Morphological characteristics of postoperative acute perforated ulcers of the small bowel

Abstract

The basic morphological characteristics of acute postoperative perforated ulcers of the small intestine were presented by analyzing cases of patients with this postoperative complication. It was determined that in the majority of patients (69,4%) the complication occurred after operations for various types of oncological diseases. Found a significant increase in the frequency of occurrence of this pathology over the past 2 decades by 8 times. The following macroscopic characteristics were revealed: in the majority of patients (83,9%), isolated perforations were initially encountered, but in almost half of the cases (46,7%) there were recurrence. The «favorite» dates of occurrence are 4-10th day and the «favorite» localization in different parts of the small intestine are from 101 to 151 cm from the ligament of Treitz (47,7%) and 51-100 cm from the ligament of Treitz (21,8%). Microscopy of the resected areas of the small intestine besides inflammatory changes in the layers of bowel wall in 100% of cases showed significant dyscirculatory changes: on the side of the submucosal layer the plethora and development of the erythrocyte sludge - 100%, vascular thrombosis - 45,5%, hemorrhagic soaking - 27,3%. Inflammatory changes were nonspecific with a predominance of various inflammatory phases: alterative (desquamation and necrosis of the epithelium of the villi), exudative (moderate to massive neutrophilic infiltration) and proliferative (proliferation of granulation tissue followed by fibrosis and lipomatosis wall). In addition, a histological study of areas of the small intestine affected by acute perforative ulcers revealed that the mucous was primarily damaged.Key words: acute ulcers of the small intestine, non-specific ulcers of the small intestine, perforation of the small intestine, peritonitis, operations on the abdominal and pelvic organs, relaparotomy, closure of the small intestine, resection of the small intestine.