Surgery

doi: 10.25005/2074-0581-2018-20-4-436-441
INTUBATION OF THE SMALL INTESTINE AS A COMPONENT OF TREATMENT OF ACUTE STRANGULATED SMALL BOWEL OBSTRUCTION

K.M. Kurbonov1, K.R. Nazirboev1, N.M. Daminova2

1Department of Surgical Diseases № 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Department of General Surgery № 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: Improving the results of treatment of patients with acute strangulated intestinal obstruction (ASIO).

Methods: Analyzed the results of complex diagnostics and surgical treatment of 49 patients with ASIO. In 20 (40.8%) observations, the cause of ASIO was the acute adhesive small intestinal obstruction, 12 (24.5%) – intussusception, 10 (20.4%) – nodulation and 7 (14.3%) – volvulus of small intestine.

Results: Established that as the syndrome of enteric insufficiency progresses, observed an increase in endotoxemia levels. Thus, with the syndrome of enteric insufficiency of II and III degrees, the leukocyte index of intoxication (LII) was 6.23±1.16 units and 8.62±2.51 units, respectively, medium-mass molecules (MMM) – 0.587±0.25 conv. units and 0.838±0.06 conv. Units, respectively, and blood lactate levels were 2.8±0.04 μmol/l and 3.1±0.06 μmol/l, respectively. At a severe and extremely severe increase in intra-abdominal pressure, the level of MMM reached 0.1104±0.53 conv. units and 0.1274±0.78 conv. units, respectively, blood lactate – 2.5±0.02 μmol/l and 3.1±0.04 μmol/l, respectively, and LII – 6.24±1.18 units, and 8.60±2.53 units, respectively. Performed various kinds of surgery with intubation of the small intestine with subsequent decompression and gut lavage, which effectively reduced endotoxemia and indices of intra-abdominal pressure, and also reduced the incidence of enteroenteroanastomosis insufficiency. Four observations have suppuration of the laparotomic wounds, in 2 patients – subhepatic abscess and in 1 – entero-enteroanastomosis nsufficiency. Two elderly patients died of peritonitis (n=1) and acute myocardial infarction (n=1).

Conclusions: Intubation of the small intestine with the implementation of hypothermic sanation allows effective removal of toxic intestinal content and prevents the risk of entero-enteroanastomosis nsufficiency.

Keywords: Acute intestinal obstruction, enteral insufficiency, intubation of intestine.

Download file:


References
  1. Altiev BK, Atadzhanov ShK, Isabaev ShB. Problemy diagnostiki i lecheniya ostroy spaechnoy tonkokishechnoy neprokhodimosti [Problems of diagnosis and treatment of acute adhesive intestinal obstruction]. Vestnik ekstrennoy meditsiny. 2010;1:88-92.
  2. Vlasov AP, Saraev VV, Shibitov VA, Abroskin BV, Vlasov PA. Optimizatsiya operativnogo lecheniya ostroy kishechnoy neprokhodimosti [Optimization of surgical treatment of acute intestinal obstruction]. Meditsinskiy al’manakh. 2013;5:135-8.
  3. Kurbonov KM, Dzhonov BN. Sovremennye tekhnologii v diagnostike i lechenii spaechnoy tonkokishechnoy neprokhodimosti [Modern technologies in the diagnosis and treatment of adhesive intestinal obstruction]. Vestnik Avitsenny [Avicenna Bulletin]. 2012;4:35-8.
  4. Pugaev AB, Negrebov MG, Achkasov EE, Aleksandrov LB, Ba MR, Andreychikov AA. Morfologicheskie izmeneniya tonkoy kishki pri ostroy strangulyatsionnoy tonkokishechnoy mekhanicheskoy neprokhodimosti [Morphological changes in the small intestine in acute strangulation of small intestine mechanical obstruction]. Klinicheskaya meditsina. 2015;4:56-61.
  5. Khadzhibaev AM, Khodzhimukhamedova NA, Khadzhibaev FA. Diagnostika i lechenie kishechnoy neprokhodimosti [Diagnosis and treatment of intestinal obstruction] Kazanskiy meditsinskiy zhurnal. 2013;94(3):377-81.
  6. Meier RP, de Saussure WO, Orci LA. Clinical outcome in acute small bowel obstruction after surgical or conservative management. World J Surg. 2014;38(12):3082-8.
  7. Kurbonov KM, Nazirboev KR, Yorov SK. Korrektsiya sindroma enteral’noy nedostatochnosti u bol’nykh rasprostranyonnym peritonitom [Correction of the syndrome of enteric insufficiency in patients with widespread peritonitis Vestnik poslediplomnogo obrazovaniya v sfere zdravookhraneniya. 2017;1:38-42.
  8. Dibirov MD, Rodionov IE, Kakubava MR, Yuanov AA, Ramazanova YuI, Ashimova AA, i dr. Korrektsiya vnutribryushnoy gipertenzii i mikrotsirkulyatsii u bol’nykh ostroy kishechnoy neprokhodimost’yu starcheskogo vozrasta [Correction of intra-abdominal hypertension and microcirculation in patients with acute intestinal obstruction of senile age]. Moskovskiy khirurgicheskiy zhurnal. 2012;3:9-14.
  9. Takha KhD, Allniazi AE, Inyutin AS, Amakhanov AK. Osobennosti techeniya sindroma enteral’noy nedostatochnosti na fone ostroy abdominal’noy patologii [Features of the course of the syndrome of enteric insufficiency on the background of acute abdominal pathology]. Permskiy meditsinskiy zhurnal. 2015;3:29-34.
  10. Lee RK. Intra-abdominal hypertension and abdominal compartment syndrome: a comprehensive overview. Crit Care Nurse. 2012;32(1):19-31.
  11. Sheyanov SD, Kharitonova EA, Zukhraeva ZI. Diagnostika ostroy spaechnoy kishechnoy neprokhodimosti metodom izmereniya vnutribryushnogo davleniya [Diagnosis of acute adhesive intestinal obstruction by measuring intra-abdominal pressure]. Vestnik khirurgii. 2012;171(5):24-30.
  12. Izmaylov SG, Lukoyanychev EE, Orlinskaya NYu. Algoritm korrektsii vysokogo vnutribryushnogo davleniya pri ostroy tonkokishechnoy neprokhodimosti [Algorithm for correction of high intra-abdominal pressure in acute intestinal obstruction]. Meditsinskiy al’manakh. 2012;2:171-4.
  13. Mendel NA, Volostnikov EV, Plotnikov YuV. Effectivna li intubatsiya kishechnika pri ostroy kishechnoy neprokhodimosti? Starye dogma i evolyutsiya vzglyadov [Is intubation effective in acute intestinal obstruction? Old dogma and the evolution of views]. Vestnik khirurgii. 2013;172(4):100-4.
  14. Achkasov EE, Negrebov MG, Ba MR, Aleksandrov LB. Osobennosti taktiki lecheniya bol’nykh s ostroy tonkokishechnoy mekhanicheskoy neprokhodimost’yu [Features of treatment tactics for patients with acute small intestine mechanical obstruction]. Uspekhi sovremennogo estestvoznaniya. 2015;1 (4): 555-60.
  15. Volkov DV, Tarasenko VS, Krasikov SI. Korrektsiya sindroma enteral’noy nedostatochnosti u bol’nykh s kishechnoy neprokhodimost’yu [Correction of the syndrome of enteric insufficiency in patients with intestinal obstruction]. Astrakhanskiy meditsinskiy zhurnal. 2013;8(1):53-6

Authors informations:

Kurbonov Karimkhon Murodovich, Academician of the Academy of Medical Sciences of the Republic of Tajikistan, Doctor of Medical Sciences, Full Professor, Professor of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University

Nazirboev Kakhramon Ruziboevich, Candidate of Medical Sciences, Assistant of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University

Daminova Nigina Madamonovna, Doctor of Medical Sciences, Assistant of the Department of General Surgery № 1, Avicenna Tajik State Medical University

Address for correspondence:

Kurbonov Karimkhon Murodovich,
Academician of the Academy of Medical Sciences of the Republic of Tajikistan, Doctor of Medical Sciences, Full Professor, Professor of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University

Nazirboev Kakhramon Ruziboevich,
Candidate of Medical Sciences, Assistant of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University

Daminova Nigina Madamonovna,
Doctor of Medical Sciences, Assistant of the Department of General Surgery № 1, Avicenna Tajik State Medical University

Materials on the topic: