Treatment Of Adhesive Bowel Obstruction Research Articles

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.

Incidence and treatment of adhesive bowel obstruction after gastroschisis closure

Background: Children with gastroschisis, especially when it is complicated by atresia or perforation, often suffer from severe long-term sequelae such as short-bowel syndrome and chronic dysmotility. These children are also susceptible to adhesive bowel obstruction later in life, which can alter their nutritional intake and may require repeated visits to the hospital. However, few long-term studies have attempted to determine the rate of occurrence of intestinal occlusion after gastroschisis. In this study we measured the incidence and management of adhesive bowel obstruction in children with gastroschisis at one academic pediatric hospital. Methods: A retrospective chart review was carried out on patients with gastroschisis born between January 2000 and December 2007. A total of 74 patients who underwent closure of their gastroschisis during this period were identified. Results: Twelve of these 74 (16%) patients were readmitted to the hospital with at least one episode of adhesive bowel obstruction. Three of the 12 patients had gastroschisis complicated by atresia. Eight patients underwent immediate primary closure of their defect on the first day of life. Silos were installed on the remaining four (36%) and were kept in place for an average of 6.25 (range: 4–9) days. Five of the 12 children resolved their obstruction with nasogastric tube decompression alone. The remaining seven (58%) required lysis of adhesions after failure of decompression. The seven children who underwent surgical lysis of adhesions did not have additional episodes of occlusion after laparotomy. Conclusion: In this study, 16% of the patients born with gastroschisis within a 7-year period presented with a adhesive obstruction. Occurrence of obstruction was unrelated to the method of closure or the severity of the defect. Although conservative management with nasogastric tube decompression may be effective initially, over half of patients with occlusion will need eventual surgery for lysis of adhesions. Keywords: bowel obstruction, gastroschisis, lysis of adhesions

Опыт ведения пациентов со спаечной кишечной непроходимостью

The article discusses the most common causes and strategies for treatment of adhesive bowel obstruction and its timely diagnostics (which consists in the need for X-ray, ultrasound and endoscopy). It is shown that laparoscopic adhesiolysis in conjunction with anti-adhesion therapy not only minimizes complications in the postoperative period, reduces the time of hospital stay and ensures a good cosmetic result, but also helps verify the nature and extent of adhesions, as well as exclude the presence of other abdominal cavity diseases.

Angiodysplasia Presenting with Multiple Polypoid Lesions: An Unusual Cause of Small Bowel Obstruction

Angiodysplasia (AD), a morphologic vascular abnormality, is a common cause of gastrointestinal bleeding. We present a rare case of polypoid AD lesions. Three years after treatment for adhesive bowel obstruction, a 57-year-old man was admitted with recurrent abdominal distension, anorexia, and lower extremity edema. Computed tomography showed his dilated proximal and collapsed distal small bowel loops had disparate calibers. The transition point demonstrated mucosal enhancement and mesenteric lymphadenopathy. We observed small intestinal wall outpouching with strong mucosal enhancement and polypoid lesions dotting the dilated intestine. Intraoperative findings revealed a hard but elastic intraluminal nodule causing small bowel obstruction and the outpouching’s occurrence on the ileum’s antimesenteric border. We performed partial resection of the small intestine involving the nodule and Meckel’s diverticulum. Macroscopically, the nodule, diverticulum, and intestinal mucosa had polypoid lesions. Histopathologically, these lesions had foci within dilated thin- or thick-walled vascular channels in the submucosa, without specific histological abnormalities. These features led to a diagnosis of AD.