Adhesive intestinal impassability
Adhesive intestinal impassability – frustration of a passage of contents of a digestive tract as a result of formation of rough cicatricial unions in an abdominal cavity. Pathology is caused by various reasons, but most often is a consequence of surgical intervention. The disease is characterized by strong pain and an asymmetric abdominal distension, vomiting, impossibility of an otkhozhdeniye of gases and a chair, gradual increase of symptoms of intoxication. Diagnostics consists in carrying out a survey X-ray analysis of abdominal organs, ultrasonography, KT and MPT. Tactics depends on a form of pathology and time of its emergence; as a rule, repeated operation is carried out.
Adhesive intestinal impassability
Adhesive intestinal impassability – the violation of advance of food masses and digestive juice on intestines connected with formation of solderings. It is quite widespread pathology which is a serious problem of surgery and gastroenterology, it occupies about 30-40% among all types of intestinal impassability. It is shown equally often both at men, and at women, irrespective of age. Relevance of a disease considerably increased recently because of growth of quantity and volume of surgeries on abdominal organs. According to many authors, about 40% of all operations are followed by emergence of solderings, at the same time to 60% of all laparotomies is carried out concerning adhesive intestinal impassability.
Reasons of adhesive intestinal impassability
Traumatic damages, bleeding in an abdominal cavity, digestive tract ischemia, foreign matters, negative impact of toxins, purulent processes of an abdominal cavity (peritonitis, appendicular abscess and so forth), surgeries during which there are peresushivany peritoneums (most often it is appendektomiya, operations for pathology of a uterus and appendages), genetic predisposition can be the reasons of formation of solderings.
The mechanism of formation of solderings is explained by disorder of processes of a rassasyvaniye of inflammatory elements and their replacement with connecting fabric. It is known that the peritoneum in response to a trauma and any influence produces exudate which has sticky properties. Soyedinitelnotkanny fibers are formed of its cages, fibrin which has to resolve upon termination of healing processes gradually drops out. If it does not occur, it sprouts collagenic and elastichesky fibers, vessels – solderings are so formed.
Symptoms of adhesive intestinal impassability
Adhesive intestinal impassability is subdivided into three look: obturatsionny, strangulyatsionny and combined (with signs of mechanical and dynamic type: usually develops in case of formation of solderings between the inflammation center in an abdominal cavity and intestines loops). Also allocate a supersharp, sharp and chronic form of pathology which differ in the development speed, severity and expressivenesses of symptoms.
The Obturatsionny type of pathology is caused by a sdavleniye of loops of intestines solderings, but at the same time they do not break its blood supply and an innervation. Pain appears suddenly, they are connected with strengthening of a vermicular movement and have pristupoobrazny character. Time of emergence of vomiting with impurity of bile and greens depends on obstacle level: the impassability is higher, the vomiting develops quicker. At the patient the uniform abdominal distension is defined, the otkhozhdeniye of gases is broken, there are locks. The doctor can see an intestines vermicular movement through a belly wall and define strengthening of noise.
Strangulyation is characterized by a sdavleniye of a bryzheyka of intestines and is complicated by a necrosis of a digestive tract. Clinical signs develop sharply and suddenly: there is severe pain in a stomach without accurate localization, pallor of integuments, the patient cannot find a comfortable position, refuses food. The necrosis of intestines can cause subsiding of symptoms, but only for a short time. Vomiting without impurity, it has reflex character and is caused by a trauma of a bryzheyka. Gradually there is a delay of an otkhozhdeniye of gases and a chair. Symptoms of toxicosis accrue promptly (increase of pulse, differences of arterial pressure, weakness, dizziness, dehydration, etc.). In the beginning the stomach soft, but painful cider causes tension of muscles of a stomach. The vermicular movement is invisible with the naked eye.
Adhesive intestinal impassability, as a rule, is a complication of surgical manipulations, at the same time it can develop in different terms. At patients with heavy peritonitis pathology is registered in the first days after operation. Serious condition of patients and the expressed symptoms of the main pathology mask impassability symptomatology. Patients are disturbed by periodic skhvatkoobrazny pains, vomiting. Gradually the asymmetric abdominal distension develops. The palpation is painful, touches to muscles cause strengthening of pain. The chair is absent.
Adhesive impassability sometimes develops for 5-13 day after operation and improvement of the general state, or on 3-4 week. At the same time distinct symptoms of a disease are observed: intensive periodic pains, frequent vomiting with bile impurity, asymmetrically blown up stomach, a visible vermicular movement, the strengthened intestinal noise. The symptomatology gradually accrues, the independent chair disappears and sharply the condition of the patient worsens.
If the disease developed through a long period after the surgical procedure, speak about late adhesive intestinal impassability. Pathology is characterized by sudden emergence of skhvatkoobrazny pain, frequent vomiting, strong concern and the compelled position of the patient. Gases and a chair independently do not depart. The stomach which is asymmetrically blown up touches to it strengthen pain attacks, the vermicular movement of loops of intestines is clearly visible. At the patient symptoms of intoxication quickly accrue.
Diagnostics of adhesive intestinal impassability
It is possible to suspect adhesive intestinal impassability on the basis of clinical signs and data of the anamnesis on the previous abdominal organs operation. Radiological are considered as the main methods of diagnostics: a X-ray analysis of an abdominal cavity survey and after contrasting of intestines a barium sulfate suspension. These researches allow to define stretching of loops of intestines, Kloyber's bowl (the inflated sites of a digestive tract containing liquid and gases), blackout of the lower departments of a stomach, a contrast delay in separate loops and so forth.
In recent years even more often as methods of diagnostics a laparoscopy, ultrasonography of abdominal organs, KT and MPT are used. They help the gastroenterologist and the surgeon to establish the pathology reason, and also severity and a type of damages.
Treatment of adhesive intestinal impassability
Therapeutic procedures depend on type of pathology and time of its emergence, and also the general condition of the patient, associated diseases. Treatment of early adhesive intestinal impassability needs to be begun with conservative methods which allow to restore functions of a gastrointestinal tract and quite often are preoperative preparation. It is very important to calculate correctly the admissible period of conservative therapy, and in the absence of positive results to perform operation at once.
At registration of early symptoms of a disease to all patients appoint the parenteral (intravenous) foods, and also the actions improving an intestines vermicular movement, preventing development of intoxication and normalizing the general state. If symptoms of a disease appeared for 2-3 days after the surgical procedure against the background of paresis of intestines and peritonitis, then it is necessary to liquidate a paretic component of impassability: for this purpose enter into peridural space. Together with it appoint washing of a stomach, siphon enemas, intravenously pour in hypertensive solution of sodium of chloride and . All above-stated procedures are carried out courses (about 2-3) within 24 hours. In the absence of positive dynamics in 5-6 hours after purpose of therapy carry out a laparotomy.
At suspicion on early strangulyatsionny impassability short-term conservative treatment, and then carrying out operation with the subsequent supporting therapy and leaving is shown. Treatment of late impassability always surgical, delay can cause necrotic changes of walls of intestines. Before the surgical procedure carry out preparation: wash out a stomach, do a siphon enema, enter . If in 2-3 hours pain abates, symptoms of pathology disappear, then leave the patient in office under observation and appoint anti-adhesive therapy. Otherwise at once perform operation on separation of solderings, imposing of a roundabout anastomoz or a resection of the site of intestines (the type of intervention is selected individually).
If the patient was taken to hospital in a serious condition, appoint intensive therapy for elimination of symptoms of intoxication, the minimum preoperative preparation and at once start the surgical procedure.
Prevention and forecast of adhesive intestinal impassability
Prevention of adhesive intestinal impassability consists in careful carrying out operation, prevention of a peresushivaniye of a peritoneum and introduction of dry medicines, timely evacuation of blood and alien objects. After operation the physical therapy gives good effect: UVCh, electrophoresis, and also physiotherapy exercises and observance of a diet. The forecast of adhesive intestinal impassability when performing timely diagnostics and rational therapy favorable, but the probability of a recurrence of pathology is high.