���Գ����������Գ�����

1　假性肠梗阻假性肠梗阻 (ｉｎｔｅｓｔｉｎａｌｐｓｅｕｄｏ -ｏｂｓｔｒｕｃｔｉｏｎ)是以肠道不能推进其内容物通过非梗阻性肠腔为特征的胃肠动力紊乱。是一组具有肠梗阻症状和体征 ,但无机械性肠道阻塞证据的临床综合征。本病可发生于小肠、结肠以及整个消化道 ,经常累及所有受自主神经调节的脏器和平滑肌1 1　假性小肠梗阻急性假性小肠梗阻常发生于手术后 ,故有术后肠麻痹、麻痹性肠梗阻和痉挛性肠梗阻之称。慢性假性小肠梗阻(ｃｈｒｏｎｉｃｉｎｔｅｓｔｉｎａｌｐｓｅｕｄｏ -ｏｂｓｔｒｕｃｔｉｏｎ ,ＣＩＰＯ)远较急性者复杂。现…     

Prevention of dynamic intestinal obstruction in children with peritonitis

In order to prevent the development of the dynamic intestinal obstruction the prolonged peridural blockade, intravenous and intraaortal injection of the solution of novocain were used with reference to the phase of the pathological process. Results of the examination of 200 patients has shown that these measures facilitate passage of flatus and stools, shortens the staying of the patients at the hospital and reduces the amount of postoperative complications and lethality.     

Pathogenetic mechanisms of peritonitis in acute small intestinal obstruction

Microscopic changes in the walls of strangulated small intestine, morphology of their vascular and resorption elements, adaptive mechanisms were studied in experimental acute small intestinal obstruction. It is demonstrated that the main factor of pathogenesis of peritonitis in strangulate and obstructive small intestinal obstruction is morphofunctional changes of intraorganic microcirculation of the small intestine.     

Pathogenesis of the failure of intestinal anastomosis sutures in peritonitis]

In the experiment on 60 dogs, it was established that the leading causes of unsatisfactory anastomotic healing in peritonitis were the disorders in hemocirculation and morphologic changes in the intestinal wall. This causes unsatisfactory healing of the inverted anastomoses, especially the multilayer ones. The everted suture with wide adaptation of the least changed submucous layer is the most reliable in these conditions. This permitted to use it in 7 patients with a positive result.     

Acute intestinal obstruction as the first manifestation of tuberculous peritonitis

Aim-Background

A case of dynamic ileus resulting from tuberculous peritonitis (TBP) is presented, which was treated with exploratory laparotomy and administration of antituberculosis therapy. TBP accounts for 0.1–0.7% of all cases of TB and usually presents as a subacute disease. Acute abdomen sometimes complicates TB, mainly because of intestinal perforation or obstruction.

Case presentation

A 20-year-old Pakistani male presented with symptoms and signs of intestinal obstruction. An exploratory laparotomy revealed ascites, small bowel distention due to adhesions around the terminal ileum, whitish nodules covering the inflamed peritoneum and omentum, enlarged mesenteric lymph nodes, and a saccular-shaped whitish mass measuring 11x7x5 cm at the right iliac fossa. Adhesiolysis, removal of the abovementioned mass, and an appendectomy was performed, and samples were obtained for microbiological and histological examination. The tuberculin skin test was positive, and since the intraoperative findings were highly suggestive of TBP, initiation of antituberculosis therapy on the 11th postoperative day was decided. Finally, the diagnosis of TBP was established both microbiologically and histologically. The patient successfully completed a 6-month regimen of antituberculosis drugs.

Conclusion

Acute abdomen necessitating exploratory laparotomy is a rare first manifestation of TBP. Early initiation of antituberculosis therapy should take place if intraoperative findings strongly favour the diagnosis of TBP.     

Enteral detoxication of patients with peritonitis and acute intestinal obstruction

Detoxicating therapy is necessary to patients with diffuse purulent peritonitis and acute ileus. One of the simplest methods of detoxication is an intraintestinal administration of sorbents, Enterodesis in particular. The application of this drug reduced toxicity of blood serum controlled by protozoa which facilitated rapid recovery of the intestine function. Most pronounced effect of enterosorption was observed in cases with acute ileus. In more severe cases the dosage of the medicine was greater without visible sequellae in the patients. The effect of detoxication was positive as a whole.     

Functional state of the lungs in toxemia in peritonitis and acute intestinal obstruction

On the basis of examination of 214 patients, it was established that the pronounced intoxication syndrome developing in peritonitis and acute ileus led to disorders in the non-respiratory pulmonary functions. This contributes to the development of arterial hypoxemia, hypocapnia and acute respiratory failure. In the complex of treatment of the patients, it is expedient to use extracorporeal desintoxication.     

Pathogenesis of experimental peritonitis

It was found that joint action of two independent factors is necessary for the development of peritonitis. They are: prolonged infection of the abdominal cavity and an inflammatory process caused by an extraperitoneal source. Investigations of the endogenous intoxication, system of regulation of the aggregate state of blood, immunity, esterase and antitrypsin activity in dynamics of the development of experimental peritonitis and septic shock were performed.