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  • Title: [ABOUT THE ROLE OF DIGESTIVE TRACT DECOMPRESSION IN PATIENTS WITH ACUTE BOWEL OBSTRUCTION. MISTAKES, COMPLICATIONS AND THEIR PREVENTION].
    Author: Benedykt V.
    Journal: Georgian Med News; 2017 Jun; (267):103-110. PubMed ID: 28726665.
    Abstract:
    The purpose of the work is improvement in treatment of patients with acute small bowel obstruction by justification for gastrointestinal decompression and different methods of small intestine intubation for effective evacuation of itscontents. We conducted morphological and morphometric study of the small intestine in 53 white rats. It was established that acute small bowel obstruction causes expansion of all parts of small bowel microvasculature with significant lesions of venous structures. We revealed thinning of intestinal muscular layer 2.15 timesand increase of submucosallayer 1.65 times. Changesin nuclear/cytoplasmic ratioof these structures showed tension and instability in structural homeostasis at cellular level. These changes lead to malabsorption and require evacuation of intestinal pathological contents. We analyzed 30 medical records of patients who died from acute small bowel obstruction. Decompression was performed only in 60.71% ofall cases and in 50.0% of re-laparotomy cases. The cause of death in 80.0% was syndrome of multiple organ failure due to progressiveintoxication caused by functional obstruction of the small intestine. 196 patients were operated. In 50% of cases nasointestinal intubation was used for small bowel decompression, in 11.22% - intraoperative one-stage evacuation of intestinal contents and in 3.57% - "open" methods of intestinal drainage. We drew attention to problems and errorsin performingsmall bowel intubation. We offered some variants of intubation using different probes according to the operating situation and aim of intubation. Design of probe for intubation and method of enterostomy was suggested. We also offered an algorithm for selectionof small intestinal decompression method in patients with acute small bowel obstruction depending on the operating situation. We emphasizethat intestinal decompression in patients with acute small bowel obstruction improves the results of surgery.
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