7 %, while in the stage of decompensation, these symptoms occurred much more often – in 88.3 % and 87.2 % of patients, respectively. Also in the stage of compensation of free fluid in the abdominal cavity was not detected, and in the stage of decompensation this sign was observed in 85.1 % of patients. Radiologically in patients in the stage of compensation Kloiberg's bowls were detected in 22.7 %, and in the stage of decompensation the sign was detected in 100 % of patients. However, in the compensation stage hyperpneumatization was observed in 76.1 % of patients, and at the stage of decompensation the symptom was detected in 68.1 % of patients.
Conclusions. Acute adhesive small bowel obstruction at the stage of compensation is accompanied by the development of intra-abdominal hypertension of I degree in 73.9 % of patients, and at the stage of decompensation intra-abdominal hypertension of II degree in 79.8 % of patients, which has the highest sensitivity and diagnostic accuracy in these stages. Ultrasonographically objective diagnostic signs of the decompensation stage are enlargement of the intestinal lumen >30 mm, increase in the height of the Kerking folds >10 mm, intestinal hyperpneumatization – in 100 % of patients, thickening of the intestinal wall over 4 mm (88.3 %) and free fluid in the abdomen (80 %).
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