The intestinal obstruction is needed if the operation is needed. Operation with intestinal obstruction

The obstruction of the intestine is a formidable complication of surgical diseases. The inflammatory process of internal organs can paralyze the intestine motorcy, and the tumor is to make it difficult to promote feast masses. This will inevitably lead to body intoxication and fatal outcome. So what to do with intestinal obstruction? Let's figure it out.

Classification

To speak in one language with doctors, let's start with the Azov. What types of intestinal obstruction are:

1. Mechanical;
2. Dynamic.

In mechanical obstruction, an physical obstacle arises to the promotion of carts. The intestinal lumen can overlap something (obtuational) or to overcene the outside (steady). Such intestinal obstruction may occur after any operation on the organs abdominal cavity and small pelvis.

With a dynamic type, the movement of the intestine loops is disturbed. There is a spasm (spastic) or, on the contrary, relaxation (paralytic). This problem should be expected in any inflammatory processes in the abdominal cavity.

The reasons for intestinal obstruction are listed in the table.

Symptoms

By the location of the "obstacles" distinguish high (subtle) and low (thick-current) obstruction. They will have different symptoms.

Simple Ileus

Thin intestinal obstructionit is always developing sharply with a turbulent clinical picture: intoxication, vomiting in intestinal content, unbearable grasp abdominal pain, rapid dehydration of the body. The chair at the same time is one-time, but the gases are no longer departed. Due to the loss of electrolytes with vomiting and urine, heart failure develops, muscle tone is disturbed.

Tolstock obstruction

Most often the obstruction of the colonmeets in the elderly.

Callery "danks", as they are called surgeons, mainly accumulate in the finite sections of the colon, straight and sigmoid. The clinical picture is developing gradually.

The first thing that pays the patient is the absence of stool and gases. The stomach slowly increases in size, often asymmetrically. The pain gradually increases, the body temperature can increase.

A few days later the patient's condition will be hard. Dehydration and intoxication increases, vomiting with fecal content can begin.

Diagnostics

What to do if the intestinal obstruction is suspected of the elderly? It is strictly prohibited by self-medication. In the event of the above symptoms, do not take the laxatives. This is the case when the delay of death is like. The presumptive diagnosis of ambulance doctor, which necessarily hospitalizes the patient.

In the reception room of the hospital, the first study will be an overview radiography of the abdominal cavity. On N.invidence of the colon in the pictureindicate: bloated intestinal loops, bowbeler bowls and liquid levels in the small intestine. Also on the radiograph can also be detected. For example, a metallic foreign body or tumor.

It is important to note that the conduct of irrigography is contraindicated to clarify the reasons for obstruction. If the punching of the wifth of the intestine became the wilt of sharp pain in the stomach, then the contrast can pour into the abdominal cavity and worsen the forecast.

The ultrasound of the abdominal organs is a very informative research method for intestinal obstruction. On the screen are visible bloated intestinal loops and reinforced peristalism. A competent specialist can determine the reasons for intestinal obstruction.

With suspected thrombosis of vessels that feed the delicious intestine, angiography is carried out. Conducting this study simultaneously allows you to remove the thrombus and restore blood flow.

Indications for the operation

Surgical assistance in intestinal obstruction It may be emergency (in the first hours of the patient's arrival), urgent (in the first day) and planned.

The emergency surgery is necessary in the adhesive disease, disadvantaged hernia, octuries and mesenteric thrombosis. These states threaten the intestine necrosis, which will result in the removal of non-visual sites.

The urgent surgery, for example, is possible with a wicked invasion and obturation of the intestine in the thorny body. Doctors have time to carry out the necessary diagnostics, evaluate the dynamics and prepare a patient for surgery.

The planned operation is appointed for several months and takes place in a relaxed atmosphere. The patient is fully examined, surgeons and anesthesiologist own all the necessary information. The planned operation is shown at slowly growing tumors and polyps.

Not always the treatment of intestinal obstructionsurgical. For example, with honeystones, surgeons first try to "blur" them with the help of a siphon enema. And only in the case when this is not possible, preparation for the operation begins.

Types of operational interventions

In the arsenal of surgeons there are 3 main operational methods of treating intestinal obstruction: endoscopic, laparoscopic and laparotomic. The last two are used when it is impossible to resolve the reason.

Endoscopy

Removal foreign languages From the colon comes most often endoscopic. After the intestinal cleansing of the intestine with siphon enema, the patient is directed to the colonoscopy.

This method in this case will be diagnostic, and therapeutic. As soon as the foreign body is discovered, it will immediately be deleted. The manipulation of the anesthesia is carried out.

Laparoscopy

This type of surgical intervention is minimally invasive. After it, the shortest recovery period. Literally for 2-3 days, the patient is already discharged home. And "for memory" remains small neat curtains.

Open operation

Every year the number of open operations decreases in favor of laparoscopic. But if there is complications without it, it is not necessary to do without it, because it is impossible to carefully check all the intestinal loops and split the spikes. Access to the abdominal cavity is carried out by a longitudinal cut, passing from a sword-shaped eprove of sternum to pubis. Suchoperation in the obstruction of the intestine is seriously transferred to the patient and requires a long recovery.

Postoperative period

The patient's nation is aimed at preventing early and late postoperative complications. Early occurs within 3 weeks after surgery on the abdominal organs, late - after discharge from the hospital, within 2-3 months.

Early complications

Early postoperative complications are paralytic and mechanical obstruction of the intestine. The first manifests itself within a week after surgery. Over time, the intestinal motor will be restored. But for the period of the alleged complications of the patient during anesthesia through the nose, a long tube is established, which is called a non-sourceal probe. The intestines will be emptied through it and gases depart.

For the prevention of mechanical obstruction of the intestine, antibiotics, anticoagulants and antiagregants are prescribed to patients after surgery. FROMthe intestinal obstruction is prevented by the reception of fibrinolysis activators.This is a modern and effective way to prevent.

At this time, the patient does not eat anything independently. All necessary nutrients are introduced using droppers. Approximately 5 days via the gastric probe introduced a ready-made easiest mixture of nutrients.

Powered with intestinal obstruction becomes possible a week after surgery. The doctor prescribes the table No. 0- liquid oatmeal on the water. The diet is then gradually expanding to the table number 17 or 1. It is allowed to eat liquid homogenized products. Vegetables are only boiled, fruit - baked apples without peel. Such a diet is observed until discharge from the hospital.

Late complications

After surgery on the intestine, you need to carefully follow yourself. Lifestyle is now aimed at preventing constipation that can cause intestinal obstruction. And if resection of the intestine, it is worth paying special attention to its nutrition.

Food should be easy. In almost unlimited quantities, it is possible to eat fermented milk products, boiled vegetables, baked fruits. Fat, fried and smoked products are prohibited. Be sure to drink 1.5-2 liters of pure water per day to maintain water balance.

To be a chair daily, surgeons advise every day to drink a tablespoon of vaseline oil. It does not affect biliary release and is not absorbed in the intestine.

It should be remembered about physical activity. It should be moderate. It is forbidden to raise gravity over 6 kg. Yes recommended yoga and swimming.

Finally

The best surgery with intestinal obstruction that managed to avoid. But there are situations when without surgical treatment can not do. In compliance with all recommendations, the postoperative period will be smooth and without complications. And relapses will be avoided.

18+ video may contain shocking materials!

And. The high probability of extremely severe flow with often inevitable death is made it so dangerous that each doctor should be recognized. Yes, and not only he.

Causes and types of acute intestinal obstruction

Under the term "intestinal obstruction" means a delay or a complete absence of passing the contents of the digestive tube due to a number of reasons. It is on this basis that the disease is mainly separated by:

BUT) Mechanicalat which there is a physical obstacle to the passage of the food lump. In turn, it is divided into:

1. Obstructory KN.arising from intestinal blockage:
   • caliac stones;
   • without calers (lump of hair, accumulating in the stomach basically in ladies who love to bother their own curls);
   • large bile stones;
   • foreign bodies;
   • sleeping intestines from outside with tumors, other localization cysts.
2. StagnayaIn which obstruction is due to:
   • current intestinal loop around himself;
   • the formation of a node of several loops;
   • rebounding the intestine, her mesense and vessels in the hernial gate;
   • spikes or scar shutters, squeezing from the outside.
3. MixedWhile combining both mechanisms - invagination, or the introduction of one part of the intestine to another.

B) D. anamicat which the content of the intestine does not pass on it due to:

1. Permanent spasm smooth musculature;
2. Her persistent paralysis.

Consequences of intestinal obstruction

This disease in the absence of treatment leads to a mass of serious complications. So, turning off the part of the intestine, donating due to the violation of blood supply in it, provokes a violation of digestion and suction of nutrients.

The decrease in the protective functions of the mucous membrane leads to an increase in the permeability of the intestinal wall for bacteria and their livelihoods - severe intoxication occurs, and later bacterial complications: peritonitis, polyorgan failure.

The cessation of suction in the dead intestine concerns water. Insufficient receipt of it into the blood, with frequent vomiting leads to a rapid dehydration of the body.

All these phenomena are developing relatively quickly and for several days lead to an inevitable fatal outcome if the patient is not timely delivered to the surgical hospital.

Symptoms of intestinal obstruction

In the development of the CN, there are three periods, each of which has its own symptoms.

Early period (up to 12 hours)

The disease debuts pain, whose character and intensity differ depending on the type of obstruction. When obturation pain rolling in the form of an attack, lasts a few minutes, after which they felt completely. When they are constant, they are constant, but they change their intensity from moderate, to unbearable, sometimes provoking pain shocks.

Vomiting in this period rarely occurs and only if there is an obstacle at the very beginning of the small intestine.

Intermediate period (from 12 to 24 hours)

After 12 hours after the appearance of the pain, the clinical picture becomes the most bright as possible. Pains cease to be parked with any type of KN, stomach swells, there is a frequent abundant vomiting. Because of this, as well as due to the impossibility of receiving liquids through the mouth, the edema of the intestine and the cessation of water suction rapidly increases dehydration.

Late period (\u003e 24 hours)

During this period, the phenomena of the organism's system response on the existing disease are growing:

• the respiratory frequency increases;
• the body temperature increases, which indicates the increase in the body poisoning with bacterial toxins;
• urine production stops;
• severe disorders of acid-alkaline equilibrium occur;
• there are signs of the defeat of the peritoneum - peritonitis;
• it is possible to develop sepsis.

The termination of the chair and the death of gases is frequent, although not permanent symptom of the KN. It is more pronounced at low obstruction (obstacle in the colon) and much less - at the top obstruction. However, even in the latter case, at the beginning of the peritonitis, paralysis of intestinal motor functions is noted, leading to the stopping of the passage of the path masses along it.

The patient's condition is progressively deteriorating from the medium-free to critical, the increasing tachycardia is observed, the temperature increases gradually to high numbers (sometimes until ultrahigh - in the case of sepsis).

In the absence of treatment, the disease inevitably leads to the development of polyorgan deficiency and death of the patient.

Diagnosis of intestinal obstruction

One objective data on the history of the development of the disease and its symptoms is often not enough to form an accurate diagnosis. Here, equipment and laboratory tests come to the help of doctors:

• Or colonoscopy allow you to clarify the diagnosis in the obstruction of the thick bowel.
• Ultrasound and in some cases give valuable information about, for example, tumors provoked obstruction.
• Laparoscopy is considered a very informative diagnostic method, during which you can directly see the place of obstruction and even spend some medicinal manipulations - to launch the spikes, expand the intestine of the intestine during its break.

Treatment of intestinal obstruction and first aid

In fairly rare cases, with uncomplicated obstructive obstruction, doctors can resort to conservative treatment. This approach is used in the earliest stages when the destruction of the intestinal wall has not yet caused systemic effects. As part of conservative treatment, apply:

• constant pumping of the contents of the stomach and intestines through the probe;
• siphonnemes;
• a colonoscopy that can sometimes eliminate the vibration of the intestine or "breaking" the obstacle, for example, by removing the stone;
• spasmolitis, eliminating intestinal spasm.

In the overwhelming majority of cases, it is still necessary to resort to the operational treatment of intestinal obstruction. This is due to the fact that often the beginning of treatment is discharged due to late circulation or tightened transportation of the patient and late diagnosis of the disease. "Golden 6 hours", during which there is a chance to eliminate obstruction without surgery, turn out to be lost and the patient is on the Surgeon table.

There are many types of operations that allow you to restore the passage of the food lump in the intestine. In some cases, the part of the dead intestine and crosslinking the edges of the cuts is carried out, in other operations are carried out in two stages:

• stoma removal (the upper end of the intestine is removed on the front abdominal wall);
• stitching the ends of the intestine in a few months.

With the improved hernia, plastic is carried out with a hernial gate and the intestinal loop right, if it is viable or removing it in case of necrosis. When the intestine of the intestine, the node is painted and estimated the viability of the intestine. When obstructive obstruction may need an opening of the intestine and removal of calmic stones from it, damasters, etc.

Before the patient's operation, it is prepared for a short time by intravenous infusion of solutions, the same thing happens in the resuscitation separation already after surgery. At the same time, anti-inflammatory drugs are used, funds stimulating the intestinal motor function, and with peritonitis - antibiotics.

The chance of a person for survival with intestinal obstruction directly depends on the speed of rendering medical care. People operated on the first 6 hours after the start of the disease, almost all are recovering, while when the operation spent in a day, each fourth die. Depressing statistics allows you to confidently say one thing - do not pull the time! With a debt of the absence of gases and chairs, the increase in pain and the scrawl of the abdomen immediately call "ambulance". Time is the only currency for which you can buy life with intestinal obstruction.

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Acute postoperative NK - severe and life-threatening patient complication. It is one of the most difficult for recognition and treatment of early postoperative complications in abdominal surgery. Acute early mechanical postoperative NK in the frequency of occurrence and reasons for repeated waste occupies second place, yielding in quantitatively only peritonitis [Z.V. Tishinskaya et al., 1980; GL Ferofilov et al., 1984]. Its specific gravity in the structure of all intra-abdominal complications is 9.1-36.9% [L.G. Certified and et al., 1992; J. Bunt, 1985].

The early postoperative mechanical NK is observed not only after large and severe operational interventions, but also with small operations on the abdominal organs.

The mechanical NK after operation is more often evolving during the first weeks of the postoperative period. Regardless, it develops in women and children.

The predominance of women is explained by the fact that their bowl is observed the development of the early adhesive process, probably due to the exacerbation of inflammation of the appendages of the uterus. Frequent origin This complication in children is explained by the fact that in childhood, due to the special reactivity of the body (pronounced plastic properties of peritoneum), the adhesion process is formed more intensively and, therefore, more often leads to the occurrence of NK in the early postoperative period. At the same time, children are faster and fully the inverse development of postoperative adhesions, which is expressed by a decrease in the frequency of the late adhesive NK.

Etiology and pathogenesis.Among the rather diverse reasons for the development of postoperative NC, pathological spying formations should be noted as a consequence of the inflammatory process or mechanical injury of serous cover, created by new topographic-anatomical relationships of organs resulting from the operation and creating conditions for coordinates, nodes, invagination, as well as technical errors resulting channel Conditions (reducing the intestinal loop in the "created" window or an unpleasant window of a mesenter transverse about K, flashing the rear wall of the anastomosis). The cause of high NK on the basis of the globe mesenter scalp with the stomach cult could be the unreliability of the mesentery of the mesenter with the seam of insufficient tissue. Postoperative NK can also develop on the soil of stenling the output area of \u200b\u200bthe stomach after the embossing FI, etc., the obturation of lumens due to the anastomosites or the outer compression of inflammatory infiltrate, an unforeseen occurrence of one of the sharp forms of the NC, not related to the operation.

The main factors contributing to the development of early postoperative NK are:
1) the insufficient resolution of the NK during the previous operation, when bloated loops of the TC remain in the abdominal cavity;
2) inadequate sanitation of inflammation focus;
3) the presence of blood between the loops of the TC;
4) traumatization of serous cover during the previous operation (tools, tampons, storms, etc.);
5) incorrect laying of the TC in the abdominal cavity during the previous operation;
6) inadequate postoperative period.

In part of patients, the development of postoperative mechanical NK may be due to various types of diagnostic errors made at the first operation (incorrect interpretation of operating finds, insufficiently complete audit of the abdominal organs).

Postoperative NK is most often observed after operations, which are produced against the background of spilled purulent peritonitis. In this regard, the careful intraoperative nesting cavity, draining its pockets and spaces, and the correct adequate drainage of the abdominal cavity is acquired.

In patients, the mechanical NK is often observed after resection of the stomach on the soil of the infringement of the TC in the "window" of the mesentery of transverse ok and the obturation of the guts of the gut with inflammatory infiltrate.

Almost in all cases, the caution of early postoperative NK and repeated waste is becoming the adhesion process (spikes) in the abdominal cavity [N.N. Smirnov et al., 1982; G.P. Rustler and et al., 1987], which is either in the form of a immediate compression of spike, or knee-formation or coast. The formation of intra-abdominal battles occurs due to inflammation, damage to the internal organs during the operation. The formation of adhesions occurs during the organization of Fibrin, which lasts in the first 2-3 weeks [O.B. Pearlbsky, R.I. Life, 1976].

Spikes can be formed everywhere, but the caller NK spikes are usually there in the lower departments of the abdominal cavity [I.F. Evening, 1985; I.P. Belov et al., 1987 et al.] The main reason for the formation of peritoneal battles in the early postoperative period, along with many factors, is the intestinal paresis, which is often incredible from the stage of dynamic NK in the mechanical stage stage. Therefore, the main task in the prevention of mechanical HC should be considered the prevention of the intestinal peristalistic disorders in the early postoperative period. Almost all the causes of the formation of early postoperative adhesions leading to the NC are reduced to bacterial or traumatic (mechanical) damage to the peritoneum. The essence lies in the one of the factors in each particular observation is the dominant (M.M. Kovalev et al., 1978). Among patients with early adhesions in the prevailing majority of cases, fine obstruction occurs, which determines the clinical manifestation of this complication.

Most often (65.2% of cases) Early postoperative NK complicates the course of appendectomy, as well as operations on the stomach and surgical interventions about the injuries of the abdomen (damage to the abdominal organs), acute inflammatory diseases of the small pelvic organs, acute NK, tumors of the thick and small intestine . The probability of the development of the NC is higher than pronounced inflammatory changes in the abdominal cavity in the primary operation.

Early mechanical NK has earned a sad reputation of a cunning complication of the postoperative period, as sheepiness clinical manifestationsThe similarity with the symptoms of the pares is dumping the vigilance of the surgeon and extremely difficult to diagnose this disease.

In the process of spike formation, fibrin plays the main role, gluing the abdominal cavity organs as a result of morphological transformations, gradually turning into a connective tissue formation - spike. Two factors are important in the formation of fibrin: injuries of peritoneum and inflammatory processes in the abdominal cavity. Almost after any operations on the abdominal organs, spikes of varying degrees of severity are formed. Traumatic agents may be a surgeon's hands, surgical instruments, chemical substances, thermal factors (washing the abdominal cavity by hot solutions, diathermy), foreign bodies (ligatures, tampons, talc, drainage). The reasons that cause inflammatory processes in the abdominal cavity are also diverse. Of particular importance are acute surgical diseases of the abdominal cavity, accompanied by peritonitis and trauma of the abdomen.

In most cases, the longer and the trauma operation and the more pronounced peritonite, the extensive adhesion process in the abdominal cavity. However, intensive spike formation is often observed after, it would seem non-flammable and short operations, and vice versa, in the presence of undoubted prerequisites, the spikes are not formed. Many surgeons observed increased incidence of adhesions. To take into account this phenomenon in practical work is very difficult [O.B. Milonov and Sow., 1990]. Of particular importance in the development of "fibrinistic diathesis" has immune aggression and the sensitization of the body, which manifests itself as a reaction of the hypersensitivity of a slow-type [R.A. Zhenchenko, 1972-1984].

There are obtuctational and strange postoperative HC. Obstrumentary NK occurs a much cup than awesome. The mechanism of its development is as follows. In the place of fixing the intestines of intestines, the intestines arises in the intestine of the intestine as a result of passive overflow by the liquid content of the overlying loops of the TC. The emerging peristalistic worsens the course of pathology and gradually develops full HC. Practice shows that the heavier operation and a pronounced paginological process in the abdominal cavity, the later the intestinal peristals appears and the HC is developing. Esha more favorable conditions For the occurrence of NCs, it is created when the intestinal intestinal hinge spikes in conglomerates. The awesome NK develops due to the infringement of the intestinal loop and its mesentery under separate adhesions. This usually occurs during the recovery of intestinal peristals after the abdominal operation. The emergence of the awesome NK contributes to the active, and often non-harmony medical stimulation of the intestinal function. At the same time, not only individual loops, but also several sections of the intestines can be infringed, as a result of which bizarre conglomerates and nodes are formed [O.B. Milonov, K.D. Toschen et al., 1990].

From the features of the early postoperative NC, it should be noted that it arises against the background of more or less pronounced biochemical shifts associated with the disease, on which the operation was carried out, as well as arising in the postoperative period in response to operating injury, therefore, unlike other types of NK With it, a violation of metabolism occurs very quickly.

The level of obstruction is of great importance: the high NC occurs with more pronounced metabolic disorders and is much harder than low.

The main shifts in the inner environment of the body arise due to severe losses of water, electrolytes, proteins and enzymes, which, in turn, are associated with the loss of gastric, pancreatic and duodenal juices, a simple secret secret. In addition to the loss with the lots, the liquid accumulates in the intestinal intestinal. The amount of liquid sequisited in the intestines depends on the level of the NK and can reach 5-9 l [o. B. Milonov and Sovt, 1990]. As a result, dehydration develops, the BCC decreases, which is manifested by arterial hypotension, a decrease in the CCLD, an increase in hematocrit, a violation of the rheological properties of blood, an increase in its viscosity, and, consequently, a microcirculation disorder. As a result of increasing the permeability of the vascular wall, the liquid part of the blood is lost and together with it sodium ions (the main electrolyte of the extracellular fluid), which leads to stimulation of the emission of aldosgerone, delaying in sodium and chlorine and chlorine in the body with the continuing distillation of potassium with urine [V.I. Podlkov et al., 1977; S. RAGENT ET AI, 1976, etc.].

As a result, a state is developing, known in the literature called "Derrou Syndrome". Three potassium ions are treated out of the cell, instead of them there are two sodium ions and one hydrogen ion, as a result of which acidosis in intracellular and alkalosis in extracellular space develops. Water loss, proteins and electrolytes reduce glomerular filtration and reduce diuresis, azotemia develops. The shifts arising during the first day in the early postoperative period after the occurrence of the NC are subsequently increasing. If the NK lasts more than a day, the specified shifts are not only increasing, but also the exhaustion of glycogen stock in the liver and muscles occurs, the decay of proteins and fats of the body's own tissues is beginning, acidic products accumulate in it, acidosis comes to replace the extracellular alkalosis. As a result of the death and decay of cells, intracellular potassium is released, but because anorya is observed, it does not exist from the body.

Consequently, hypocalemia is replaced by hyperkalemia. Continues to increase the concentration of residual nitrogen and urea. As a result, with a mechanical NK in the early postoperative period, complex pathophysiological disorders occur in homeostasis, which, in principle, do not differ from those with an acute NC, not related to the operation [O.B. Milonov and Sovt, 1990].

Clinic and diagnostics.The diagnosis of postoperative mechanical NC, especially in the early period of its development, represents certain difficulties that are largely due to the term of this complication. The greatest diagnostic difficulties arise in the development of the NC in the first days after operations.

The difficulties of diagnosis are associated with the emergency diversity of this complication, mainly with the clinical picture of the early postoperative mechanical NK, its nonspecification, the general severe condition of the patient due to the previous operating injury, which continues the peritonitis and the intestinal car.

Due to the ambiguity of the clinical picture of the early mechanical NK (the symptoms of peritonitis and the intestine paresis are superimposed) sometimes it makes it difficult to the timely formulation of the correct diagnosis. Early recognition of this complication is difficult due to the fact that its clinical manifestations are masked by pain in the abdomen associated with the operation carried out intensive therapy in the early postoperative period. In contrast to this, the symptoms of mechanical NK, developed in a later date (6-14 days) after the operation, is more pronounced, therefore its diagnosis of special difficulties does not represent

The difficulties and complexity of the diagnosis of this complication are that many signs of mechanical NCs could be noted before the operation. They are regarded as the results of the unresolved intra-abdominal inflammation due to the preceding disease. Li help to establish a diagnosis, since they depend mainly on the severity of the underlying disease, the nature of operational intervention, the flow of the postoperative period. The data of the RI, and the use of analgesics often leads to a change in the nature of the pain reaction. Many difficulties depend on the age of the patient, the peculiarities of the development and course of the disease, as well as on the development time of the NK.

Sometimes it is very difficult to distinguish the mechanical NK from dynamic. This is due to the fact that often the signs of mechanical NK are considered as a postoperative intestinal paresis (therefore, repeated attempts are being made to improve the condition of patients with conservative methods, which delays re-operational intervention), and, secondly, almost completely Differential-diagostic signs of disorders of the intestinal motor function arising in the postoperative period [A.I. Necha, M.S. Ostrovskaya, 1981; N.Vesket Et AT., 1980].

Our observations show that the phenomena of the mechanical NC is usually beginning to manifest themselves in the first 4-5 days, when the intestinal paresis is still kept, caused by the main disease and the operating injury. However, most patients in the first days after surgery, the symptoms of mechanical NK are leveled intensive infusion therapy, Nasicastral drainage, drug stimulation, lack of clear x-ray symptoms and other reasons. Because of these other reasons for the diagnosis of mechanical NK, and therefore, the definition of indications for operational benefits is discarded that it cannot but affect the results.

An important role plays a kind of psychological barrier in front of the surgeon - the possibility of an erroneous diagnosis at dynamic NK. Meanwhile, both literary data and our clinical observations show that the delay in the re-operational intervention in mechanical NK is immeasurably higher than the risk of diagnostic relaparotomy (RL). Therefore, in doubts about the nature of the NK, the absence of a resistant positive effect on the conservative treatment and the preparation of the corresponding x-ray picture is shown.

Unlike paralytic NK and anastomositis, which are successfully treated conservatively, with mechanical NK requires urgent surgery. It is especially difficult to put the correct diagnosis and determine the testimony to the RL in those cases of an early postoperative period when the mechanical NK occurs in seriously ill. The picture of the mechanical NK is masked by a rather difficult condition. At the same time, this is the situation when dynamic observation for a long time is dangerous, as it can lead to the death of the patient.

In practice, multiple vomiting at high subtle obstomability is often mistakenly explained by anastomosite during operations on the stomach or its paresium with interventions accompanied by sketching the large curvature of the stomach.

If there is a mechanical NK in the ileum area, the symptoms grow slowly and the clinical course is similar to the delayed intestinal paresis. It is especially difficult to diagnose the mechanical NC, which occurred on the soil of the infringement of the discharge loop of the heel in the "window" of the mesentery of the transverse approx. and high adhesion NK. At the same time, the form of the NK in patients there are signs of a disorder of evacuation from the stomach cult. It should be noted that with a mechanical disruption of evacuation from the stomach culture of the intestinal peristalistic, peristaltic noises are preserved clearly. When the early postoperative mechanical NC is diagnosed in each specific case, it is necessary to decide: whether we are dealing with functional disorders in the postoperative period or from mechanical NK. Signs of NC are often considered by passing paresis or as peritoneal phenomena due to the first operation. From here it becomes clear how important the dynamic postoperative NK from mechanical is differentiated.

However, strict separation of the NK on the mechanical and dynamic is sometimes conditional, since in reality the dynamic, and vice versa, is soon connected to any mechanical NC. Along with this, sometimes such a unit is justified, indicating in each particular case on what is primary and leading in the occurrence of the process. Analysis of clinical data and comparison with the operating finds during the RL show that the symptoms of the mechanical NC, which arose in the early postoperative period, are similar to the symptoms of the NK at all. However, the symptoms of the early postoperative NK are distinguished by a sequence of occurrence, duration and intensity of manifestation, which is associated with many reasons: the volume of operational intervention, the deadlines for the development of complications, the weakening of the body's reaction by the transactions and the disease itself, as well as the treatment.

In suspected early adhesion NK diagnostic and medical events It is recommended to start with nasogastric drainage, for the number and nature of the gastric discharge has a large diagnostic value.

Leading in the diagnosis of acute NK after surgery is a clinical picture. The earlier the postoperative period is complicated by the NK and the younger patient, the less clearly expressed the clinical picture of the NK and it is more difficult to diagnose its diagnosis. The clinical picture of the NK depends on the nature of the preceding disease and the level of the obstacle, as well as the timing of the development of the NK. Early adhesion NK in the overwhelming majority of observations is developing gradually. The NK phenomena begin to manifest usually on the 3-7th days after the operation, when the gases begin to depart and there is an independent or after the intestinal stimulation of the chair. In this case, periodically appear borter abdominal pain. The intestinal peristalsis at the beginning of the NC development increases, then gradually fades

The main complaints of patients with postoperative NK are pain in the abdomen, vomiting, the latency of the chair and gas, the bloating of the abdomen. Pains are the earliest and permanent symptoms. Their intensity and character depends on the time of the emergence of the early postoperative NK. For the NK, which developed for the 5-6th day after the operation, the constant sawing pain of spilled character is more characteristic, often very intense. Catching pains are rarely observed. If the NK develops in a later date on the background, it would seem a favorable flow of the postoperative period "The pain arise suddenly at any time of the day and more often worn gravity. With the strange NK, the fights are almost not stopped, and during the intestinal obturation they can completely disappear. As the duration of obstruction is increasing, the intensity of pain can decrease, but they do not stop the disappearance of the peristaltic capture.

With early adhesions, the pain differs little by nature from pain in the postoperative wound region, and yet, with a thorough and constant dynamic observation, the patients can be noted the moments when it begins to periodically manifest itself concern and noted with the beginning of the restoration of intestinal peristals. However, the presence or absence of peristaltic noise may have diagnostic value only in combination with repeated concern, the enhancement of pain in patients. The combination of these symptoms indicates mechanical NK. Such signs like a temperature reaction, an increase in the number of leukocytes and biochemical changes in the blood are common to both forms of NK. Chair and partial separation of gases after the enema do not exclude obturation. In the development of the NK in the first days of the postoperative period, it is important to establish a complication of complications early signs NK, without waiting for the development of all the symptoms. Otherwise, the diagnosis is difficult to put it, and the help of the patient is delayed.

The overall sympathetic complex characteristic of the early mechanical NC, expressed by pain, vomiting, the latency of the chair and gases, the bloating, is not always typical. In contrast to the postoperative pares, these signs are intense and progress over time. The pains are more pronounced here, they carry a grapple-shaped character and indicate the appearance of a mechanical obstacle.

Postoperative NK often develops against the background of peritonitis and paralytic NK. With a normal postoperative course, the peristalistic is restored to 2-4 months, disappears stagnation in the stomach, the gases begin to depart, the chair appears. In the case of mechanical NK, the passer of the intestine, the pains are long and persistent. They continue to be exacerbated, disappearing after the use of conservative therapy. Catching and eventually growing pains have a clear localization, corresponding to the place of mechanical obstacle. Alarming symptom - long-term incessant vomiting congestive gastric content. The number of vomit masses distinguished by spontaneously or through a nasogastric probe significantly increases, reaching 3-4 l / day.

Increasing the number of highlighted gastrointestinal content from the first day after surgery or a permanent period over time (4-5 months of the postoperative period) aspirated by a probe from the stomach volumes of the fluid indicate the mechanical NK. In severely ill, vomit can be with an admixture of intestinal content with a specific odor. The nature and number of the nasogastric pronom disclosed on the nasogastric probe is important. If its volume exceeds 1000 ml / day, it, as a rule, indicates mechanical NK.

For low NC, the bloating is characteristic, a gas delay, no stool. With a mechanical obstacle in the top department of the gastrointestinal tract frequent vomit. However, it should be borne in mind that in the first hours of complications after the enema and stimulation of the intestine, the gases and feces can be separated: it is emptied by the loops of the fine and colon, located below the obstacles. Pain in such cases is very short, weakly expressed. In patients with early NK, the bloating sometimes can be accompanied by a strengthening of peristaltic noise. With the postoperative paresis of the intestine, this does not happen. Finally, with postoperative mechanical NK, symptoms characteristic of NK are noted at all: symptom of SKlyarov ("Slot's noise") "Determination of high tympanite at percussion over bloated intestinal loops (valya symptom), abdominal asymmetry. We attach great importance to the presence of a symptom of gas imbalance at percussion of the abdomen. Later through the abdominal wall becomes noticeable loops of the bloody intestine (symptom of the stairs).

The overall condition of the patients sharply deteriorates, signs of dehydration (severe thirst), intoxication, weakness, exhausting nausea, vomiting, a dry tongue, covered with a dirty flap, rotten rotten. The expression of the patient's face is suffering, during the attack of pain, he moans and dares to bed. Signs of intoxication, pronounced tachycardia, dehydration, decreased by the turgor of the skin are growing. It should be noted that the occurrence of grapple-shaped pain in the abdomen on the 5-7th day after the operation is sometimes binding to a diet violation, power mode. With a rectal study, an empty PC ampoule is detected, the absence of a tone of the sphincter in the presence of reaching the abdominal cavity and hanging its front wall. In contrast to the pelvic jellis, the hanging is not accompanied by the formation of infiltrate and almost painlessly. Temperature, pulse and blood pressure can fluctuate in significant limits, depending on the presence or absence of peritonitis and the duration of the NK.

From other symptoms, it should be noted Ikota, thirst and dryness in the mouth, indicating rather not about the NK, but about severe violations of the marked processes associated with the disease. In the diagnosis of postoperative NK, it is necessary to consider the county of peritonitis, which is either the background on which the NK occurs, or soon joins it.

The examination of patients with early postoperative NK shows the following clinical picture: Dry language, covered with a dirty gray or brown chain; The stomach is increased or evenly at low NK or by blowing the upper departments with high. Sometimes it is determined by the distinct asymmetry of the abdomen. Participation in the act of breathing is limited. Very rarely, thin or depleted subjects are observed in the eye peristalistic, on the front abdominal wall The bloated loops (symptom hose) may be contour.

When palpation of the abdomen, spilled soreness is revealed, and with accompanying peritoneal phenomena - a slight rigidity of the muscles of the abdominal press and a positive symptom of Blumyberg-brush. We indicate that the tension of the muscles of the abdominal press or peritoneal symptoms never reach this level, as with perforative peritonitis. Percussion of the abdomen in running cases is characterized by the accumulation of free fluid in the detached places. With auscultation of the abdomen, if the NK arose in the first day (2-5) after the operation, weakened intestinal noises are noted. If the NK occurs later, the peristalistic is usually enhanced, and sometimes becomes violent. The most convincing sign of the NK in the early postoperative period is the symptom of Slyov. Exploring the belly; It is necessary to pay attention to the region of the inguinal and femoral rings, so as not to miss the infringement of hernia in the postoperative period.

Under paralytic NK in clinical picture Disturbing pain in the stomach, the latency of the chair and gases, the lack of peristaltics, vomiting. When palpation is determined by moderate pain in all parts of the abdomen, the weak tension of the abdominal muscles, the noise of the splash.

The features of the clinical picture of postoperative mechanical NC are determined by the caused by its causes. Inside the developing forms of the strange NK are characterized by rapid clinical manifestations with sharply pronounced pain syndrome. Disruption of mesenteric circulation, accompanying this type of NC, leads to a rapid development of changes in the intestines and the appearance of exudate in the abdominal cavity in 2-3 hours from the moment of the disease ("catastrophe" in the abdominal cavity).

Fast NK in the postoperative period begins to clinically manifest themselves with grapple-shaped pains in the abdomen, nausea, vomiting, the incentiveness of gases, meteorism, tachycardia, local pain.

With a high NK, the diagnosis is facilitated by esophagogro-duodenoscopy, at which the parethic, filled with the contents of DPK, TC above the narrowing section, and with thick-binded obstruction - colonoscopy.

Early Obstrument NK, due to anastomosite or squeezing from the outside of the intestinal lumen with inflammatory infiltrate, in contrast to the previous forms proceed relatively peacefully and painlessly. Leading clinical symptom - Violation of evacuation from the initial sections of the gastrointestinal tract. Complication is developing gradually: on the background of a smooth flow, the evacuation delay from the stomach is detected, manifested by the vomiting or the growing amount aspired by the probe of the gastric content. The painful syndrome is usually expressed slightly. If the NK is caused by inflammatory infiltrate, the latter can decide in the abdominal cavity. Peristaltic noises are listened, gases are departed. General well-being in the initial period may not suffer. The ri reveal a long delay in the evacuation of a contrast substance from the stomach. To clarify the diagnosis, it is advisable to produce an EI, which helps differentiate obstruction (anastomositis, compression of inflammatory infiltrate or coarse scar deformation of the coal) and establish the possibility of eliminating it.

There are basic and additional criteria for diagnosing mechanical NK. The main criteria include: the lack of positive dynamics in the health of the patient, suppressing the mental state, constant or grab-like abdominal pain, the increase in the pulse (up to 100 ° C. / min), the presence of a cisheber bowl, intestine pneumatosis (Symptom of Styrillin), vomiting, expressed Meteorism, delay in the contrast agent in TC longer than 4 hours. Additional criteria include: respiratory syndrome, light meteorism, compensated acidosis, the noise of the splash, a positive symptom of Grekova, hypocoagulation syndrome, violation of electrolyte syndrome (pshocalemia, guilochloremia).

The most important diagnostic sign of the NK, developed in the early postoperative period, is the lack of a clinical effect from such targeted conservative measures, as a paranefral blockade, intestinal stimulation, constant transnasal drainage of the stomach, cleansing or hypertonic enema, peridural anesthesia, and the duration of these events should not exceed 5 -6 h. Excessive perseverance in the implementation of conservative therapy often leads to the loss of time and the development of a launched NC with all the sorrowful consequences that arise.

Great informative value in the diagnosis of postoperative NK, especially in doubtful cases, represents the RGCT - irrepresentant and contrast vertical position patient. Ri should be done urgently.

With the usual survey radiograph of the abdomen, it is possible to identify a number of radiographic symptoms characteristic of paralytic and mechanical NCs, which, in combination with clinical signs, help establish the correct diagnosis. For example, for paralytic NK, a large amount of gas in bloated loops of fine and colon, high standing of the diaphragm domes and the limitation of their mobility, a significant accumulation of fluid and gas in the stomach, cube boxes (are defined fuzzy and in small quantities).

In the early periods of NK, it is not always possible to determine its reliable radiological signs, however, the detection of inflated TC gases, the absence of gases in the thick intestine with a moderate swolley of thin indicate the possibility of a mechanical obstacle to the passage of intestinal content. The total filling of the thick intestine gas serves as an indirect sign of a low obtuctive NK. Only in part of patients with a high-level ventiosophy of the abdominal cavity with a high level of NCs may have characteristic x-ray signs. The diagnostic informativeness of the reviews is quite limited [A.N. Kishkovsky, PA. Tyuty, 1984]. They do not always allow you to determine the type of NC and the approximate localization of the obstacle. Often, especially in doubtful cases, along with the conduct of conservative activities, it is necessary to carry out a contrast study using barium sulfate, which is introduced into the stomach and intestines through the mouth or using the probe. Practice convinces that due to the dynamic radiological control of the passage of a contrast agent (barium suspension) on the stomach and intestines in most observations allows for 4-5 hours to establish the nature and level of the NK.

Ri can be carried out already from 2-3 days of the postoperative period and with it to keep track of the passage of the barium suspension on the housing and communal services. If you need to set the time: 1) the appearance of barium sulfate in the SC; 2) the total transition of the contrast substance from the TC into Tolly; 3) the appearance of the barium suspension in the sigmoid and rectum. It is recommended to observe the promotion of contrasting suspension to the SC for approximately 4-6 hours after the cottage of the barium suspension, producing x-ray and radiography at intervals of 1-2 h [M.S. Rzhevskaya, 1981; N.M. Zyubritsky et al., 1985, etc.]. The increase in the time of promotion of contrasting mass on the gastrointestinal tract may indicate the NC in the early postoperative period.

With a dynamic ri, the following symptoms of the mechanical NC occurred after surgery can be set: a resistant barium sulfate delay in the area of \u200b\u200bnarrowing; The pendulum movement of the barium sulfate in the extended loop of the intestine; Thickening (swelling) of circular folds; three-layer arrangement of pathological elements (horizontal level of fluid with a gas bubble above it, liquid intestinal content with admixture of barium sulfate, accumulation of barium suspension between circular folds); After 2-3 hours, a significant decrease in the number of contrast agent in the loops of the TC (with high NK) and an increase in its stomach; Barium sulfate delay in the stomach, shifting it up and right [O.B. Milonov and Sovt, 1990; N. Yoldberg et al, 1979].

In order to diagnose postoperative NK with atypical flow, as well as differential diagnosis An early postoperative NK and the intestines in clinical practice developed and used the method of probe enterography [A.N. Pak, 1986], in which the barium suspension is summarized to the obstruction site and it is possible to determine the nature of the NK. In this method, the main radiological symptoms of the early mechanical NK are: a pronounced prestrial expansion of the proximal loops of the TC, reaching 4-8 cm in diameter; A sharp disruption of the motor-evacuator function of the intestine, the delay of a contrast substance over the obstacle is more than 1.5-2 hours; The lack of gas in the colon and the impaired by its contrast.

With paralytic NK, it is noted: the rapid restoration of the width of the intestinal lumen, its evacuator function and the tone, coming after active decompression; In the process of study, an increase in the amount of gas in the colon and a decrease in it in thin; contrasting the colon for 15-90 minutes; Uniform filling with a contrast substance looped TC.

For an early stage of development of the OBRUCTION NK, a moderate blown of the TC in the form of an archer without a liquid, a finely wavy circuit of the TC, visible Kerkringer folds (symptom of a stretched spring) and the presence of a large amount of gas and liquid in the stomach and intestines, stasis of a contrast agent and lack of gas in the colon . The obstacle in the intestines is evidenced by the presence of horizontal levels of fluid with gas over them - bowber bowls (clearly contiguous and in large quantities).

Other reliable radiological symptoms include the detection of fluid transfusion phenomenon from the peristallation proximal loop to another, located below the obstacles. However, according to literary data [A.I. Zibik et al., 1973] and their own observations, reliable radiological signs of complications (the presence of Clabeber bowls, delay in the promotion of the contrast of intestinal) are sometimes due to the intestinal paresis and do not provide high diagnostic accuracy. In addition, in the early postoperative period, these signs are inconsistently, they are detected in 30.5-89, 4% of observations [AA. Shalimov et alt, 1984; V.F. Tshai, 1986]. Therefore, the main attention in the diagnosis of postoperative NC should be given not to individual symptoms, but developing complications syndromes. Certain assistance in diagnosis may (increase the number of leukocytes).

If in the first days of leukocytosis can be explained by the operating injury, then in a later date, an increase in the number of leukocytes during normal normal temperature Body testifies to early NK. The leukocyte formula is also noted, the increase in ESP, the increase in the content of hemoglobin and red blood cells (dehydration). In patients with mechanical NK, severe geoproteinemia and disproteinemia are detected, which progress, despite the transfusion of protein preparations. There is also a sharp impairment of VEB (hypochloremia, hypokalemia and hypocalcemia), Kos, an increase in residual nitrogen, hypovolemia. Unfortunately, the value of laboratory research is small, biochemical indicators Blood is manifested late when they do not acquire a lot in diagnosis and become prognostically unfavorable signs.

In this way, early diagnosis Postoperative mechanical NC should be based on a thorough analysis of clinical manifestations: objective assessment leading symptoms and other signs of this complication, the use of radiological and endoscopic research methods, the correct interpretation of the data obtained. In the clinical plan about the presence of a mechanical obstacle in the intestine, the resistance and stiffness of the gravating pain in the abdomen after surgery on the abdominal organs, the latency of the chair and gases, the lack of effect from the complex of conservative measures aimed at eliminating the cause of the violated passage of intestinal content and to recognize the nature of the NK ( The drainage of the upper intestinal departments, the stimulating intestine of the event, the paranefral blockade and peridural anesthesia for 6-7 h), the increasing phenomena of the NC, corresponding to the data of the control dynamic river barya suspension. The presence of this data serves as a testimony to the RL. If the NK is dynamic, then the complex conservative treatment Allows you to restore the normal GTS function.

Treatment. Treatment of postoperative mechanical NK - operational. Long and ineffective conservative treatment is unreasonable. It further worsens the patient's condition, the late operation often does not bring success.

The duration of observations during postoperative adhesive NK largely determines the outcome of the RL. The question of re-operation should be solved if possible, as quickly as possible, since the duration of the period of the phenomena of the NK is a decisive factor of the outcome of treatment. Therefore, if nausea and vomiting continues, radiographic signs of the NK, even if there is a temporary relief from conservative measures, in the absence of the abdomen, pain and conservation of ordinary peristaltics, the issue is solved in favor of the RL. Note that the re-operation in such a situation is much less dangerous for the patient, rather than a long catching. The oscillations, doubts arising in these cases in the surgeon, are natural and understandable, but they should be allocated very limited time. Conservative measures aimed at the possible elimination of this complication are simultaneously becoming a preoperative preparation that is usually 3-4 h.

With repeated waste on postoperative mechanical NC, two basic principles should be followed. First, regardless of the place of the first operation, it is always possible to produce wide median laparotomy under endotracheal anesthesia, which allows you to perform a thorough revision of the abdominal cavity, determine the reason for the obstacle to the passage of intestinal content, produce a dissection, dissection of adhesions, and, if necessary, enter the enterosomes, reducing TC and elimination The coast of the fine and colon. If the first operation was performed through a median incision, then when performing the RL, the same access uses the same access. If the initial access was other, the PL is produced through a wide mid-incision. Secondly, we should try to fulfill the minimum intervention in terms of volume (dissection, declosage of the charring, the imposition of stoma in the presence of testimony or bypass anastomosis).

Patient anesthesia should be carried out taking into account the peculiarities of the damage and pharmacological action of the substances used. Especially complex anesthesiological problem - pain reliefing of sick elderly and senile age. As a result of intoxication, which is inevitable at the NC, the activities of the SS and respiratory systems are disturbed, renal and mon. The combination of these disorders leads to a sharp voltage of protective compensatory mechanisms. Any additional stimulus (anesthesia, operation) can cause decompensation. This causes certain requirements for the anesthesia in this category of patients. The operation is produced under endotracheal anesthesia. The nature and volume of operational intervention in the early postoperative H K should be individualized depending on the age, the clinical form of NC, pathological changes identified with the RL, and the overall state of the patient both before and during the operation.

The surgical allowance aims to carry out the audit of the abdominal cavity, establish the reasons that caused the NK, and eliminate it, those. Restore the normal passage of intestinal contents, as well as assess the viability of pathologically modified tissues, bowel decompression, recurrence prevention and secure the gastrointestinal tract.

The volume of surgical intervention to eliminate the cause of obstruction fluctuates widely - from simple dissection of single stagnation chickens or multiple operations, imposing bypass anastomoses before resection of the dead intestine or anastomosis. All non-visual fabrics are removed during operation. The decompression of the intestines is carried out by puncture with the subsequent aspiration of the liquid and gases or the intestinal intersection integrated for resection, or for the purpose of continued decompression by intubating the intestine with a tube derived through the Tosquin-Zhlebrovsky, or by the method of disinteresting total intubation.

It is necessary to take into account the variety of possible options. There are usually one obstacle, but there may be several anatomical substrates that violate the intestinal permeability. Set which one is the main one, is not always easy, therefore it is necessary to consistently explore all the intestinal departments and restore its permeability throughout. With the impossibility and danger of the separation of intestinal intestinal loops from infiltrate, it is necessary to prefer by bypass anastomosis, but at the same time it is necessary to be sure that the intestinal hinges in the intestinal conglometer are viable. Patenitivity of the gastrointestinal tract after resection of the intestine within healthy tissues is restored by an analysis of the leading and reducing ends.

When surgery for early postoperative NK, a number of important principles are required [O.B. Milonov et al., 1990]:
1) with a significant inconsistency of the diameters of the segments of the intestine after its resection, it is better to use the anastomoses "side in side", if there are peritonitis and sufficient length of the leading TC (at least 1.5 cm), more securely complete the operation with the removal of end fistulas on the front abdominal wall;
2) a large gland that is directly involved in the emergence of complications, especially if it is infiltrated, it is more expedient to resperate;
3) Avoid desserting the walls of the intestine, applying the atraumatic technique of the operation. All weather surfaces need carefully peri-toning;
4) The through hole in the TC, resulting from its accidental injury, should be immediately embritt. It always infects the abdominal cavity of the virulent microflora, and therefore it is necessary to produce its massive lavage and drainage, as with the total peritonitis;
5) If H K. is caused by a scar deformation of a previously imposed anastomosis or squeezing with inflammatory infiltrate, it is advisable to restore the permeability with the help of bypassing between leading and discharge departments.

In the course of the audit of the intestine, all the extent is made by the separation of battleships and dissection of adhesions, which are the cause of the NK, peritonization of damaged areas, the exemption of the intestine from the compression, the fraud of the coast and transfers the intestine, correcting errors made during the first operation. In the presence of testimony, with the aim of eliminating H k, they impose bypass anastomoses, fistulas on a thin and blind intestine, resection of the TC and others.

Often, the operational intervention in the early postoperative NK is not limited to the simple dissection of adhesions or disgraced in the form of double-barbing. If the TC to the obstacle can be very bloated, then after separation of adhesions, it is performed by its intranasal intubation with a silicone multireforized tube - a probe with a diameter of 8 mm with a special conductor to a baguin flap.

In the presence of intimate steps, forming a conglomerate on a fenced area, when it is difficult to highlight the intestines without risk to open the intestinal lumen, it is recommended to apply bypass intercircuit anastomosis. One of the main methods for the prevention of adhesive NK is a complete primary sanitation of an inflammatory hearth, gentle handling of tissues. The prevention of high NK on the basis of the scaling of mesenter transverse OK from the stomach crust is a reliable mesentery of the mesenter with a seam in the seam of sufficient tissue, the correct fixation of the stomach culture in the "window" of the mesentery of the transverse approx. The outcome of the postoperative mechanical NK largely depends on the timeliness of the diagnosis and the term of operational intervention. If it is performed in a timely manner, it becomes one of the most important links in the complex of postoperative measures and a serious guarantee of salvation of the life of patients.

We should not forget that postoperative NK very often recurrences. The prevention of relapse is one of the most important, but difficult solvable tasks of the operation produced about the early postoperative H to. A lot of ways are proposed. Some surgeons are recommended to introduce various drugs and mixtures into the abdominal cavity [N.P. Batyan, 1982], others - various technical techniques [K.D. Toskin, V.V. Sezhbrovsky, 1979]; Enter oxygen into the abdominal cavity [R.G. Zelenetsky, 1973], Novocaine [R.A. Beetle, 1963]. For the prevention of fasting formation, hyaluronidase is given in a certain value | MA. Alaverdyan, 1963; F. Ries, 1953], fibrinolysin [R.A. Zhenvsky, 1966], streptokinase, streptodornase. However, all these methods have not found wide practical applications, since their effectiveness is very low.

To prevent the formation of new adhesions, it is proposed [N.P. Batyan, 1982; G. P. Shoreh et al., 1987] In the abdominal cavity to introduce a bump mixture (500 ml of a 0.25% novocaine solution, 300 mg of gadroarthortisone, 5 ml of 0.05% sosmene solution, 1 million units of Penicillin and streptomycin). This mixture is introduced at the end of the operation, over the next four days in the abdominal cavity on the tube once a day.

The prevention of the NC recurrence lies in early operational intervention before the development of severe inflammatory complications, in a gential attitude to tissues, compliance with the atraumatic technique of operation. The required technical prerequisite of the prevention is a thorough peritonization of pathologically movable hinges of the anastomoses, eliminating possible cracks, windows, pockets and other defects arising in the process of operation in mesentery, peritoneum, between organs and so on.

Early motor activity of the patient and the restoration of intestinal peristalsis are important in the prevention of adhesive NK. Functioning intestines Even if the most physiological position is found for itself.

The epicenter of the Spipe Forum is often the postoperative scar from the abdominal cavity [O.B. Milonov and Sovt, 1990]. In order to prevent such battlefields [k.d. Toskin, V.V. Zhrabrovsky, 1982] Recommend the most movable portion of the large gland before sewing wounds without any mobilization to lay so to completely limit postoperative wound and the zone of injured peritoneum from the abdominal organs, and then by the knotted seams, capturing only the front leaflet of the peritoneum of the large gland, hedit it to the parietal peritoneum in the circle of the wound, retreating from its edges by 5-6 cm, i.e. Where the peritoneum was less injured to the tools.

In cases where the recurrence of the NK still occurs and the patient is re-operated on the early postoperative NK, it is recommended to carry out a long-term, for 8-10 days, total intestinal intubation through a micro-cecid to the stomach. With prolonged intestinal intubation to prevent the formation of the sistema of the intestinal wall, it is recommended periodically, after 3-4 days, tighten the probe by 5-10 cm, periodically rinse and introduce into the intestinal lumen daily 40-80 ml of vaseline or vegetable oil solution. After 8-10 days, when the patient has an independent chair, the probe is extracting. In the postoperative period, the same activities are carried out as in the treatment of patients with postoperative peritonitis.

Thus, the postoperative NC operation should be carried out after a preoperative preparation and as early as possible, to be short-time, technically simple, non-immature and sufficiently radical.

Content

Problems with the intestine today are very common. One of them is the obstruction of the intestine - a serious state, with a sharp stage of which surgery is necessary. The earliest harbingers of the ailment is pain: it starts suddenly, at any time, without a visible reason. Less often pain increases gradually, and after some period of time it becomes intensive.

What is intestinal obstruction

The obstruction of the intestines is called the impossibility of the physiological nature of the passage to the rear passage of the carts. The process of natural emptying of the rectum becomes difficult, the separation of gases is stopped, cavalous dilutions are formed. Symptoms become more distinct with a deterioration in the state. The source of problems is an irregular chair: right if a person is emptied once a day. In the case of the appearance of signs that indicate obstruction should be consulted.

Causes of obstruction

Disability in the intestines is developing under the influence of various reasons that are divided into two categories: functional and mechanical. Factors such as an increase in the length of the sigmoid intestine, the presence of peritonean pockets, a movable blind intestine, spikes are promoted by the development of a non-surv of mechanical type. Functional obstruction is developing against the background of overeating after starvation, a sharp increase in fresh fruits, translation of newborns on adapted mixtures up to a year.

Mechanical

Mechanical causes of illness, which markedly poisoning the existence to the patient:

• hematoma;
• failures in the formation of the intestine;
• failures in the structure of peritoneum;
• bile and fertile stones;
• vascular ailments;
• inflammation;
• neoplasms (cancer or benign);
• oncology;
• intestinal obturation;
• spikes;
• hernia;
• intestinal breakthrough;
• the thieves of the congenital type;
• hitting alien elements in the intestines;
• reducing the gossip.

Functional

Functional causes of obstruction of obstruction are also known. Their list usually depends on the accompanying problems, but its short version looks like this:

• paralytic phenomena;
• spasms;
• failures in the intestinal motorcycle.

Symptoms and signs of intestinal obstruction

According to doctors, with suspected intestinal obstruction, the patient must be delivered to the hospital as soon as possible. So the forecast will be favorable. Violations can be corrected without surgery in some cases. The obvious signs of the appearance of the disease are the impracticity of the fattening of fees and gases. In the case of partial obstruction or obstruction of the upper departments of the intestine, there is a poor chair and a slight separation of gases. There are symptoms such as multiple vomiting, an incorrect shape and bloating.

There are also specific symptoms that can be identified only by a specialist, so the most important hospitalization of the patient is so important. If you do not begin to treat the patient on time, then the risk of developing hazardous consequences increases, among which violations of cardiac activity, hepatic and renal failure, fatal outcome. In the case of squeezing vessels, necrosis develops. Even the operation (if the case is running) may not save the patient.

The most dangerous states include the intestinal obstruction in infants. Therefore, moms and dads are important to know the symptoms that should cause concerns:

• essential weight loss due to fluid loss,
• vomiting with an admixture of bile that appears after eating,
• sandish tint child's skin,
• temperature,
• swimming up the top of the abdomen.

A calm baby can abandon meals, become restless and capricious. Then you need to immediately call a doctor.

Types of intestinal obstruction and how they manifest

Intestinal obstruction is divided into two types by the nature of the flow: it is chronic and acute. In addition, the disease can be partial or complete. By the origin of the disease is divided into acquired and congenital, the latter is caused by the intestinal blockage with dense Mekonia, anomalies in its development. Depending on the cause of the disease, the disease may be mechanical and dynamic.

Favoric obstruction

Favoring obstruction is called a violation of the intestinal passage, which is provoked by the adhesive process of the peritoneum. Heavy and spikes are developing after limited, acute diffuse peritonites, hemorrhages, abdominal injuries. There is such a type of intestinal obstruction can be on any of the bowel levels. In most cases, the spike of the gland with the postoperative scar of the peritoneum or organs that were injured during the operation.

The disease is based on a distillation of the peristaltics, which is due to the formation of adhesions. Favoring obstruction proceeds in several types:

• Obstrument Type - The disease begins acutely and leaks quickly. Sometimes patients may suffer from chronic interspersed obstruction, which later flows into the sharp phase.
• Stage Type - It occurs when the intestinal section is infrained with the involvement of mesenter. The disease occurs sharply and violently, hemodynamic disorders appear early, leading to the development of peritonitis and intestinal death.
• Mixed form It is a combination of a dynamic and mechanical form of illness.

Partial

The partial form of this illness can occur chronically: the patient periodically experiences pain, suffers from vomiting, gas delays and chairs. In most cases, such symptoms are not sharp, pass after conservative events in the hospital or independently. The disease can last long, dozens of years. In case of obstruction due to a tumor, which grows inside the intestinal lumen either from the outside, the symptoms gradually grow. Sometimes constipation arise, vomiting, flatulence. As the tumor grows, the symptoms are rapidly.

The stage of partial blockage is replaced by periods of permission for which diarrhea is characteristic. Caliac masses are liquid, abundant, with a grinding smell. A peculiarity of partial obstruction is that it can do at any time to the complete obstruction of acute type.

Thin intestinal obstruction

The impassability of the small intestine occurs on any portion of the small intestine. The part of the intestine above the localization of the obstacle continues to work and swell as food fills. SAME frequent reasons The occurrence of the disease is the obstruction of the small intestine. The symptoms of obstruction are meteorism, disgust for food, vomiting, dehydration, severe pain of the epigastric area.

Tolstoy intestine

Violation of the passage of contents in the colon (obstruction) is manifested in a delay or absence of stool, bloating, difficult to disrupt gases, pains of a grapple nature, tensile belly, vomiting, nausea, impaired appetite. Such obstruction can be full or partial in nature, more often is observed in the case of organic colon lesions.

Subject to the progression of the violation in the intestine, symptoms of intoxication, violation of the exchange processes, the bloating, signs of inflammation of the peritoness are increasing. Partial obstruction is characterized by an incomplete periodic disorder of gases and stools, shifting diarrhea to constipation, long or short-term remissions, temporary cessation of bloating and pain.

Find out what is how to treat this disease.

Treatment of disease in adults and children

At the beginning of the treatment of the illness, the intestinal intestine in children, adults, the elderly, emergency measures are applied to remove pain, replenishing fluid losses, an x-ray is carried out. With the help of the probe there is a liberation of the upper departments of the digestive tract, and with the help of siphon enema - lower departments.

Introduced medicines (antispasmodics), which relax muscular walls intestines, stops reinforced peristaltics. In some cases, such measures and drugs are enough to restore functioning. If not, it means they are resorting to surgical interference in the clinic.

Surgical intervention

The volume of the operation in surgery in the obstruction of the intestine is justified individually when taking into account the characteristics of the organism, the anatomical features of the hearth and the history of the disease. Also, determine the causes of pathology. With the following cases of the disease, operational intervention is the only way to treat:

• when bothering the small intestine;
• when blocking with bile stones;
• with intestine nodes formation, when one intestine is wound on the axis of another;
• when immersing one intestine to another.

Diet

Depending on the course of intestinal disease and the patient's condition, a diet is assigned. After surgery, it is impossible to eat and drink in intestinal obstruction and drink for twelve hours. Nutrition takes place parenterally: the patient intravenously introduces nutrient solutions into the rectum. Five days later, nutrient mixtures are introduced through an umbrella. The probe is removed if the patient can eat himself. Equality products are allowed, nutrient mixtures (baby food) with frequent small portions.

A few days after surgery, the intestine is transition to a zero diet, developed in order to maximize the gesture of the digestive tract. Easy-friendly liquid products are introduced, and salt consumption is limited.

Gradually go to a diet close to diet No. 4, which is developed for the purpose of the maximum chemical and mechanical germs of the intestine, reduce fermentation processes in it. The amount of fats, carbohydrates, smoked, spices, pickles, fiber, milk is limited. Dishes are boiled, prepared for a pair, shared.

Gradually, the dietary menu is expanding, there is a complete transition to diet No. 4, which is designed for patients with intestinal diseases at the stage of recovery and rehabilitation, including obstruction. Provides full-fledged nutrition that gentle for the intestine. The diet is more diverse, food does not rub.

Dishes are boiled or prepared for a couple, which is useful for the intestine of the patient. The diet of the diet in chronic and acute obstruction prevents the development of grinding, fermentation processes. Simple carbohydrates and fats are limited, irritants of mechanical, chemical and thermal type are excluded.

Folk remedies

With a partial form of obstruction, treatment methods from the arsenal of traditional medicine helps:

• 0.5 kg Drain without bones pour water liter, boil an hour, cool and drink three times a day by half a cup.
• 1 kg sea buckthorn crowded, pour boiled cooled water in an amount of 0.7 liters, mix. Juice squeeze and take once a day at half a glass.
• Mix 20 pieces of Kuragi, 10 tbsp. Izyuma, 10 pieces of figs and prunes. Pour boiling water, rinse, twist. Eat on an empty stomach on a tablespoon.
• Having half a glass of milk, add 20 g of butter. To lie on the left side and enter the solution as an ordinary enema. Take the procedure for three days in a row in a row a couple of hours before sleep.

Attention! The information presented in the article is familiarized. Article materials do not call for independent treatment. Only a qualified doctor may diagnose and give recommendations on treatment, based on the individual characteristics of a particular patient.

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In the case of the diagnosis of intestinal obstruction, the operation often becomes the only method of treatment that allows you to save the life to the patient. However, the results of operational intervention are not always successful, which is associated with a large number of postoperative complications. Increase the results of a favorable outcome can the maximum rapid beginning of treatment, the correct selection of the necessary method of operation, comprehensive infusion and supporting therapy.

Ileus requires surgery at mandatory in mechanical intestinal obstruction. In such a situation, if possible, the reason that caused the disease is eliminated:

• intestinal tumor;
• spikes of the abdominal cavity, etc.

The main task of surgeons is the restoration of the continuity of the gastrointestinal tract. However, in some cases, treatment is multicomponent and requires re-operation.

Therapeutic tactics in intestinal obstruction is determined by the cause, species and degree of expression of pathology. Indications for the implementation of surgical intervention determines the surgeon based on clinical manifestations and research results. With dynamic Ileus, therapy is always starting with conservative measures. Mechanical intestinal obstruction in most cases requires an operation.

Surgical intervention is necessary at:

1. The strategic obstruction of the intestine, which led to the dying of the sector of the intestine due to:

• coordination;
• nodes formation;
• infringement of hernia content.

1. Obstructive intestinal obstruction, when there is a mechanical obstacle to the movement of intestinal content. Causes can be:

• caliac challenge;
• helicing stones;
• accumulation of helminths;
• foreign body;
• intestinal tumor;
• scar state changes;
• neof formation of the abdominal cavity.

1. Incaptation of the intestine in the event of the ineffectiveness of conservative events.
2. Abdominal spikes in the absence of conservative treatment results.

Operation with intestinal obstruction can be carried out in emergency and urgent order. If there is no emergency intervention, the operation is carried out immediately after the diagnosis is established. Any delay can threaten the patient's life. Surgical interventions are shown in emergency order in cases:

• thrombosis of the arteries that feed the intestine;
• infringement of hernia content;
• obstructive obstruction of the intestine.

Essentially, but with a delay of 4-6 hours, operations are carried out in complicated cases of the disease. The reason to postpone the surgical intervention becomes the need to restore water-electrolyte disorders and prepare the body, which will improve the forecast. Delay is necessary when:

• significant loss of water and electrolytes;
• severe patient condition;
• large timing more than one and a half days from the beginning of the disease.

The urgent surgery is carried out with the ineffectiveness of conservative treatment after 12 hours. This takes place when invagination of the intestine and the spikes of the abdominal cavity. Signs of ineffectiveness of conservative measures are:

• preservation or resumption of complaints on abdominal pain;
• repetition of nausea and vomiting;
• determination of free fluid in the abdominal cavity;
• the appearance of symptoms of peritonitis;
• an increase in the number of probe content up to 0.5 liters and more;
• no dynamics of promotion of contrast content by intestines.

It is often necessary to carry out an intestinal operation at obstruction of the intestines in elderly patients. Young sick chances of avoiding surgery above.

Preoperative preparation of the patient

In addition to situations requiring emergency operational intervention, preoperative preparation includes a complex of conservative treatments for the intestinal obstruction. Patient with Ileus is produced:

• unloading of the intestinal departments above the place of obstacles using a nasogastric probe;
• infusion therapy, including salt and colloidal solutions for the correction of water-salt metabolism and replenishment of the deficit of minerals and protein;
• introduction of spasmolitics;
• siphonic enema;
• the introduction of contrast into the intestine.

Methods of operational interventions

The choice of a method of operational intervention depends on the cause of the intestinal obstruction, the severity of the adhesive process and obstruction, the state of the intestine. Surgical operations When Ileus is held:

1. Laparoscopically through small holes in the abdominal cavity using video equipment.
2. Larotomically, carrying out a large cut of the abdominal wall. The most convenient access to the middle line of the abdomen.

Laparoscopy is used in the adhesive process. Contraindications for it are several operations on the abdominal cavity organs in history, necrosis of the intestine and peritonitis.

The following stages of surgical intervention are distinguished:

1. During the operation, a revision (inspection) of the abdominal cavity and identifying the cause of obstruction is made.
2. Determination of signs of viability of part of the intestine in the area of \u200b\u200bobstruction. Based on the assessment of its color and peristaltics, the pulsation of blood vessels is made a decision on the need for resection of the intestine (removing part of the intestine).
3. In case of identification of signs of necrosis, part of the intestine is removed within viable tissues.
4. Then the tactics are different depending on the affected intestinal department. In case of obstruction in the small intestine, after its resection, anastomosis is imposed (compound) between the viable ends. With damage to the colon, the colostom is derived (a hole in the abdominal wall, in which the end of the intestine is sewn).
5. With the help of the probe of the nasogastric (through the nose in the stomach) or the unportest (through the nose in the intestine), the digestive tract departments are completely unloaded.
6. Drainage and drainage of the abdominal cavity.
7. Layered restoration of the integrity of the abdominal wall.

When Ileus, the following variants of surgery are possible:

• adhesiolysis (separation of adhesions) in adhesive intestinal obstruction without intersection of the intestine;
• the intensity of the intestinal loopers in their viability is back into the abdominal cavity (when the intestines is protruding in the hernia);
• enterotomy (section of the intestinal wall) with the removal of obstacles from the intestine (with obturantic Ileus, due to the bile stones, soreness, etc.);
• resection of the intestine with the creation of anastomosis when necrosis of the small intestine;
• imposing bypass anastomosis when it is impossible to remove the cause of Ileus;
• decractions of the intestine with the removal of a colostome in necrosis of the colon or extensive destruction of the small intestine.

The colostom can be temporary when planning the next operation in a few months to restore the integrity of the gastrointestinal tract. In some cases, the colostom is a forced measure, and it is formed for life. This takes place when palliative surgical interventions, when to cure the patient is not possible (untapped malignant neoplasms).

Postoperative period

Conducting surgical intervention in Ileus does not guarantee a favorable forecast. This is due to the fact that the obstruction of the intestine after the operation is characterized by structural changes in the digestive tract and a violation of homeostasis in the body. Internal toxins arising from Ileus continue to poison the body. In order to avoid postoperative complications, a complex of conservative events must be implemented. Postoperative therapy is to carry out:

• Infusion therapy for the correction of water-salt balance and replenishing the shortage of water, minerals and protein. For this purpose, crystalloid (salvizor, glucose solution, etc.) and colloidal solutions (refooliglucin, gelatin, etc.) are used.
• Adequate anesthesia to improve the patient's well-being and intestinal motility stimulation.
• Antibiotic therapy. A wide spectrum antibiotic (carbapenes, cephalosporins 3 generations, fluoroquinolones) are prescribed.
• Parenteral (intravenous) food before moving on independent foods.
• Enterotherapy. It consists in unloading the small intestine and washing it with the introduced probe. Nutrition mixtures are also injected with it.
• Processing postoperative wounds.
• Restoration of normal peristals of the gastrointestinal tract (prozerne, hypertensive solution).

In the postoperative period, careful observation of the patient is carried out. The results of the overall analysis of blood, biochemical analysis of blood and acid-alkaline equilibrium are regularly estimated. Also performed an ultrasound study of the abdominal organs to assess the operation of the digestive tract.

Diet in the postoperative period

The diet in the postoperative period during Ileus is quite strict. In the first days it is completely forbidden to eat. The parenteral nutrition is carried out. When signs of intestinal functioning, liquid write is allowed. Products are crushed or purtered by a blender. In most cases, food intake is allowed 3-4 hours after surgery.

• smoking and alcohol are excluded;
• it is prohibited sharp, roasted, smoked, pickled, pickles;
• seasonings and spices are excluded, the use of salt is limited;
• portions must be small;
• it is necessary to eat often 5-7 times a day;
• products can be boiled or baked;
• at the beginning, mature food is recommended: puree soups, vegetable puree, porridge, etc.;
• the food must be warm (excluded too hot and too cold);
• vegetables and fruits should be thermally processed;
• a small amount of ferocular products is allowed;
• it is necessary to limit products that increase gas formation in the digestive tract (cabbage, legumes, beans, carbonated drinks).

What to do so that there is no complications

Complications after surgical intervention in the obstruction of the intestines are quite common. They are primarily due to untimely treatment and inadequate preoperative preparation and postoperative activities. Reduce the risks of the emergence of complications can be the following:

• maximum rapid diagnosis of Ileus and performing surgical intervention;
• correctly selected by the volume of operational treatment;
• careful preoperative preparation;
• required postoperative treatment.

Intestinal obstruction is a state of an acute obstacle to the normal passage of dietary masses (from the stomach to the rear pass). It may occur in any section of both thin and large intestines.

The reasons for this state can be different, but the clinical picture, the pathogenesis of complications, the principles of treatment and the need for urgent measures are the same for all types of intestinal obstruction.

The intestinal obstruction is at one of the first places in the cause of surgical mortality. Without during the treatment, 90% of patients are killed.

The main causes of the death of patients with intestinal obstruction:

Shock (pain, hypovolemic); Endotoxicosis; Abdominal sepsis; Peritonitis; Sharp electrolyte disorders.

What happens

According to the mechanism of occurrence, two main types of obstruction are distinguished:

Dynamic obstruction is the result of a violation of the normal reduction in the intestinal wall. It can be due to both strong spasms and full relaxation of the muscles of the intestinal wall. This species Neverthentime needs to be treated conservatively, operational intervention on the contrary may aggravate peristalistic disorders.

Mechanical obstruction is a real obstacle on the path of dietary masses in the intestine. It happens:

Obtultational; Stagnaya; Mixed.

Mechanical obstruction very rarely passes independently or from conservative measures. It is this kind of obstruction - an absolute reading to the operation. The causes of the mechanical obstacle in the intestine can be:

To suspect the intestinal obstruction along the clinical picture is quite easy. The main symptoms are pain, vomiting, bloating, lack of stool. These same symptoms may be observed with other catastrophes in the abdominal cavity, but in any case it is an acute state that requires emergency hospitalization.

In the presence of such symptoms, the patient is emphasized in the surgical department. Dates of hospitalization determine the forecast. The later the patient entered the hospital - the higher the mortality rate.

An abdominal radiography is prescribed to confirm the diagnosis, emergency irrigoscopy (intestinal radiography with contrast) or colonoscopy can be carried out. Sometimes there is a diagnostic laparoscopy in difficult cases.

In urgency, all necessary analyzes are carried out. The most important indicators of the level of hemoglobin, hematocrit, leukocytes, ESO, serum - level of protein, sodium, potassium, creatinine, amylases are most important. The blood type and the rhesus is determined.

Several groups of patients with intestinal obstruction phenomena can be distinguished, to which various reference tactics are applied:

Patients who arrived in the first 24 hours from the beginning of the symptoms, from dynamic obstruction or with suspicion of common, but without phenomena of peritonitis. Conservative therapy and intensive observation are appointed. Conservative measures can eliminate symptoms of dynamic and certain types of mechanical obstruction. If the condition does not improve for 2 hours, the patient is taken over to the operation. Patients with suspicion of steady obstruction With the phenomenon phenomenon phenomena, in a compensated state immediately for the operation. Patients in serious condition arrived later than 24 hours, In a state of hypovolemic shock, heavy electrolyte violations are carried out intensive preoperative preparation (sometimes it takes more than 3-4 hours) and the subsequent emergency operation.

Preparation for unemployment operation

When a patient arrives in the hospital:

Setting the catheter to the central vein to control the central venous pressure and parenteral infusions. Bladder catheterization for controlling diuresis. Installing a nasogastric probe.

Principles of conservative therapy

Conservative therapy is also a preoperative preparation method (if the operation still takes).

Aspiration of the contents of the stomach and the upper departments of the intestine through the established probe. Cleaning and siphon enema. Sometimes this measure can help eliminate the obstacle (for example, blur tight felling dawns). Urgent colonoscopy. It is carried out with a diagnostic goal, but may also eliminate some types of obstruction (for example, invagination, or partially expand the intestine during the obturation). Replenishment of fluid and electrolyte losses. To do this, under the control of FVD, Diurea, plasma electrolytes are carried out by infusion of saline, salt solutions, protein hydrolyzates, rheological solutions, plasma. Typically, the volume of the funds of the means is up to 5 liters. With enhanced peristaltics and pains, antispasmodic agents are prescribed, with intestinal paresis - means of stimulating peristaltics. Antibacterial agents are also prescribed.

Operations for intestinal obstruction

If conservative measures have not eliminated the problem, the operation is not avoided. The main tasks of surgical intervention:

Elimination of obstacles. If possible, eliminating the disease led to this complication. Maximum possible actions For the prevention of postoperative complications and relapse.

The main stages of the surgery and tactics

1. Anesthesia. This is usually endotracheal anesthesia with muscle relaxants.

2. Access - most often wide median laparotomy.

3. Audit of the abdominal cavity. There is an accurate level of obstacles. Above this place of the location of the intestine of the intestine, the bugvo-shiny color, the wedding intestine - the sleeping, the color is usually not changed. The entire intestine is investigated, since sometimes obstruction can be determined at different levels at the same time.

4. Decompression and purification of the leading intestine, if it failed to do before surgery. For this, it is a non-sourceal intubation (through the esophageal probe), or the intubation of the intestines directly through a small cut.

5. Immediately eliminating the obstacle itself. Several types of interventions can be applied here:

Enterotomy - the intestinal wall is opened, remove an obstacle (for example, a tangle Askarid, a foreign body, gallstones) and sewn. When the hernia is infrained - the right of the intestinal disadvantaged loops. With strange obstruction - dissection of adhesions, unleashing nodes, elimination of invagination and coast. Resection of the intestinal portion in the presence of a tumor or intestine necrosis. Bypass anastomosis in the case when the obstacle can not be eliminated. The imposition of colostomas (constant or temporary) is usually in cases of left-sided hemicultomy.

6. Estimation of the viability of the intestine and its resection.

This is a very responsible moment of the operation, further forecast depends on it. The viability of the intestine is estimated at its color, reduction and ripple of blood vessels. Any doubts in the normal state of the intestine - reason for its resection.

In the signs of the necrosis of the intestine, this area is restended within healthy tissues. There is a rule to learn the intestine by 40-60 cm above the border of non-viability and 10-15 cm below it.

With resection of the small intestine, anastomosis "end to the end" is formed. In case of obstruction in the area of \u200b\u200bthe blind, ascending or right half of the transverse border is performed right-sided hemicotomy With the imposition of an Ileotransversoanastomosis.

When the tumor is located in the left half of the colon, the simultaneous operation is not possible in most cases. In this case, the imposition of worship resection is carried out, and the subsequent operation of the removal of colostomas and the creation of anastomosis is carried out.

A single-stage radical operation is carried out and with a developing peritonitis. In this case, the task of surgeons is to eliminate the obstacle, rinse and drain the abdominal cavity.

Sometimes surgical treatment is divided even into three stages: 1- Overlaying of the unloading stoma, 2 - resection of the intestines with a tumor, 3 - the creation of anastomosis and the elimination of the stoma.

7. Washing and removing traffic from the abdominal cavity.

8. Drainage of the abdominal cavity.

9. Entering the wound.

After operation

The postoperative stage in such patients is a very important point of treatment, no less significant than the operation itself.

The patient after the operation is sent to the ward of intensive therapy. Main events:

24-hour monitoring of basic life functions. Suction of intestinal content through an intestinal probe. It is carried out for the prevention of the intestinal paresis, reduce intoxication. Aspiration is combined with the intestinal washing and the introduction into its lumen of antibacterial agents. It is carried out before the appearance of active peristaltics (usually it is 3-4 days). Parenteral injection of fluid under the control of the CVD and Diurea. Parenteral administration of saline solutions under the control of plasma electrolytes. Parenteral nutrition (glucose solutions, amino acids, protein hydrolyzates). Antibacterial therapy. A hypertensive solution of sodium chloride, anticholinesterase agents (prozerne) are introduced to stimulate the intestines, the anticholinesterase agents (prozerne), the prescription of physioprocessor in the form of intestinal electrostimulation is carried out. Good effect Gives a paranefral blockade. Elastic binting lower extremities For the prevention of thromboembolic complications.

After 3-4 days, liquid food and drink are allowed. The diet is gradually expanding - mucous porridges, vegetable and fruit puree, meat souffle, dairy products are allowed. Diets with the exception of coarse, acute food, products causing reinforced gas formation and fermentation should be adhere to 2 months.

Features of the operation at the most common types of obstruction

The most common type of fine obstruction is obstruction with adhesive disease. For the colon is the overlap of the intestinal lumen with a tumor.

Favoring intestinal obstruction

Spikes are scar tires in the form of harnesses or films arising after operations on the abdominal cavity. Speakers can cause both obtuctural obstruction (squeezing the intestinal lumen) and the strategular (squeezing the bow / intestine).

The essence of the operation is the dissection of scar chickens, resection of the necrotic sector of the intestine. Dropped by all the spikes, and not just those that caused complete obstruction.

The peculiarity of this type of obstruction is that adhesive obstruction is prone to relapses. Walking spikes, we create prerequisites for the formation of new adhesions. It turns out a vicious circle.

favoring intestinal obstruction

In recent years, new techniques have been proposed for the prevention of recurrence during adhesive obstruction. Briefly the essence of them is as follows: Madely put the loop of the small intestine in the abdominal cavity, try to fix them as much as the mesentery). But these techniques do not guarantee the lack of relapses.

In addition, laparoscopic elimination of adhesive obstruction is gaining popularity. This operation has all the advantages of minimally invasive surgery: Malotavraumum, Fast Activation, Short rehabilitation period. However, surgeons reluctantly go to laparoscopic operations when intestinal obstruction. As a rule, during such operations, it is still often necessary to switch to open access.

Intestinal obstruction due to tumor

The tumor nature of obstruction is a special part of surgery. Operations with this form of obstruction belong to the most difficult. Often patients with intestinal tumors come for the first time in the hospital just with the developed intestinal obstruction picture, the diagnosis is made on the operating table. Such patients are usually weakened, anemized long before the operation.

The operation costs two tasks: the elimination of obstruction and tumor removal. Very rarely, this can be done simultaneously. The radical operation cannot be executed:

With the technical inability to remove the tumor. Extremely serious condition. With a developing peritonitis.

In these cases, with the aim of eliminating obstruction, limited to the removal of intestinal stoma. After eliminating the symptoms of intoxication, the patient's preparation after a few weeks is carried out radical operation - resection of the intestine of the intestine with a tumor and the elimination of the colostoma (the removal of the worship can be delayed and moved to the third stage).

If the patient's condition allows, the removal of the tumor is carried out simultaneously with the elimination of intestinal obstruction. Removal is carried out with observance of ablastics - that is, as expanded as possible, a single block with regional lymph nodes. In tumors in the colon is carried out, as a rule, right-sided or left-sided hemicultomy.

right-sided / left-sided hemicultomy

With the tumors of the small intestine - subtotal resection of the small intestine. When the tumor is located in the sigmoid intestine, the operation of Gartman is possible. With the rectal cancer, an extirpation or amputation of the rectum is carried out.

If it is impossible to remove the tumor, palliative operations are carried out - a unifasted rear pass or bypass anastomosis is created to restore passability.

Mortality in acute intestinal obstruction remains high enough - an average of about 10%. The forecast depends on the deadlines of the treatment. At the hospital entered in the hospital during the first 6 hours of the beginning of the disease, mortality is 3-5%. Of those who come later than 24 hours, it dies already 20-30%. Very high mortality in elderly weakened patients.

The removability operation of the intestine belongs to emergency care. It is carried out for free in any nearest surgical hospital.

Perhaps a paid operation, but you need to know the clinics that specialize in the provision of emergency care. The price depends on the volume of intervention. The minimum cost of such operations is 50 thousand rubles. Next, it all depends on the duration of stay in the hospital.

The cost of a laparoscopic operation for adhesive intestinal obstruction - from 40 thousand rubles.

Video: intestinal obstruction in the program "Live Great!"

The intestinal obstruction causes difficulty or complete cessation of the promotion of the edible lump on the thin or thick intestine. Select mechanical (associated with an obstacle) and dynamic (due to impaired motor activity of the intestinal integrity). Most pathological processes in which the normal movement of food on the digestive tube is disturbed, require urgent treatment. The peculiarity of the therapy of this complication is that if the intestinal obstruction arose, the operation should be carried out as soon as possible in the absence of the effect of the use of drugs.

What is the dangerous intestinal obstruction?

What will be the consequences in case of obstruction, depends on the immediate cause, the degree of reduction of the intestinal lumen and the duration of this process.

The mechanical disorders of the passage of food leads:

The formation of adhesions with the development of intestinal obstruction is probably after the operation on the abdomen organs, in the breakthrough of ulcers in the abdominal cavity, diseases of the inner sexual system in women. They may occur under the influence of radiation during radiation therapy during oncological processes, as well as to be distant consequences of stupid injury with damage to the gastrointestinal tract.

Not only intestinal cancer can be the cause of obstruction, but also malignant neoplasms of closely located organs: liver, adrenal glands and kidneys, bladder, uterus.

Intestinal obstruction can also occur when squeezing the ligament fabric, ensuring the attachment of the intestine to the rear wall of the abdomen. Damage to the vessels and nerves located in its thicker leads to a violation of nutrition and regulatory activities of nerve fibers. Most often, this pathology is observed at the breakthorn.

In the introduction of one intestine section inside the other, the development of invagination is possible. In this case, there is a partial overlap of the intention of the intestine of the intestine, nerve fibers and blood vessels. Most often, such an intestinal obstruction in babies up to 9 months.

All these pathologies are dangerous with their consequences in the absence of adequate and timely treatment. Violation of the normal movement of the edible lumps dramatically impairs the course of the main disease. And also in itself has difficult consequences.

The most dangerous changes in the obstruction of the intestine:

loss of fluid, violation of normal salts, acids and alkalis in the body; poisoning of metabolic products that were not brought through the intestines, leading to the deterioration of all internal organs; the emergence of the incessant vomiting, nausea; dysfunction of organs and tissues; activation of the processes of rotting and reproduction of pathogenic microbes; The color of the intestinal section, in the most difficult cases - the break of the wall with the ingress of the contents into the abdominal cavity and the development of purulent inflammation.

For further development Pathology purulent infection spreads throughout the body, which in the absence of effective therapy may result in patient death.

A sharply disturbed cleansing intestine function in the end leads to an irreversible damage to all organs and systems. This process also carries a direct threat to the patient's life.

In what cases is required operation?

When signs of intestinal obstruction, it is necessary to consult with the surgeon doctor. It is this specialist that determines the amount of necessary medical events.

The intestinal obstruction is a mandatory indication to the operation, if it caused a mechanical obstacle. In this case, it is necessary to remove the reason to the maximum, which caused the overlap of the intestinal lumen, restore the normal promotion of the food lump.

Absolute testimony for surgical intervention:

tumor education; overlap of the intestinal lumen with bile stones; twisting loops of a thick or small intestine with the formation of nodes; Invagination (introduction of a part of the intestine to another).

Intestinal obstruction, due to impaired motor function and nervous regulation, is treated with medicines. The goal of therapy is to eliminate the factors provoked that in some cases leads to the restoration of the normal promotion of the edible lump. If, with this pathology, the vessels and nerves are damaged, possibly doned fabrics, the operation is also mandatory.

Preparation for the operation

Depending on the cause of development, the timeliness of the diagnosis, the general state of the patient, the operational intervention may be urgent and planned. Before intervention, patient preparation is carried out. With a planned operation, it can be started at home, continue in the hospital, with urgent - for several hours, in the hospital.

The main components of the preparatory phase:

special intestinal diet with sufficient water, the exception of vegetables, fruits and bread; Appointment of laxatives daily (Fortrans, Magnesia solution, Vaseline oil); Cleansing enemas every evening; use of drugs to reduce spasms (drootaverin, barallgan); intravenous administration solutions to normalize the level of electrolytes, the amount of liquid, acid-alkaline indicators, the energy exchange, the protein composition of the blood; Consultations in narrow specialists about concomitant diseases, treatment in order to maximize change correction.

The amount of fluid that needs to be used during the day is calculated based on the daily urine release (normally about 1.5 liters). The recommended volume is adjusted depending on weight and functional state of cardio-vascular system, kidneys and urinary organs.

Simultaneously with the preparation, it is necessary to carry out a complete comprehensive examination of the patient. As a result of the analysis of all obtained data, a decision is made on the operation method.

Stages of holding

Depending on the location of the obstacle, doctors are planned operational access. The most common incision is carried out in the middle line of the abdomen, which ensures maximum availability of abdominal organs and minimal tissue trauma.

General steps operations for intestinal obstruction:

Laparotomy - incision with access to the abdominal cavity. Removal from the abdominal cavity of the physiological and formed due to inflammation of liquids. Additional administration of painkillers into a thick and indocidant mesentery, solar plexus zone. Inspection by the surgeon of organs and tissues of the abdominal cavity, the detection of the focus, overlapping the intestinal of the intestine. Introduction through the nasal probe probe for the aspiration of intestinal contents; Removal of the pathological focus, as well as all non-visual fabrics, restoration of the intestinal wall and its lumen. Sewing layer in all areas of the cut.

Depending on the nature of obstruction, special individual approaches to surgical treatment have been developed.

Features of operational tactics depending on the cause:

with hernias, it is removed by the affected intestinal loop, immersed viable departments in the abdominal cavity and sew the hernia; With the development of adhesions of any nature, the resulting scars dissect; If there are neoplasms, the tumor is removed, the affected part of the intestine within a healthy organ; When the intestine, the node, the rags are raised by damaged tissues, ripples and movements are determined by their viability, unviable fabrics are removed; In the presence of worms, foreign bodies cut the intestinal wall and remove the cause of obstruction; If it is impossible to restore the intestinal permeability at a tumor, part of the intestine is output from the formation of the colostomy (unnatural rear pass).

Operation in intestinal obstruction is large in volume, it is traumatic and difficult to port patients. Therefore, more often interventions are performed in several stages. Then the task of the first stage will be the removal of the affected tissues and the immediate cause of pathology, the formation of colostit. In the second stage, the intestinal integrity is restored (it is carried out on average, in a few months).

In newborns, at obstruction of the intestine, the urgent surgery is carried out if the vibration of the guts is diagnosed. With anomalies of development, planned treatment is carried out after a complete examination and training, given the immaturity of the child's bodies.

Postoperative period

Operations about intestinal obstruction belong to bulk interventions with a long postoperative period. It is determined by the time of full wound healing and the maximum possible restoration of the body.

Basic medical tactics in this period:

control and restoration of the normal functioning of internal organs (respiratory and cardiovascular system); adequate anesthesia; washing the stomach, intestines; restoration of normal peristaltics; processing of the surface of the operating wound; In case of embezzlement, the patient's training is care for it.

Daily washing the stomach using the probe. Permanent suction of the intestinal contents is possible. The greatest effect is observed from the use of the probe introduced during the operation through the nose into the intestine. It allows and during this period to remove the liquid content of the intestine and gase, which reduces the inxication phenomena, contributes to the recovery of the peristaltics. As a rule, in the middle of the postoperative period, the probe is removed (5 days).

The peristaltic is activated by the introduction of small quantities (up to 40 ml) of hypertensive solutions of 10% sodium chloride, the introduction of cholinesterase inhibitors (prozerne).

Gradually, as the intestinal motor function is restored, the patient is allowed to eat. During this period, the food must be as gentle as possible mechanically and thermally. The food must be wired or crushed with a blender. Temperature should correspond to human body temperature.

The dishes should not contain salts, substances affecting the peristalsis, are excluded spices and spices. Food up to 8 times a day, small portions. Vegetable beams are allowed, rubbed porridges, coiled and crushed fruits (apples, pears), low-fat veal, chicken. It is recommended to drink to one and a half liters of fluid per day.

As the postoperative period is completed after the operation over the intestinal obstruction expands. Its main task is the maximum prevention of such symptoms as pain in the abdomen area, increased gas formation and broken stools with a tendency to constipate or diarrhea.

Food should be energetically complete, contain enough protein, fats, carbohydrates for the maximum possible restoration of the active functional state of tissues and patient organs, ensure the saturation of the body with vitamins.

The diet must contain:

vegetables, non-acidic fruits and berries are mainly in the treated form; Oatmeal, wheat, rice porridge; The bread is a non-acid, containing bran; fermented milk products (low-fat cottage cheese, cheese); fastening tea, kissel, compote with a small amount of sugar; Non-fat varieties of beef and fish, rabbit meat, chicken, turkey in stew and boiled form.

The diet after the operation categorically should not contain sharp, salt, smoked dishes, sausages, saturated broths from meat, mushrooms, fish. It is better to eliminate white-baked cabbage, tomatoes, mushrooms, legumes, chocolate, carbonated and alcoholic beverages, bakeries and cakes, nuts.

The amount of liquid drunk is up to two liters per day. In the future, a gradual expansion of a diet under the supervision of a doctor is allowed. However, aggressively active products on the intestines are advisable to exclude completely from the power.

Effects

With a diagnosed diagnosis, an effective operation and postoperative restoration, the forecast for life and recovery from obstruction is favorable. Provided that the operational intervention radically cured the main disease. The functional ability of the intestine is restored, the chair and weight is normalized.

However, in rare cases, with operations over the intestinal obstruction, adverse effects arise.

Perhaps the emergence:

single and multiple gaps of the wall of the small intestine; Peritonitis - inflammation of the peritoneum; necrosis - the loss of the viability of the plot of the small intestine; discrepancies of intestinal seams; Violation of the functioning of an artificial rear passage.

These phenomena are rare, however, it is necessary to monitor the patient and fulfill all the recommendations of the doctors to prevent them.

Intestinal obstruction is a dangerous complication of a number of diseases. The forecast depends on the cause of the emergence, timeliness of diagnosis and treatment. In most cases, adequate medical events lead to complete recovery. Even with the most difficult pathologies, the malignant nature of obstruction, operational interventions eliminate obstacles, significantly improve the overall state, prolong the patient's life.

Useful intestinal obstruction video

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Among all digestive bodies, the intestine is most mobile and has a greater length - about 4 meters. It consists of 2 departments - thin and colon, which in turn are also divided into departments that differ in their function. Movement (peristalistic) contribute to the passage of food, and enzymes allocated and abundant blood supply ensure its digestion and suction.

In the sublock, which includes a 12-robbing, skinny and iliac, the processes of splitting, enzyme treatment of food and suction of nutrients, the production of immune tel. A thick department, which includes the blind, rimmed, sigmoid and straight intestine, performs the function of suction of salts, water, formation of vitamins due to the useful microflora, the formation of carts and their evacuation.

When obstruction occurs, all these functions are violated: exchange processes In the tissues and organs, the water-salt balance, toxins accumulate. In the absence of treatment, the outcome is easy to predict.

Intestinal obstruction - concept, causes, types

A condition in which the promotion of the intestine is fully or partially disturbed is called its obstruction (medical name Ileus). The reasons may be the most different:

tumors; Inflammatory process (Crohn's disease); Spikes in the abdominal cavity; strangulated hernia; Athony, parisses; blocking with bile stones; Glice invasion; Hall stones; congenital anomalies; abdominal injuries; Thrombosis of mesenter vessels; volvulus.

Ileus may be congenital associated with the anomalies of the digestive tract, and acquired. Depending on the cause, it can be mechanical as a result of closing the lumen of the tumor, spikes, stones; dynamic when the peristalistic is weakened; strategy, bound to circulatory impairment; and mixed. Dynamic Ileus in the intestinal paresis and the strategious blood circulation, as a rule, has a more severe course and worst forecast.

Children are more commonly found by stagnation obstruction - invagination when part of the intestine is being introduced into the nearby department. Current is characteristic with rare meals and overeating. Thromboembolia of mesente vessels is more often evolving in the elderly. Safdening Ileus is a frequent complication of operational interventions - resection of a small intestine, stomach, gynecological interventions, appendectomy, and even after removing the fistula of the rectum.

Council: It must be remembered that often the development of Ileus leads infringed hernia. Therefore, the "possessors" of the hernia must, not expecting complications, contact the surgeon for surgical treatment, when it is much easier and safer.

Symptoms and diagnostics

Clinical manifestations. The disease is manifested by very characteristic symptoms. These are pain in the abdomen of a grapple-shaped character, bloating, nausea, vomiting, not extinguishing gases, lack of stool, violation of a general condition. The clinical form of the disease may be acute when all the listed symptoms are pronounced sharply, and chronic, at which they manifest themselves periodically and there are no sharp disorders of the overall state.

These symptoms may arise both in the early and late postoperative period after operations on the intestines and other abdominal organs, they can be expressed in varying degrees

Council: The appearance of any of the specified symptoms should be a reason for immediate appeal to the doctor. With pain in the stomach and the latency, the chair cannot be taken by laxatives without consulting a doctor. When breakdown, invagination, the obturation of the intestine, they will only exacerbate the state.

Diagnostics. In the case of acute Ileus, the patient enters the surgical department in an urgent basis, where he is conducted by an express examination confirming the diagnosis. This is the radiography of the abdominal cavity organs in a vertical position, ultrasound examination. The horizontal levels of fluid - stagnant intestinal content, as well as the "Clabeber bowls", formed by the accumulation of gas in the upper sections of intestinal loops and having a kind of inverted bowls. ECG, main laboratory tests for preparation for the operation are also fully implemented.

If the disease has a chronic course, and evacuation disorders are partial in nature, the patient passes a complete examination of the abdominal organs. Initially, a contrasting X-ray study is prescribed with barium / irrigoscopy, on which the narrowing of the intestine of the intestine can be revealed, the defects of its filling, shock shift. After that, preparation for the colonoscopy is carried out - the intestines is cleaned, after which it is examined with the introduced fibroid probe with a video camera, a lighting system and an increase. Fibrocolonoscopy allows you to identify the inflammatory process, the presence of polyps, tumors, biopsy and histological examination is performed. According to the results and diagnosis, the issue of choosing a treatment method is solved.

The small intestine for the listed research methods is inaccessible due to the set of bends and loops. In modern clinics, a new unique capsule endoscopy technology is used. The patient swallows the capsule - a miniature video camera. Moved gradually on the digestive tract, it scans all its departments, passing information on the display, and outlook outwardly. This diagnostic technology is not traumatic, has no contraindications and highly informative.

In case, for patient, irrigoscopy or colonoscopy are severe procedures, for example, in heart failure, hypertension, a computer tomographic study is carried out - virtual colonoscopy. It is painless, short-time and easily tolerated patients. After the injection of the patient's liquid contrast is placed on the table under the arc of a tomographic scanner, the image is transmitted to the display in the volume (3D) format, pictures are taken.

And acute, and chronic forms of the disease in most cases are treated with a surgical method. Only at the very beginning of the disease, when the overall condition of the patient is not yet violated, after examination, conservative measures are used - washing the stomach, cleaning enemas, while atony is carried out stimulation of peristaltic drugs (prozermin injection, neostigmine). If within a few hours the treatment is ineffective or the cause is a tumor, spikes, anomalies, mesenter thrombosis, surgical treatment.

Surgical treatment of intestinal adhesions

During the intervention, the cause of the disease is eliminated: the spikes are dissected, the tumor, stones, wobbies, rebounding the loops are removed. Not in all cases it is immediately possible to eliminate the cause of the Ileus, for example, when cancer or with serious condition of the patient. Or when the extensive portion of the intestine is removed about the tumor, inflammation, necrosis. Then the discharge stoma is superimposed after the intestinal operation - the outer fistula for emptying. It can be constant and temporary. The latter is removed when re-operation after eliminating the cause and recovery of patency.

Very often, obstruction is developing as a result of adhesions after interventions on the abdominal organs, pelvis. They glue the intestinal loops, limiting their movements, cause them to fight them with other bodies. How to treat intestines after surgery or prevent their education? For this purpose, the patient is prescribed as an earlier rise after the operation, medical gymnastics, prescribe proteolytic enzymes and physiotherapy, if there is no contraindications to it.

Postoperative period

The first days or weeks postoperative patient is in the hospital and gets all the appointments of the attending physician:

diet and therapy; stimulation of intestines; anti-inflammatory therapy; intravenous infusion for filling fluid, minerals, removal of toxins; physiotherapy for the prevention of adhesion formation (exception is the abdominal tumor); Medical gymnastics.

After discharge from the department, the patient is observed outpatient and performs all the recommendations and appointments of the doctor. Be sure to perform special exerciseBut with the limitation of the load.

Tip: Some operated patients try to spend more time in bed, believing that so safer (the wound hurts less, the seams and so on). This is a mistake, the consequence of which again may be obstruction due to the development of adhesions against the background of hypodynamia.

And finally, the diet, the observance of which is very important. Food after surgery on the intestines depends on its nature and volume, and should be within the framework of the individual recommendations of the doctor. However, exist general rules Food, which you need to stick. This is an elimination of acute and coarse food, fermentation products and blooming (milk, legumes, carbonated drinks), extractive products, nutrition broths. Limit the number of fats and carbohydrates, and the consumption of protein and vitamins should be sufficient.

Acception products containing lactobacilli and bifidobacteria are recommended for restoring intestinal microflora, fruit purees and juices, dilated mucous porridges and soups. You can expand the diet not earlier than 2-3 months, and only consulting with a specialist.

The state of health after surgery about the obstruction of the intestine to a large extent depends on the patient himself. You can avoid re-operation and warn unwanted consequences, carefully fulfilling all the necessary medical recommendations.

Attention! The information on the site is represented by specialists, but is familiarized and cannot be used for independent treatments. Be sure to advise your doctor!

What is the procedure for which?

The small intestine (Small Intestine) is a part of the intestine, which starts from the stomach and ends with a colon. In this part of the intestine, most of the processes of digestion and suction of food passes.

Resection of the small intestine Or its parts will be considered as possible treatment in several cases:

1. Crohn's Disease Disease - inflammatory disease intestine characterized by chronic inflammatory processwhich can affect all areas digestive system, including the small intestine. In severe cases when medicia treatment It does not help to alleviate the symptoms, it may be necessary to resection parts of the small intestine.
2. Malignant tumors: malignant tumors In the small intestine are rare phenomenon, but in most cases they require surgical intervention in order to remove them.
3. Interesting obstruction: The operation carried out in order to resemble the part of the intestine in which obstruction occurs, it will be necessary when conservative treatment (drainage of the stomach by administering the gastric probe) was unsuccessful or when there is a suspicion of ischemic intestinal damage, which led to the elimination of the intestinal part.
4. An abdominal injury, which led to damage to the small intestine.
5. Preiodine polyps in the small intestine.

The resection of the small intestine can be carried out by the "open" method (that is, with the help of a large abdominal cut) or a laparoscopic (minimally invasive) method, which is carried out by several small incisions through which operating instruments and a camera with a light source are entered. The laparoscopic method has several advantages compared to the open method, among which: aesthetic advantages (very small scars), fewer infections, less pain after surgery, smaller time in the hospital and a rapid process of restoring forces after surgery.

How is this procedure performed in practice?

Operation to remove the small intestine by laparoscopic method is carried out under general anesthesia, so the patient will be shipped into rough sleep throughout the operation and will not be aware of its condition. Immediately before the start of operation, the patient will be connected to infusion through which the anesthesiologist will introduce the sedatives to it in order to help the patient reduce the feeling of anxiety.

At the beginning of the operation, the patient's belly will be separated by carbon dioxide with the introduction of the needle (the purpose of this procedure is to facilitate the manipulation of surgical instruments inside the abdomen). After that, the abdominal wall will be executed OK. 4-6 small cuts (1-2 centimeters). Laparoscope (small camera with light source) will be introduced into one of these cuts), which will remove the operating field. The surgeon will be able to see the operating field on the screen installed in front of it. Surgical instruments will be introduced through other cuts (for example, scissors, electric diathermokuagulant, clips, thread and needle).

During operation, the surgeon will remove the damaged part of the intestine. Then it will connect two healthy parts of the intestine by stitching or imposing surgical brackets. In some cases, it is necessary for some time to protect the intestine from passing food through it. In these cases, the upper part of the intestine will be removed from the body (this is called "stoma") and is connected to the carriagory. The connection of the two parts of the intestine will be produced later during the additional operation.

At the end of the operation, the surgeon will extract surgical instruments and will bring carbon dioxide from the patient's body, takes it off or links the cuts and impose bandages on them. In some cases, depending on the medical condition of the operated, the decision to transition to an open operation will be made (instead of using minimally invasive technology). This will not be considered a surgical complication, but only the right calculation of the surgeon, the purpose of which is to ensure the safety of the patient.

What anesthesia will be used during the operation?

How long does the operation usually last?

From 1 to 3 hours.

How to prepare for surgery and hospitalization in the hospital?

Before surgery, you need to perform an ECG, a snapshot of the chest and standard analyzes blood, including general analysis blood biochemical analysis and analyzing electrolytes (including calcium, magnesium and phosphorus), functional hepatic samples and blood test for clotting.

Possible preoperative examinations of medical visualization methods include magnetic resonance imaging (MRI), computer tomography (CT) of the abdomen after receiving inside barium, as well as endoscopic examination by video cab. (The examination is performed using a capsule, which is a small camera 2 cm long and a diameter of 1 cm. The camera is stored in the shell with a vitamin tablet; it makes the shooting and translates signals to the receiving devices located on the special belt surface, which is put on the patient to the lower back.

The purpose of the examination is to see the mucous membrane of the small intestine in order to detect pathological changes in its cavity.)

A week before the operation, it is necessary to stop the reception of anticular drugs, such as aspirin or Kumadin.

On the day of operation, within 8 hours before it began, you need to completely refrain from meals and water.

What happens after surgery?

At the end of the operation, the patient will be in the postoperative compartment approximately two hours in order to ensure slow and safe awakening after the operation. After that, the patient will be transferred to another compartment, and after a few hours he will help to get out of bed or sit in a chair.

The presence of strong pain is not assumed (in any case, pain can be monitored by painkillers). At the same time, patients often suffer from discomfort in shoulders due to inflating the abdominal cavity with carbon dioxide.

An extract from the hospital is possible, as a rule, after 4-7 days after the operation (in comparison with 7-10 days of hospitalization after the "open" operation).

What will happen after discharge from the hospital?

Return to daily activities that do not require special efforts is possible a few days after the operation. In the first month after the operation, refrain from lifting weights.

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