Acute Adhesive Intestinal Obstruction Research Articles

ОСТРАЯ СПАЕЧНАЯ КИШЕЧНАЯ НЕПРОХОДИМОСТЬ У БЕРЕМЕННОЙ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Acute intestinal obstruction during pregnancy is a rare but extremely dangerous surgical pathology. Despite advances in medical technologies, preoperative diagnosis of acute surgical conditions of the abdominal organs during pregnancy is still imperfect. During pregnancy the clinical picture of the disease and laboratory parameters are nonspecific and variable which causes untimely provision of care and severe complications for both the mother and the fetus. The high incidence of acute intestinal obstruction during pregnancy is due to the adhesive process caused by surgical interventions including caesarean section the rates of which continue to rise steadily. The article presents a clinical case of a patient whose pregnancy was complicated by acute adhesive intestinal obstruction caused by the adhesive process after a previous caesarean section. The authors have noted the importance and necessity of multifield cooperation, timely decision-making both at the stage of diagnostic examination and during treatment, which made it possible to avoid severe complications from both the mother and the fetus.

Unformed conglomerate debilitating jejunal fistulas and their two-stage surgical treatment via posterolateral laparotomy

To create a method of two-stage repair of high unformed conglomerate delimited debilitating jejunal fistulas via posterolateral laparotomy with low risk of surgical complications. Methodology and treatment outcomes were analyzed in 37 patients with unformed conglomerate high debilitating delimited jejunal fistulas. Of these, 22 patients underwent one-stage treatment through 2 converging incisions and/or two-stage treatment through anterolateral access. They made up a control group. Fifteen patients in the main group underwent two-stage treatment via posterolateral left-sided laparotomy with unilateral disconnection of jejunum with fistula. In most patients of both groups, fistulas complicated surgery for acute adhesive intestinal obstruction. Topography of adhesions that caused acute intestinal obstruction in both groups was studied in 172 other patients. Identical jejunal fistulas and two different surgical approaches made it possible to consider our groups representative. Two-stage treatment via posterolateral left-sided laparotomy reduced mortality from 63.6±10.2% to 20.0±10.3% (t=11.8; p<0.001). This approach simplified intraoperative diagnostics that became more informative. Posterolateral access increased the quality of anastomosis and safety of viscerolysis. A new two-stage approach with posterolateral left-sided laparotomy allowed atraumatic imposing of inter-intestinal anastomosis with proximal disconnection of jejunal fistula. This exclusion turns the fistula into analogue of the definitive Meidl's jejunostomy, unloads the intestinal anastomosis and increases the quality of suture. New strategy reduced the risk of complications and mortality.

Mini-invasive technologies in the treatment of patients with acute adhesion small intestinal obstruction

Modern technologies in surgery lead to an increase in the number of surgical interventions, which in turn increases the number of patients with peritoneal adhesions disease. Patients with acute adhesive small intestinal obstruction make up to 70 %. Acute adhesion small intestinal obstruction takes the leading place among mechanical forms of intestinal obstruction and reaches 63–80 %, and the mortality rate is 5.1–8.4 %.&#x0D; The aim. Improvement of minimally invasive technologies in the treatment of patients with adhesive small intestinal obstruction.&#x0D; Materials and methods. The main group – 99 (58.6 %) patients with adhesions of the small intestine, who underwent minimally invasive treatment technologies. The comparison group included 70 (41.4 %) patients with acute adhesion small intestinal obstruction, who were treated with traditional methods.&#x0D; Results. Based on clinical laboratory and instrumental research results, 21 (12.4 %) patients out of 169 patients underwent emergency surgery: 7 (10.0 %) patients of the comparison group and 14 (14.1 %) patients of the main group. Minimally invasive surgical intervention was performed in 45 (45.5 %) patients of the main group with viscerolysis in 29 (29.3 %) patients and conversion was performed in 16 (16.2 %) patients. Median laparotomy was performed in 54 (54.5 %) patients of the main group and in 70 (100.0 %) patients of the comparison group.&#x0D; The complications of acute adhesive small intestinal obstruction and the complications of the postoperative period in the comparative analysis of the results of the treatment of patients were taken into account. The grading of postoperative complications was carried out in accordance with the classification of P. A. Clavien and D. Dindo (2009), according to which a statistically significant difference is noted in the studied groups: 14 (14.1 %) of the main group and 23 (32.8 %) of the comparison group, III, IV and V degrees of complications were preferred. Relaparotomy was performed in 5 (7.1 %) patients of the comparison group and in 2 (2.0 %) patients of the main group. Mortality decreased from 6 (8.5 %) in the comparison group to 2 (2.0 %) in the main group.&#x0D; Conclusions. The use of an improved approach in diagnostics and treatment of patients with acute adhesion small intestinal obstruction ensured improved results of surgical treatment. The use of mini-invasive technologies in diagnosis and treatment made it possible to reduce the frequency of postoperative complications from 32.8 % to 14.1 %, the mortality rate from 8.5 % to 2.0 %, which confirms the effectiveness of the use of mini-invasive technologies in the treatment of patients with acute adhesion small intestinal obstruction.

Outcomes after staged surgical treatment of children with ileocecal lesions and active extensive inflammation in Crohn’s disease

Introduction. Crohn’s disease is characterized with transmural lesion of the gastrointestinal tract which is frequently localized in the ileocecal region. Despite the achievements in medicamentous therapy, 15–45% of children have to be operated on within 5 years after the diagnosis is verified. Purpose. To substantiate the efficacy of two-stage surgical treatment of children with Crohn’s disease , ileocecal lesion and active extensive inflammation. Material and methods. A single-stage retrospective-prospective study included 43 children with ileocecal lesions and advanced colitis. Two-stage surgical treatment was performed. In the preoperative period, the following parameters were assessed: physical state, clinical activity, anemia and the level of hypoalbuminemia as well as inflammation markers, findings at endoscopy and MRI. Indications for surgical treatment were strictures in the ileocecal region, endoscopic and clinical activity and colon lesion and / or purulent-septic lesions in the perianal region. 39 (90.7 %) children had laparoscopically-assisted surgeries. 4 (9.3 %) children underwent conversions due to a pronounced infiltrative process in the abdominal cavity. Results. Lengths of hospitalization for children with stoma varied from 5 to 20 months (median 8 months). PCDAI index: in 25 (57.8 %) high activity, in 18 (41.2 %) moderate activity. After surgical intervention: 7 (16.2%) children had mild course, 36 children (p 0.05) SES-CD before surgery – all children had high endoscopic activity. In the postoperative period by Rutgeerts scale findings, there was a statistically significant positive dynamics (p = 0.011). Anthropometric parameters (HAZ p 0.05; BAZ p 0.001) and laboratory findings (p 0.001) were statistically significant for positive dynamics too.In the postoperative period: 5 (11.6 %) children developed ligature fistulas; 2 children (4.6 %) had narrowed intestinal anastomosis without passage disorders; 2 (4.6 %) children developed acute adhesive intestinal obstruction. In foreign and Russian publications, postoperative complications were reported in 6 % to 29 %. Conclusions. Crohn’s disease has led to chronic anemia, hypoalbuminemia, chronic bacterial inflammation, reduced physical growth and worsen quality of life. After the two-stage surgical treatment, the statistical analysis demonstrated a significant improvement in mass-growth, laboratory and endoscopic parameters.

Systematic Review of the Clinical Efficacy of Various Terms of Non-Surgical Treatment in Patients With Acute Adhesive Intestinal Obstruction

BACKGROUND The question of the duration and volume of conservative measures in patients with acute adhesive intestinal obstruction (AAIO) remains the subject of numerous discussions. Aim of study To evaluate the efficacy and safety of various periods of conservative therapy in patients with AAIO using a systematic review. MATERIAL AND METHODS Criteria for inclusion in the systematic review were cohort studies investigating various regimens and duration of conservative therapy in adult patients with AAIO. The search for primary sources was carried out in the CENTRAL, PubMed and eLibrary databases. The assessment of the safety of various terms of AAIO was carried out by comparing the immediate results of treatment. RESULTS The review included 19 papers with a total of 2,570 observations. At the first stage, the effectiveness of various conservative therapy regimens was evaluated by calculating the risk ratio for the success of non-surgical treatment. Taking into account the significant statistical heterogeneity of the participants, the calculation of the final risk ratio was carried out using a random effects model. The hazard ratio for nonoperative success was 1.91 (95% CI 1.2–3.1) in favor of gastrografin and 3.71 (95% CI 1.3–10.6) in favor of preoperative intestinal intubation. Taking into account the multidirectional pathogenetic action of the studied methods of conservative therapy, the obtained results suggested that the probability of success of non-surgical treatment correlates to a greater extent with the total duration of the AAIO episode than with the duration of conservative therapy, which was indirectly confirmed by constructing scattering graphs with approximation lines and calculating the coefficients determination, which amounted to 0.69 and 0.77 for the subgroups of standard therapy and undiluted gastrografin, respectively. Subsequently, the impact of different duration of an episode of AAIO on the immediate outcomes was assessed: mortality, frequency of resection interventions, complications, and total bed-day. There were no statistically significant differences in favor of early interventions (up to 48 hours) for all compared parameters; an increase in the total duration of AAIO up to 89 hours was not associated with worse results. CONCLUSION The total duration of the episode of acute adhesive intestinal obstruction, including both the pre-hospital duration and the duration of non-surgical treatment is prognostically significant. In other words, when calculating the allowable duration of conservative measures, one should proceed from the total duration of intestinal passage disturbance, which should not exceed 89 hours.

Evaluation of Role of Laparoscopy in Treatment of Acute Adhesive Intestinal Obstruction

Evaluation of Role of Laparoscopy in Treatment of Acute Adhesive Intestinal Obstruction

Morphofunctional changes in the small intestine in acute adhesive small bowel obstruction

Aim: To study the features of morpho-functional changes in the small intestine mucosa in acute adhesive small bowel obstruction.Material and methods. The results of a comprehensive study of morphological and functional changes in the small intestine’s mucous membrane in 20 patients out of 50 with acute adhesive small intestinal obstruction were analyzed. Patients underwent resection of the small intestine with a biopsy from the mucous membrane, followed by a pathomorphological and biochemical examination of biopsy specimens.Results. The study results show that more pronounced pathomorphological changes in the mucous membrane of the small intestine were observed in patients with acute adhesive small intestinal obstruction with widespread (multiple) adhesions compared with limited (single) adhesions. In the study of biochemical parameters in the small intestine mucosa in patients with acute adhesive small intestinal obstruction with the presence of multiple (widespread) adhesions, there was a significant and critical increase in lipid peroxidation and proinflammatory cytokines, a decrease in antioxidant protection compared to the patient group with the presence of single (limited) adhesions. There was also a decrease in the concentration of serotonin in the mucosa of the small intestine. In the presence of single (limited) adhesions in these patients, it decreases to 0,50±0,3 units, and in patients with multiple (common) adhesions - to 0,20±0,2 arb. units.Conclusion. The severity of morpho-functional changes in the mucosa of the small intestine directly correlates with the severity of the development of the adhesive process and acute adhesive small bowel obstruction.

APPLICATION OF INTESTINAL LAVAGE FOR CORRECTION OF PROTEOLYTIC ACTIVITY IN ACUTE I NTESTINAL OBSTRUCTION

Summary. The aim of the work is to improve the results of treatment of patients with acute adhesive intestinal obstruction in the postoperative period by correcting the proteolytic activity of small intestinal contents&#x0D; Materials and methods. 62 patients were operated on for acute adhesive intestinal obstruction. All patients underwent nasogastrointestinal intubation with aspiration of intestinal contents and subsequent prolonged intestinal decompression.&#x0D; Research results. In the second group, after intestinal lavage with α-aminocaproic acid, a decrease in total proteolytic activity was observed both in the contents of the small intestine and in blood serum.&#x0D; Conclusions. The use of intestinal lavage with the use of aminocaproic acid leads to a faster normalization of total proteolytic activity both in the contents of the small intestine and in the blood serum, to a decrease in the α1-antiproteinase inhibitor, proteolysis index, and also contributes to an earlier elimination of intestinal paresis.

Advantages of computed tomography in the treatment and diagnostic algorithm of acute adhesive intestinal obstruction

Objective: To improve the treatment and diagnostic algorithm for acute adhesive intestinal obstruction. Materials and methods: We have studied the results of surgical treatment of 114 patients with OCD, which included spiral computed tomography using phytocomposite in the preoperative examination complex. Results: The inclusion of CT examinations in the ТDA allowed patients of the 1st main group to operate in 21 (70%) cases in the first 6 hours after hospitalization, in the 2nd group, where patients were traditionally examined only in 6 patients (13%) Conclusion: The developed diagnostic algorithm for acute adhesive intestinal obstruction, including computed tomography in the examination, reduced the number of intraoperative, early postoperative complications and fatal cases in the main group by 1.6 times than in the 2 control group 2 (p&gt;0.05), and by 1.4 times than in the 1 control group (p&gt;0.05).

PATHOMORPHOLOGICAL CHANGES OF THE PERITONEUM IN PATIENTS WITH ACUTE ADHESIVE INTESTINAL OBSTRUCTION

Acute adhesive intestinal obstruction is a complex and often unpredictable pathology. Therefore, the study of the pathomorphological component of this problem is important for the selection of adequate surgical and conservative therapy of the disease.The aim of the study is to research the pathomorphological changes in the peritoneum in patients with acute adhesive intestinal obstruction and determine the basic patterns of adhesions.Material and methods. The study covered 117 operated patients with various acute diseases of the peritoneal cavity of an infl ammatory nature, which to varying degrees were accompanied by damage to the peritoneal mesothelium. Collection of material for morphological studies was performed according to standard requirements for the manufacture of histological specimens. Biopsies included areas of adhesive and peritoneal tissue.Results. Through the examination of peritoneal biopsy material in the event of local peritonitis was found that some mesotheliocytes developed pronounced dystrophic changes, in some cells with the transition to necrosis. The lumens of the vessels of the microcirculatory tract were moderately dilated, fi lled with erythrocytes, and stasis developed in some of them. The main component of the infl ammatory focus was the increase in catabolic processes that led to metabolic disorders in connective tissue, accumulation of breakdown products of fat and carbohydrate metabolism and the development of tissue acidosis.Summary. Adhesion disease is characterized by a great variety of pathomorphological picture, which is due to the phased development of infl ammatory and hyperproliferative processes, and that is fundamental in the pathogenesis of adhesive disease.

ДИНАМИКА КАЧЕСТВА ЖИЗНИ ПАЦИЕНТОВ, ПЕРЕНЕСШИХ ХИРУРГИЧЕСКИЕ ОПЕРАЦИИ НА ОРГАНАХ БРЮШНОЙ ПОЛОСТИ

The quality of life of patients undergoing surgery is a subjective measure of psychological and physical well-being. In order to assess the quality of life indicators, the results of a survey conducted using the Russified questionnaires SF-36 v.2 and AQLi were analyzed. The aim of the study was to determine the dynamics of the quality of life of patients before and after undergoing surgery. The application of the new AQLi scale will make it possible to objectify the indications for surgical intervention, namely, when the Summ value is less than 65 and the SBP is reliably confirmed by instrumental research methods, the performance of planned adhesiolysis is shown. The main indicators in the group of patients with acute adhesive intestinal obstruction, operated on by the laparoscopic approach, had higher values and came to normal earlier than those in the group with the laparotomic access, which indicates a better tolerance of laparoscopic surgical interventions in this pathology.

Our experience of laparoscopic treatment of acute adhesive intestinal obstruction

The issues of the most common causes and tactics of treatment of adhesive intestinal obstruction, its timely diagnosis (consisting in the need for X-ray, ultrasound and endoscopic examination) are discussed. It is shown that laparoscopic adhesiolysis in combination with anti-adhesive therapy makes it possible not only to minimize complications in the postoperative period, reduce the patient's stay in the hospital, provide a good cosmetic result, but also allows to verify the nature and prevalence of the adhesive process, as well as to exclude the presence of other diseases of the abdominal cavity.

ПРОФИЛАКТИЧЕСКИЕ МЕРОПРИЯТИЯ КАК ОБЯЗАТЕЛЬНЫЙ КОМПОНЕНТ В ЛЕЧЕНИИ ПАЦИЕНТОВ С ОСТРОЙ СПАЕЧНОЙ КИШЕЧНОЙ НЕПРОХОДИМОСТЬЮ

Objective. Reducing the recurrence rate of adhesive disease after its surgical treatment by developing a differentiated approach to preventive measures. Methods. A retrospective study included patients (n=260) with adhesive disease complicated by recurrent attacks of acute bowel obstruction has been performed. The main (n=105) and control (n=155) groups were formed. The patients of the main group were undergone to algorithmfor prophylaxisandtreatment in patients providing the implementation of planned surgical treatment and measurestoprevent recurrence. The nature of preventive measures was determined by the volume of surgical trauma of the peritoneal mesothelium and the prevalence of cicatricial-adhesive changes. In the control group, patients underwent standard measures aimed at conservative resolution of acute adhesive bowel obstruction: depending on their effectiveness, patients were discharged for further outpatient treatment or for urgent surgical intervention without any preventive measures. The primary outcome was considered to be the incidenceandrecurrencerate of adhesive disease and the severity of clinical symptoms, which were traced to a depth from 2 to 10 years by interviewing patients. If it was impossible to assess long-term results, patients were excluded from the study. Results. The total frequency of adhesive disease relapses requiring hospitalization was 8.6% (n=9) in the main group and 27.1% (n=42) in the comparison group, respectively. The best results were obtained in the subgroup of patients operated on for adhesive disease in a planned manner - the frequency recurrence rate was 4.6%. Conclusion. The use of the developed therapeutic and prophylactic algorithm in the surgical treatment of adhesive disease led to decline in relapse ratesfrom 27.1 %-8.6% cases of an improvement of life quality of patients with acute adhesive intestinal obstruction who underwent surgical treatment. What this paper adds The differentiated approach to the choice of operative access and surgical treatment of adhesive bowel obstruction has been developed. Indications for the use of specific preventive measures, depending on operative access and the nature of the surgical intervention have been substantiated.

The Point-Rating Scale for Determining Treatment Tactics in Patients With Adhesive Small Bowel Obstruction

Relevance. The most practiced method of treating patients with acute intestinal obstruction - urgent surgical intervention - does not guarantee remission, contributing to the progression of morphological changes in the abdominal cavity. From this perspective, a shift in emphasis towards the planned surgical treatment of patients with adhesive disease with the use of the existing anti-adhesive methods after conservative resolution of the intestinal passage disorders looks like a promising direction.Aim of the study. Improving the results of patients with acute adhesive intestinal obstruction treatment by developing a point-rating scale that allows to highlight groups of patients who are prone to conservative resolution of intestinal passage disorders episode, and, thereby, reduces the proportion of urgent interventions.Material and methods. The analysis of the 125 patients treatment results (retrospective group) admitted with symptoms of acute adhesive intestinal obstruction was carried out. On this basis, the point-rating scale was developed including a number of factors that have certain value in terms of predicting the probability of conservative therapy success. Subsequently the developed scale was applied in 170 patients (prospective group) as part of treatment tactics implementation aimed at maximally conservative resolution of adhesive intestinal obstruction without negative effect on the immediate results of patients operated in later periods.Results. The developed point-rating scale made it possible to reduce the frequency of urgent interventions among patients with signs of acute adhesive intestinal obstruction (from 79.2% to 57.6%) due to longer conservative measures — 18.1±17.2 and 11,2±8.7 hours in prospective and retrospective groups, respectively). There was no negative impact on the frequency of resection interventions (12.2 and 16.1% in the prospective and retrospective groups) as well as postoperative complications and overall mortality.Conclusions. The developed point-assessment scale made it possible to stratify patients in accordance with the probability of conservative therapy success and to justify its continuation for more than 12 hours in low-risk patients. The obtained results allow us to recommend the proposed scale for use in clinical practice.

Modern aspects of surgical treatment of patients with adhesive small bowel obstruction

Despite the ongoing preventive measures aimed at reducing the formation of adhesions in the abdominal cavity with an increase in the number of surgical interventions on the abdominal organs, the number of patients admitted to surgical hospitals with adhesions of the small intestine is also increasing. It should be noted that annually about 12% of previously operated patients undergo treatment in surgical departments while the exceptional fact is that 5070% are patients with acute adhesive ileus of the small intestine and the mortality rate in this group ranges from 13 to 55%. In recent years the literature has been actively discussing the advantages of minimally invasive technologies in the treatment of adhesive small bowel obstruction since the use of traditional methods often leads to the development of complications with repeated (in 60% of cases) surgical interventions. The purpose of this study was the development and implementation of an improved therapeutic and diagnostic algorithm in patients with adhesive small bowel obstruction which made it possible to improve the results of treatment. A comparative analysis of 338 patients with adhesive small bowel obstruction who were treated in the surgical departments of the St. Elizabeth Hospital in St. Petersburg in the period from 2016-2019 was carried out. All the patients were divided into 2 groups: the main (I) group (2018-2019), which consisted of 198 patients who received the improved diagnostic and treatment algorithm as well as the comparison group (II) (2016-2017) which included 140 cases these are patients examined according to the standard protocol and operated on in the traditional way. Moreover, in 98 cases, it was possible to resolve acute adhesive small intestinal obstruction in a conservative way, and 240 patients underwent surgical treatment. The developed diagnostic algorithm is based on the consistent application of the most informative diagnostic methods. At the same time the indications and the sequence of their application were established which ultimately made it possible to shorten the preoperative time interval as well as to determine the optimal treatment strategy with the choice of the type of surgical treatment (laparotomy or laparoscopy). The proposed treatment and diagnostic algorithm allowed to reduce the complication rate from 46.5% (53) to 22.2% (28) (р 0,001), and the mortality rate from 14.9% (17) to 3.9% (5) (p 0,01).

TREATMENT OF ACUTE ADHESIVE INTESTINAL OBSTRUCTION WITH MINI-INVASIVE METHODS

The authors studied the results of treatment of patients with adhesive disease of the abdominal cavity, determined the frequency of relapses of adhesive intestinal obstruction and studied the possibility of laparoscopic adhesiolysis in the surgical treatment of acute adhesive intestinal obstruction. A total of 987 patients with AIN were operated on: of whichlaparotomy adheziolysis - 539, intestinal resection laparotomy with interintestinal anastomosis-246, intestinal resection laparotomy with excretion of intestinal fistula-88, laparoscopy adhesiolysis-114. The use of laparoscopic adhesiolysispromotes to the early restoration of intestinal motility within 24-48 hours, reduces the frequency of relapses of adhesive disease, and reduces the length of hospitalization on average to 6.8 days.

Hepatic distress syndrome in surgery: concept, pathogenesis, prevention and correction

To establish the universality and regularity of hepatic disorders, their role in pathogenesis of homeostasis impairment and determine scientific base for a new syndrome - hepatic distress syndrome in surgery. Chronic experiments on outbred dogs were carried out. Acute peritonitis was simulated in the first group (n=15), acute destructive pancreatitis in the second group (n=15), acute obstructive intestinal obstruction in the third group (15). In the fourth group, experimental acute peritonitis (n=15) was followed by Remaxol infusions (20 ml/kg). Liver function was evaluated using the indicators of endogenous intoxication, lipid metabolism markers, as well as composition of lipids in liver tissue. Clinical studies included 44 patients with peritonitis (the first subgroup - standard therapy (n=20), Remaxol infusion in the second subgroup (n=24), severe acute pancreatitis (n=18), acute adhesive intestinal obstruction (n=20)). Patients underwent surgery. Along with routine indicators, we analyzed severity of endogenous intoxication, lipid peroxidation, phospholipase activity, serum lipids and red blood cell count. Experimental and clinical studies have shown significant liver damage in all diseases with various pathogenesis. Regardless of urgent disease, one of the leading component is membrane-destabilizing process. The last one is determined by excessive activity of membrane lipid peroxidation and phospholipases in liver tissue. Severe abnormalities are followed by impairment of liver detoxification ability and liver may be a source of toxins per se. Remaxol infusion in the treatment of experimental and clinical acute peritonitis increased liver tolerance to trigger pathogenetic agents. This process resulted improvement of laboratory and clinical parameters. In general, we obtained high significance of liver damage in pathogenesis of acute urgent abdominal pathology. Experimental and clinical data for determining hepatic distress syndrome as important aspect in acute abdominal surgical diseases have been obtained. Hepatic distress syndrome in surgery is a combination of abnormal processes with progression of endogenous intoxication, oxidative stress and phospholipase activity following membrane-destabilizing phenomena and secondary liver dysfunction.

Botkin Hospital Transplant Program: 100 solid organ transplantations

Objective : to evaluate the first results of the Botkin Hospital transplant program. Materials and methods . From June 2018 to October 2019, 100 solid organ transplants were performed at the Botkin City Clinical Hospital. Out of the 100 transplantations, 72 were kidney transplants (average age of recipients was 45.65 ± 11.35 years, HLA match averaged 2.09 ± 1.03) and 28 were liver transplants (average age of recipients was 50.14 ± 7.62 years, average MELD was 17.78 ± 3.28 (14–34). Results . After transplantation, there was no 30-day mortality. Postoperative complications following kidney transplantation were established in 11 patients (15.2%). In 3 patients (4.3%) – suppuration of postoperative wound, in 2 patients (2.8%) – hematomas in the area of the postoperative suture during hemodialysis, in 5 patients (6.9%) – retroperitoneal lymphocele, in 1 patient (1.4%) – urosepsis. There were 4 cases (5.5%) of acute rejection, 3 cases (4.2%) of humoral rejection, and 1 case (1.3%) of cellular rejection. Early postoperative complications following liver transplantation were detected in 2 patients (7.2%). In one patient – hematoma under the right lobe of the liver on the 1st day after surgery, the diaphragm was the source of bleeding, in one patient – ascites leakage through postoperative sutures, which required relaparotomy. In 2 patients (7.2%), postoperative complications were found in the separated postoperative period. In one case, of choledochocholedochal anastomotic stricture – stricture stenting was performed with coated nitinol stent. In another case, acute adhesive intestinal obstruction, which required laparotomy, adhesiolysis. Conclusion . Implementation of the transplantation program in multidisciplinary hospitals can boost transplant care in a district and improve the treatment results of patients with terminal organ damage.

ROLE AND PLACE OF ULTRASONOGRAPHY IN DIAGNOSTICS OF ADHESIVE INTESTINAL OBSTRUCTION

The aim: To study the possibilities of ultrasound in adhesive ileus obstruction diagnosis and indications for surgical treatment determination. Materials and methods: The results of diagnosis and treatment of 60 patients with acute adhesive intestinal obstruction with comparative use of X-ray and ultrasound methods were analyzed. Results: The use of a standard X-ray examination of the abdominal organs upon admission to the hospital allowed the diagnosis of acute adhesions of small bowel obstruction in only 32 (53.3%) patients. Transabdominal ultrasonography allowed the establishment of adhesive ileus during hospitalization in 53 (88.3%) patients and also in 7 (11.7%) during a dynamic examination 2-3 hours after admission. Due to the lack of positive effect from the conducted conservative therapy relying on the data of ultrasound studies, 33 (55%) patients were operated on. During X-ray examination, only 10 (30.3%) of these patients demonstrated negative X-ray dynamics, and with an ultrasound study, deterioration of echo pictures was observed in all 33 (100%) patients. Conclusions: Compared with the X-ray method, transabdominal ultrasonography is established to be safe, affordable, simpler, non-invasive and highly informative method for the study of acute adhesions of the small intestinal obstruction. The method allows the assessment of the ongoing conservative therapy dynamics and determination for surgical treatment indications.

КЛИНИЧЕСКИЙ СЛУЧАЙ ЛЕЧЕНИЯ ПАЦИЕНТА С ПОРТАЛЬНОЙ ГИПЕРТЕНЗИЕЙ, РАЗВИВШЕЙСЯ НА ФОНЕ ТРОМБОЗА ВОРОТНОЙ ВЕНЫ

Non-cirrhotic causes of the development of portal hypertension make up about 10%. The factors leading to its development are the development of thrombosis in the portal vein system, occlusion due to pancreatitis, pancreatic tumors, and other causes. Acute bleeding from esophageal varices is a formidable complication of portal hypertension, regardless of its etiology. The tactics of treatment and prevention of bleeding from esophageal varices in patients with portal vein thrombosis generally corresponds to that for intrahepatic portal hypertension in liver cirrhosis with some additions. Aim. Presentation of the results of clinical observation of an open Hassab operation (esophagogastric devascularization without esophageal transection + splenectomy) in a patient with portal vein thrombosis complicated by portal hypertension and esophageal varices, as well as a short literary excursion on this issue. Materials and methods. The patient was admitted to the surgical department with thrombosis of the portal, splenic and superior mesenteric veins complicated by subhepatic portal hypertension with splenomegaly, varicose veins of the esophagus and stomach of the 2nd-3rd degrees, left-sided hydrothorax, moderate anemia. Direct anticoagulants, antibiotics, non-steroidal anti-inflammatory drugs, proton pump inhibitors were used. Given the risk of bleeding from varicose veins of the esophagus and stomach, as well as existing necrosis in the spleen, Hassab operation (esophagogastric devascularization in combination with splenectomy) was performed at the fourth level of surgical management. Results. Despite ongoing therapy with antiplatelet agents, in 2 months after the operation the patient developed thrombosis of the left subclavian and internal jugular veins as well as recurrent left-sided hydrothorax. Conservative therapy has been successful. Relapse of esophageal varices bleeding was diagnosed in a patient 4 years after surgery, conservative and endoscopic hemostasis being successful. Acute thrombophlebitis of the saphenous veins of the right lower leg was diagnosed in the patient 9 years after surgery, it having been treated conservatively. Acute adhesive intestinal obstruction developed 11 years after surgery, conservative therapy was successful. Currently, the patient is being followed at the outpatient department, his condition being satisfactory and hydroxycarbamide, antiplatelet agents and non-selective betablockers being taken by him on a regular basis takes. Based on this clinical observation, it seems difficult to judge the effect of Hassab operation on the course of the disease in the described patient. However, it is worth noting a persistent increase in the level of platelets in the general blood test in the postoperative period, which could contribute to the recurrence of venous thrombosis in the patient. Conclusions. According to the current scientifically based recommendations in the treatment of these patients priority should be given to conservative and minimally invasive endoscopic and interventional X-ray endovascular techniques.