Diagnostic Criteria of Acute Intestinal Obstruction of Non-Tumoral Origin

Liulka A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Acute intestinal obstruction takes one of the leading places in the structure of acute surgical pathology of the abdominal cavity. The absence of highly informative criteria of obstruction detection at an early stage of development leads to diagnostic errors and late surgical intervention. The analysis of the examination and treatment of 89 patients with acute intestinal obstruction of non­tumoral origin who were hospitalized in the surgical ward of the 2nd Municipal Hospital of Poltava in the period from 2009 to 2013 was performed. Patient’s age was in the range from 21 to 76 years. Under acute disorders of the intestinal passage (less than 12 hrs.) were hospitalized 42 (47.2 %) patients, in the stage of hemodynamic disorders of the intestinal wall and its mesentery (less, than 24 hrs.) – 21 (23.6 %) and in the stage of organ failure (more than 24 hours.) – 26 (29.2 %). Mixed form of acute intestinal obstruction was in 70 (78.7 %) patients, strangulative form – in 19 (21.3 %). Diagnostic algorithm included physical examination, laboratory general clinical and biochemical analyzes, X­ray and ultrasound of the abdomen. Clinical manifestations of acute obstruction was due to the level of obstruction of the intestines, level of bowel mesentery involvement in pathological process, disease duration and practically did not depend on the form of obstruction. Pain syndrome was observed in all patients. Delay of the defecation act and discharge gases – in 83 (93.3 %) patients and 2 (2.2 %) patients experienced mandatory emptying. Other symptoms: abdominal distension in 86 (96.6 %) patients; violation of peristalsis in 81 (91 %) cases; in 23 (25.8 %) patients – splashing sound; symptoms of peritonitis – in 22 (24.7 %). Also common disorders of the body were defined, that were caused by the level of endotoxemia and metabolic disorders, disease duration, presence of comorbidities and age of the patient. The value of laboratory blood parameters in the survey reflects only the degree of dysfunction of various organs and systems and helped during their pharmacological therapy. All patients fulfilled synoptical radiography of the abdomen. Determined: pneumatosis of the small intestine in 49 (55.1 %) patients with adhesive obstruction and in 6 (31. 6 %) with strangulative; Kloyber’s bowls – in 44 (62.8 %) observations with mixed and in 15 (78.9 %) with strangulative form; small intestine arches with transverse striations (“fish tail” or “stretched spring” symptoms) in 21 (30 %) in the adhesive observations and in 8 (42.1 %) with strangulation. Direct radiological signs of obstruction (Kloyber’s bowls and small intestine arches) were determined mainly in patients with disease duration more, than 12 hours. The presence of free fluid in the abdominal cavity were found during synoptical radiography in every case. Ultrasound of the abdomen was performed in 79 (88.7 %) cases. In 76 (96.2 %) patients was determined the phenomenon of “fluid sequestration” in the lumen of the small intestine with hyperpneumatosis and intestine content reciprocates. Wall thickening in the adducent department with visualization of folds and increase of intestine diameter was diagnosed in 73 (92.4 %) patients. In 17 (21.5 %) patients revealed free fluid in the abdomen with a lapse peristalsis, indicating the development of peritonitis. In order to monitor the effectiveness of conservative treatment ultrasound of the abdominal cavity was performed in second time to 43 patients. During surgery in all observations diagnosis of acute obstruction was confirmed. The volume of operations is primarily determined by the degree of morphological changes in the part of colon and by diagnosed cause of the disease. Ultrasound method has advantages over currently leading radiological method in the detection of obstruction signs, in determining the dynamics of the disease due to greater information content and safety for patients.

ultrasound, acute intestinal obstruction

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«Bulletin of problems biology and medicine» Issue 3 part 2 (111), 2014 year, 179-182 pages, index UDK 616. 34­007. 272­07