ОПЫÒ ЛЕЧЕНИЯ БЕРЕМЕННЫХ С «ОСÒРЫМ ЖИÂОÒОМ»Материалы и методы. Анализ результатов лечения 183 беременных с острыми хирургиче скими заболевани-ями в условиях двух многопрофильных стациона ров г. Красно дара. Наибо лее часто встречаемыми ургентными хирургиче скими заболевани ями у беременных являются ост рый аппендицит, желчнокамен ная бо лезнь и ее ослож-нения, острый панкреатит, острая кишеч ная непроходи мость.Результаты. Диагностика заболеваний, учитывая контингент боль ных, весьма затрудни тельна и нередко про-должается длительное время, суще ственно ухуд шая прогноз как для ма тери, так и для плода. Использование УЗИ брюш ной поло сти всем пациенткам позволяет уточнить диа гноз и скорректировать так тику лече ния. При сомне нии в диагнозе необходимо выполнять диагностиче скую видеолапароско пию.Заключение. Использование малоинвазивных технологий в лече ние беремен ных позволяют умень шить часто-ту хирургиче ских и связан ных с ними перинаталь ных осложнений, способ ствую т пролонгированию беременно сти и снижению показателей материн ской и перинаталь ной смертно сти. ABSTRACT Aim. To summarize the current experience of diagnosis and treatment of pregnant women with acute abdomen. Materials and methods. Analysis of treatment results of 183 pregnant women with acute abdomen in the conditions of two multidisciplinary hospitals in Krasnodar. The most common urgent surgical diseases in pregnant women are acute appendicitis, cholecystitis and its complications, acute pancreatitis, acute intestinal obstruction.Results. Diagnosis of diseases, providing the contingent of patients, is quite difficult, and often takes a long time, significantly worsening the prognosis for both the mother and the fetus. The ultrasound examination of the abdominal cavity in all patients makes it possible to clarify the diagnosis and adjust the treatment tactics. When doubting the diagnosis, it is necessary to perform diagnostic laparoscopy.Conclusion. The use of minimally invasive technologies in the treatment of pregnant women can reduce the frequency of surgical and associated perinatal complications, promote the prolongation of pregnancy, and reduce maternal and perinatal mortality.
Aim. This study was conducted to assess the possibility of ultrasound elastometry using the shear wave method in the preoperative assessment of the stiffness condition of the pancreatic parenchyma in order to predict the risk of complications and the choice of the method for the formation of pancreatoenteroanastomosis in pancreatoduodenal resection.Materials and methods. The study was performed in 10 patients operated in the volume of pancreatoduodenal resection. All patients underwent preoperative ultrasound pancreatic elastometry with transcutaneous shear wave access method. The results were compared with the intraoperative data obtained by the visual examination and palpation. Depending on the average "stiffness" indicators of the parenchyma in comparison with the intraoperative data, one of two ways of forming the pancreatic intestinal anastomosis was preferred: either end-to-side or pancreatoenteroanastomosis with a wide atraumatic peritonization of the pancreas stump cutoff by the jejunum according to the original technique.Results. The inconsistency of class A pancreatoenteroanastomosis was noted in 2 (20%) patients, it was transient, asymptomatic, did not require additional medical interventions and did not extend the duration of the postoperative period. There were no inconsistencies of classes B and C, pancreonecrosis of the stump, repeated surgical interventions, and lethal outcomes.Conclusion. Ultrasound pancreatic elastometry with the shear wave method can be used in the preoperative assessment of the "stiffness" of the parenchyma in order to predict the risk of the complications and the choice of the method for the pancreatoenteroanastomosis formation.
A clinical case demonstrates the potential of transabdominal ultrasound of the large intestine in diagnosis and follow-up in a patient with ulcerative colitis. It is shown that transabdominal ultrasound examination performed in seroscan mode (B-mode) with the use of Doppler color mapping allows to monitor the degree of resolution of inflammation in the mucosa of the large bowel, as well as to evaluate the effectiveness of conservative approach.
Background. Colorectal obturation is a fairly rare complication in patients with colorectal polyposis. Case descriptions of colonic obturation with underlying familial adenomatous colorectal polyposis have not been reported to date in national and foreign literature.Clinical Case Description. Patient G., female, 31 yo, was emergently admitted to a surgical unit with a preliminary diagnosis: acute intestinal obstruction, complaints of abdominal pain, nausea, vomiting, stool and gas outlet blockage, marked general weakness. Clinical and biochemical blood tests without peculiarities. Signs of intestinal obstruction in abdominal ultrasonic and X-ray examination. Obstructive right hemicolectomy performed as emergent surgery. Diagnosis: transverse colonic C-r T3NoMo, stage II, clinical group 2. Patient had routine fibrocolonoscopy in six months; polyps were revealed in all operated colon portions. APC genetic test was positive, total colectomy was decided with single-barrel ileostomy excretion on anterior abdominal wall. Definitive diagnosis: transverse colonic C-r T3NoMo, stage II, developed with underlying familial adenomatous colorectal polyposis, clinical group 2.Conclusion. Diagnosis of familial adenomatous colorectal polyposis with acute intestinal obturation is challenging due to forced urgent surgical intervention and lack of time for a detailed deeper examination in avoidance of baleful consequences. The case reported demonstrates that clinical manifestations of familial adenomatous colorectal polyposis extend beyond the routine complaints of abdominal bloating, stool blockage and rectal bleeding towards a formidable complication of acute colonic obturation of polypoid genesis.
Background. Splenic artery pseudoaneurysm is a rare complication of acute and chronic pancreatitis caused by an arterial wall lesion with aggressive pancreatic enzymes and followed by arrosive bleeding into pseudocyst lumen and the formation of a dense fibrous capsule prone to growth.Clinical Case Description. Patient M., 61 yo, was emergently admitted to Territorial Clinical Hospital No. 2 with a preliminary diagnosis: Chronic pancreatitis, incomplete remission. Pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting. Gastrointestinal haemorrhage. The patient complained of moderate persistent belting upper abdominal and left subcostal pain, nausea, general weakness, black liquid stool over last five days. Pancreonecrosis in history. Pseudocyst formation in two months, endoscopic papillosphincterotomy and pancreatic stenting in hospital, the aforementioned complaints appeared past three months. Moderate anaemia (haemoglobin 73 g/L, erythrocyte count 2.8 x 1012), hyperamylasaemia (amylase 170 U/L), no other pathology in general and biochemic blood panels. The patient was rendered urgent oesophagogastroduodenoscopy for large duodenal papilla, with no evident bleeding detected. Abdominal CT angiography revealed a haemorrhagic mass connected with splenic artery lumen in the projection of pancreatic tail. The patient was transferred to an interventional radiology room for coil embolisation of splenic artery. The postoperative period was benign, and the patient discharged on day 3 after surgery for outpatient surgical patronage. Definite clinical diagnosis: Chronic pancreatitis, incomplete remission. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting.Conclusion. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst is reluctant to early diagnosis due to a lacking definite clinical picture and tractable only at an interdisciplinary institution disposing with a rich diagnostic toolkit and sufficiently qualified medical personnel. Endovascular treatment is overall most effective and enables a reliable aneurysm isolation from the splenic artery basin.
Benign neoplasms of the colon, rectum, anus and anal canal are true neoplasia of the colon mucosa and are associated with a high risk of colorectal cancer (CC). The literature review analyzes epidemiology, risk factors, and modern methods of diagnosis and treatment, and describes priority minimally invasive interventions for benign colorectal tumors.
Габриэль Сергей Александрович, заведующий отделением эндоскопии, д. м. н.Дурлештер Владимир Моисеевич, заместитель главного врача по хирургии, заведующий кафедрой хирургии № 3 ФПК и ППС, профессор, д. м. н.Гучетль Александр Якубович, руководитель центра эндоскопических методов диагностики и лечения, к. м. н. Крушельницкий Владимир Станиславович, врач эндоскопист отделения эндоскопииДынько Виктор Юрьевич, врач эндоскопист отделения эндоскопии, к. м. н.Тлехурай Руслан Махмудович, врач эндоскопист отделения эндоскопии, к. м. н. Кортиева Алена Таймуразовна, врач эндоскопист отделения эндоскопииИгнатенко Василий Васильевич, врач хирург отделения хирургии № 3 (колопроктология), к. м. н.
Aim.This study was conducted to assess the compliance of patients with duodenal ulcer disease during the dispensary observation.Materials and methods.We carried out an examination and a prospective observation of 1896 patients with uncomplicated duodenal ulcer and 43 people with sub- and decompensated scar-ulcerative stenosis of the duodenum.Results. The analysis confirmed that the compliance of patients with duodenal ulcer depends on the professional employment of patients, their gender, the level of education, presence of comorbidity, absence of undesirable effects of the taken medication, contact establishment with the patient, and presence of non-adaptive types of attitude to the disease.Conclusion.The interaction between different factors affecting the compliance should be taken into account when planning the tactics of dispensary observation of patients with uncomplicated duodenal ulcer and after eliminating the complications as wel.
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