Instrumental Diagnostics and Treatment of Acute Adhesive Bowel Obstruction

Abstract

© 2020, Springer Science+Business Media, LLC, part of Springer Nature. Despite advances in medicine, acute adhesive bowel obstruction (AABO) continues to be one of the most difficult problems of emergency abdominal surgery. The study was based on the results of treatment of 150 patients with AABO from 2016 to 2018. Age of patients was from 16 to 96, Ме = 55 (38–70), men were 55 (36.6%), and women were 95 (63.3%). In the first 12 hours from the onset of the disease received 70 (46.7%) patients, from 12 to 24 hours – 30 (20%), in 50 cases (33.3%) patients were admitted a day or more after the onset of the disease. Patients had complex examination with clinical, laboratory, and radiological tests. According to the indications, CT scan and laparoscopy were performed. All patients had intra-abdominal pressure monitoring. Based on data obtained from information of ultrasound picture, the “enteral index” was offered by authors. It reflected the degree of structural and functional disorders in the small intestine. For more visual representation of the prevalence of the adhesive process, the authors during the US examination divided the anterior abdominal wall into 4 sectors (S). Early postoperative AABO were diagnosed at 9 (6%) patients. Sixty-three (42%) patients were operated. With a diffuse adhesive process, adhesiolysis was performed by laparotomy, with a local laparoscopy. Laparotomy was performed at 16 patients. Laparoscopy was performed at 47 cases, of which 43 (91.5%) patients had successful results of adhesiolysis. The new therapeutic and diagnostic algorithm allowed to reduce the duration of the diagnostic stage for adhesive bowel obstruction with strangulation up to 3 h (2.75–3.25), and it determined the indications for surgery in a timely manner. The rate of postoperative complications was 14.3%, postoperative mortality was 7.9%, and “good” long-term treatment results were obtained in 64.9% of patients