DIFFICULTIES OF SURGICAL TACTICS IN PATIENTS WITH ACUTE OBSTRUCTION OF SMALL INTESTINE IN THE CONDITIONS OF STRANGULATED ABDOMINAL HERNIA

Abstract

SUMMARY. In the work, based on the analysis of the results of surgical treatment of patients with acute obstruction of the small intestine, the peculiarities of the course of this pathological condition against the background of strangulated abdominal hernia have been established.

The aim – to improve the results of surgical treatment of patients with acute obstruction of small intestine (AOSI), the cause of which was strangulated abdominal hernia by developing a diagnostic and treatment complex aimed at preventing possible complications.

Material and Methods. 221 patients with AOSI were examined, of which 10 (4.52 %) were diagnosed with strangulated abdominal hernia. 32 medical records of inpatients with this disease with unfavorable treatment results were retrospectively analyzed. The comorbidity index was determined (Charlson M.E. et al., 1987), the level of intoxication was studied using the leukocyte intoxication index (LII), and the anesthetic-operative risk was determined according to the ASA scale.

Results. The duration of the disease in patients with AOSI, the cause of which was a strangulated abdominal hernia, was (3.73±0.36) days in the group with an unfavorable course, and (3.56±0.41) in patients who recovered. In 70.0 % of cases, patients of all age groups were admitted to the surgical department after 24 hours, mostly patients aged 60 and over. Only 30.0 % of all cases were hospitalized on the first day of the disease. The average time of the operation in this group of patients with AOSI was (2.05±0.37) hours, however, in 46.43 % of cases it exceeded 2 hours. In 7 (23.33 %) cases, relaparotomy was performed with a duration of operation of 2.15±0.42 hours, and in 3 (10.0 %) patients, a third operation was performed with a duration of 2.06±0.32 hours. Preoperative preparation patients with AOSI was carried out for an average of (40.29±7.28) hours, and only 17 (60.72 %) patients had the operation done within 24 hours. The average duration of surgery in patients with an unfavorable course of the disease was 2.12 ± hours. 41.67 % of patients had severe compensated diseases that posed a constant threat to their lives. According to the ASA scale, 33.33 % of patients corresponded to class V, which caused a fatal outcome in these patients.

Conclusions. The course of acute obstruction of the small intestine, the cause of which was a strangulated abdominal hernia, was more severe and unfavorable than with other etiological causes.