Adhesive disease – the disease caused by education soyedinitelnotkanny tyazhy between internals and a peritoneum. Pathology is most often connected with the previous operation. Symptoms depend on localization of solderings and their prevalence. Abdominal pains, ponosa or locks, vomiting, pressure drop, temperature increase, weakness are characteristic of the sharp period. Diagnostics consists in careful collecting the anamnesis and complaints, and also carrying out a X-ray analysis of abdominal organs, ultrasonography, MRT, a laparoscopy. Treatment is directed to knocking over of symptoms, prevention of progressing of pathology, at frequent aggravations and a recurrence carrying out operation is shown.
Adhesive disease - the pathological state caused by formation of soyedinitelnotkanny unions (solderings) in an abdominal cavity. A human body it is unique it is arranged, at a given time it turns on protective mechanisms which can prevent development of heavy complications, but it is reflected in the general state. For the purpose of a protection of healthy bodies from the damaged structures around the pathological center connecting fabric is formed. Of course, it cannot fill the function lost, but allows to fill emptiness and to protect surrounding fabrics from pathology. In the beginning this fabric friable, then it is condensed and sometimes stiffens. And solderings are formed.
Solderings in an abdominal cavity represent soyedinitelnotkanny tyazh which connect a peritoneum and internals. Unions draw bodies and limit their mobility, create conditions for violation of their functions therefore quite often become the reason of serious diseases, for example, of impassability of intestines or female infertility.
Reasons of an adhesive disease
Internals of an abdominal cavity are covered with thin leaves of a peritoneum. Normal they have a smooth surface and sekretirut a small amount of liquid to provide free movement of abdominal organs rather each other. Various provocative factors lead to hypostasis of fabrics and emergence of a fibrinous raid on a peritoneum. Fibrin is an adhesive which promotes compound of nearby fabrics. If at this time not to carry out adequate therapy, then after subsiding of pathological processes on the place of pasting solderings are formed.
Process of formation of unions takes place in several stages: in the beginning fibrin drops out, then in 2-3 days on it there are special cages (fibroblasta) which sekretirut collagenic fibers. The expressed replacement of the inflamed fabrics with connecting begins for the 7th day and comes to an end on 21. For this period of an union turn into dense solderings, in them sprout capillaries and nerves.
Diseases of internals in combination with an operational trauma (in 98% of cases) can be the provocative factors starting the mechanism of an adhesive disease. If join a trauma an infection, blood, drying of a peritoneum, then the risk of emergence of solderings increases.
Bruises and injuries of a stomach can start process of an adhesive disease. Stupid mechanical damages quite often are followed by internal bleedings, formation of hematomas, violation of a limfoottok and metabolism in the struck fabrics. It leads to frustration of a blood-groove in a peritoneum and to the beginning of an inflammation with all that it implies. Congenital anomalies and malformations, chemicals, medicines and foreign matters can also cause an adhesive disease.
Symptoms of an adhesive disease
Clinical symptoms of an adhesive disease depend on localization of solderings and prevalence of pathology. The disease can proceed asymptomatically or appear suddenly and sharply with need of urgent hospitalization in office of surgery.
Medical emergencies at an adhesive disease are most often connected with impassability of intestines. In similar situations patients show complaints to intensive pain, nausea, vomiting, temperature increase of a body. The palpation of a stomach causes sharp pain, besides the patient cannot define their exact localization. The disease exerts strong impact on an intestines vermicular movement: its strengthening with development of a diarrhea or, on the contrary, weakening before total disappearance is possible that leads to emergence of locks. Repeated vomiting sharply worsens a condition of patients and causes dehydration, it is combined with falling of arterial pressure, sharp weakness and fatigue.
Sometimes symptoms of an adhesive disease have periodic character, appearing, suddenly disappearing. In this case the patient is disturbed by pains in a stomach, a lock or diarrhea. If clinical manifestations are poorly expressed, occasionally there is an aching pain and insignificant disorders of intestines, then speak about development of a chronic adhesive disease. Most often gynecologists as adhesive process can affect internal genitals face similar states, exerting negative impact on menstrual function and ability to a child-bearing.
Diagnosis of an adhesive disease
The surgeon can suspect an adhesive disease during primary survey of the patient in the presence of characteristic complaints, the previous inflammatory diseases of abdominal organs, operational procedures and infectious pathology. Diagnostic actions mean carrying out a laparoscopy, ultrasonography and MSKT of abdominal organs, a X-ray analysis, an elektrogastroenterografiya.
Laparoscopic research – the most informative method of diagnosis of an adhesive disease. It is in essence the microoperation consisting in performance of small cuts, introduction to them of special tools with the camera which allows to carry out video visualization of internals. It not only diagnostic procedure: after detection of a problem it is possible to perform surgery for treatment of an adhesive disease at once.
The survey X-ray analysis of an abdominal cavity plays a large role in diagnosis of an adhesive disease. The method allows to find inflammatory exudate in an abdominal cavity, the increased gas generation in intestines and its swelling. Often the research is conducted with use of contrast substance for definition of impassability of intestines. Elektrogastroenterografiya means measurement of electric signals from different departments of a digestive tract during its reduction. Ultrasonography and MRT of abdominal organs – the exact methods allowing to define an arrangement of solderings and their prevalence.
Treatment of an adhesive disease
Treatment of an adhesive disease consists in holding conservative and surgical procedures. Conservative therapeutic actions are directed to prevention of formation of solderings and their negative consequences, and also knocking over of symptoms. Surgery is carried out at sharp medical emergencies, a constant recurrence of pathology and frequent aggravations.
At the beginning of conservative treatment of an adhesive disease first of all stop pain. It can achieve by carrying out a cleaning enema (if pain is connected with locks and a delay of gases), imposing of heat on a stomach, reception of spazmolitik. It is possible to solve a problem of locks purpose of the special diet enriched with products which strengthen a vermicular movement (any errors in food can cause a sharp exacerbation of pathology). If it does not help, appoint light laxative medicines and physiotherapy: diathermy, paraffin applications, , mud cure. To patients recommend to exclude physical activities to prevent muscles spasms which cause strengthening of pain. For elimination of vomiting appoint antiemetic medicines, and also use intravenous solutions for removal of symptoms of dehydration.
Surgical interventions at an adhesive disease are quite difficult, besides they mean serious preoperative preparation. Very often operations do concerning medical emergencies: training of such patients is transient, but is always full. The patient pour plasma, solution of chloride of sodium, Ringera-Locke, a sodium hydrocarbonate for elimination of symptoms of dehydration and normalization of the acid and main condition of blood. For the purpose of a detoxication enter salt solutions, with Prednisolonum or a hydrocortisone.
Old hems on skin from the previous operation do not excise as it can lead to complications as loops of intestines are soldered to a hem. Solderings delete, divide, move apart. The choice of a method depends on a concrete situation. If sites of a necrosis of intestines are found, then rezetsirut the damaged area, and restore passability or impose Stomu. At the solderings deforming intestines form roundabout . Similar manipulations are shown in the presence of a dense conglomerate of loops, but sometimes rezetsirut this site.
During operation observe the main measures for prevention of a recurrence of a disease: do wide cuts, prevent drying of leaves of a peritoneum, carry out a full-fledged stop of bleedings and in due time delete blood, exclude hit in a wound of alien objects; do not bring dry antiseptics and antibiotics in a wound, for sewing together use polymeric threads. After operation vnutribryushinny introduction of proteolytic enzymes, purpose of anti-inflammatory and antihistaminic medicines, carrying out stimulation of a vermicular movement is shown. It should be noted that surgical manipulations in 15-20% of cases lead to repeated formation of solderings therefore it is worth approaching a question of therapy after careful consideration.
Prevention and forecast of an adhesive disease
The forecast at single solderings favorable, but multiple damages are caused by negative consequences. It is possible to prevent development of an adhesive disease, performing a number of simple operations: it is necessary to lead the correct life, it is full and rational to eat, play sports. It is impossible to allow the periods of long starvation alternating with overeating attacks. It is important to watch a chair regularity, and also to provide full digestion, carrying out prevention of diseases of digestive tract and having regular examinations at the gastroenterologist. In many respects prevention of an adhesive disease depends on competence of doctors, observance by them of the equipment and rules of operation, purpose of adequate therapy.