Паёми Сино (Dec 2018)
INTUBATION OF THE SMALL INTESTINE AS A COMPONENT OF TREATMENT OF ACUTE STRANGULATED SMALL BOWEL OBSTRUCTION
Abstract
Objective: Improving the results of treatment of patients with acute strangulated intestinal obstruction (ASIO). Methods: Analyzed the results of complex diagnostics and surgical treatment of 49 patients with ASIO. In 20 (40.8%) observations, the cause of ASIO was the acute adhesive small intestinal obstruction, 12 (24.5%) – intussusception, 10 (20.4%) – nodulation and 7 (14.3%) – volvulus of small intestine. Results: Established that as the syndrome of enteric insufficiency progresses, observed an increase in endotoxemia levels. Thus, with the syndrome of enteric insufficiency of II and III degrees, the leukocyte index of intoxication (LII) was 6.23±1.16 units and 8.62±2.51 units, respectively, medium-mass molecules (MMM) – 0.587±0.25 conv. units and 0.838±0.06 conv. Units, respectively, and blood lactate levels were 2.8±0.04 μmol/l and 3.1±0.06 μmol/l, respectively. At a severe and extremely severe increase in intra-abdominal pressure, the level of MMM reached 0.1104±0.53 conv. units and 0.1274±0.78 conv. units, respectively, blood lactate – 2.5±0.02 μmol/l and 3.1±0.04 μmol/l, respectively, and LII – 6.24±1.18 units, and 8.60±2.53 units, respectively. Performed various kinds of surgery with intubation of the small intestine with subsequent decompression and gut lavage, which effectively reduced endotoxemia and indices of intra-abdominal pressure, and also reduced the incidence of enteroenteroanastomosis insufficiency. Four observations have suppuration of the laparotomic wounds, in 2 patients – subhepatic abscess and in 1 – entero-enteroanastomosis nsufficiency. Two elderly patients died of peritonitis (n=1) and acute myocardial infarction (n=1). Conclusion: Intubation of the small intestine with the implementation of hypothermic sanation allows effective removal of toxic intestinal content and prevents the risk of entero-enteroanastomosis nsufficiency.
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