Tactics of the surgical treatment of acute intestinal obstruction]

The results of treatment of 184 patients with acute ileus of non-tumour genesis operated on at the clinic within the period of from 1981 to 1990 are presented. In elimination of ileus without the surgical intervention, together with intensive therapy, intestinal decompression was used. Of 19 patients with acute ileus associated with peritonitis operated on, 12 underwent resection of the intestine. The use of enterosorption as well as extracorporeal hemosorption contributed to elimination of endogenous intoxication.     

Tactics in cholelithic intestinal obstruction

Tactical manipulations in cholelithic intestinal obstruction are analysed. The authors had 4 cases with cholelithic intestinal obstruction, in one of them obstruction with a gallstone occurred again on the 23rd postoperative day. Relaparotomy, correction of the obstruction, and cholecystectomy with one-stage removal of a biliodigestive fistula had to be conducted. It is pointed out that in obstruction of the intestine with a gallstone correction of the obstruction is a more sparing operation than one-stage cholecystectomy and removal of a biliodigestive fistula. With the use of this tactics there were no fatal outcomes.     

Indications for relaparotomy in acute postoperative intestinal obstruction]

For the period of 1977-1987, operations on the abdominal organs were performed in 13,306 patients. Of them, 115 (0.86%) developed 1 to 21 days after the operation acute ileus requiring the performance of emergency relaparotomy. Lethality in this complication was 33.9%. A retrospective analysis of 103 case records and observations on 12 patients who underwent at the early postoperative period emergency laparotomy for acute ileus were performed. The data were entered on a formalized card. The material was processed by means of a computer. The integral criteria for diagnosis of acute postoperative ileus which permitted to predict with an accuracy of 99% the complication serving an indication for relaparotomy were developed.     

T-shaped anastomosis in treating acute intestinal obstruction in newborn infants

Newborns with the ileus caused by developmental defects of the digestive tract have, as a rule, suprastenotic dilatations of all the intestine or a considerable part of it higher than the ileus zone and a great difference in the width of the lumen of the intestine portions left after resection of the injured area. In the Center of Developmental Defects of Newborns 190 patients with ileus have been treated for the recent 10 years. In 37 cases T-shaped bypass anastomosis was used which has considerable advantages over "dead" anastomosis. T-shaped ileostomy allows unloading the dilated adducting part of the intestine overfilled with the contents in early terms after operation and simultaneously fulfilling "the feeding" into the abducting part of the intestine.     

Experimental study of selective mesentericography in acute intestinal obstruction]

Experimentally on 76 animals (dogs) the authors have studied some diagnostic opportunities of angiography in various forms of acute intestinal obstruction: strangulation, obturation and paralytic (in peritonitis) types. Angiographic symptoms of an organic origin proved to be mainly typical for strangulation obstruction. Symptoms of a functional character reflecting disorders in mesenteric hemocirculation were found to be equally pronounced in all kinds of intestinal obstruction, these consisted in a retarded linear rate of arterial and venous blood flow, in particular.     

Anesthesia for patients with intestinal obstruction]

The pre- and intra-operative care of patients with acute intestinal obstruction is reviewed. The most important pre-operative problems are hypovolaemia, sepsis, electrolyte and acid-base imbalances. The evaulation and treatment of these disorders are discussed. The importance of preventing regurgitation and inhalation of stomach contents is emphasised and the methods which are used are described. The safest techniques of induction and maintenance of anaesthesia as well as muscle relaxation and intra-operative fluid therapy are indicated.     

Laparoscopy in acute intestinal obstruction

The results of the use of emergency laparoscopy in 78 patients are presented. Of 25 patients with clinical signs of acute ileus (AI), the diagnosis was confirmed in 12, of 42 with suspected AI--in 14. In 11 cases, AI was a laparoscopic finding. In 18% of the cases, no changes in the internal organs were revealed at investigation, in 30.8%--the other diseases of the abdominal organs were diagnosed. In 6 patients, AI was dynamic, in 8--strangulative, in 23--obstructive. Laparoscopic investigation performed in 94.9% of cases permitted to establish the accurate diagnosis.     

Acute cholelithiasic intestinal obstruction]

The paper presents the data of diagnosis, clinical picture and surgical treatment of 8 patients with acute cholelythic ileus. The authors describe the specific features of the clinical course of the disease and emphasize high diagnostic value of general rentgenography of the abdomen for the recognition of this complication. Operations in acute cholelythic ileus are characterized. Prevention of such pathology is dependent on timely surgery for such patients.     

Combination therapy of acute intestinal obstruction

The article discusses the results of complex surgical treatment of 108 patients with acute intestinal obstruction which was caused by benign lesions in 64 and by malignant tumors of the rectum in 44 patients. Twenty-three persons (21.2%) died after palliative and radical operations. The main causes of death were intoxication (52.2% of fatal cases) and peritonitis (26.1%). Hemosorption is the most effective measure for the prevention and treatment of the endogenous intoxication syndrome in the postoperative period. A brief therapeutic effect or inefficacy of hemosorption is evidence of persistence of the pathological process in the abdominal cavity.