Gallstone disease is one of the most common surgical nosologies, which tends to increase steadily. More than 2.5 million cholecystectomy surgeries are performed annually in the world: in European countries – from 45 to 80 thousand, in the United States – more than 700 thousand choledocholithiasis with the development of mechanical jaundice. Diagnosis of these complications in most cases is not difficult, and the provision of surgical care is standardized. Bouvet’s syndrome (syn. Acute biliary ileus, Gallstone ileus) is a very rare complication of gallstone disease and is caused by the development of inflammatory degenerative-dystrophic changes between the gallbladder and the duodenal wall, leading to the formation of fistulas through which -intestinal tract with the development of obstruction. However, it should be noted that only in 7–10% of cases, the formed fistula can cause the migration of stones and the development of intestinal obstruction. By 2008, only about 300 cases of the syndrome had been described in the world literature. Patients with a long history of stone disease, frequent episodes of exacerbation of cholelithiasis, female gender, old age are the main risk factors for Bouvere syndrome. Compared to other types of mechanical obstruction, the frequency of biliary ileus is only 1–4% and can reach 24% in people over 70 years. The complexity of the diagnosis is due to the nonspecificity of the initial manifestations, comorbidity of patients, late treatment. Postoperative mortality in acute calculous cholecystitis ranges from 0.28% to 3.01% (on average in Ukraine 0.94–0.81%), and in Bouvere syndrome can reach 24%. The main direct causes of death are bleeding, perforation, acute pancreatitis, severe dyselectrolyte disorders. The possibility of widespread use of computed tomography and magnetic resonance imaging greatly simplifies the diagnostic search. However, unfortunately, preoperative diagnosis of the syndrome is achieved only in a quarter of patients. Minimally invasive methods, given the growth of scientific publications and personal experience, can be successfully used to correct this pathology as a final method. A literature review of the etiology, pathogenesis, clinical manifestations, prevalence, methods of diagnosis and treatment of Bouvet syndrome is presented. Clinical case (short description). Presented own clinical observation of Bouvere syndrome in a patient hospitalized in the surgical department of the KNP «Regional Clinical Hospital named after O.F. Gerbachevsky» with the phenomena of duodenal immobility and long history of stone-bearing. Consecutive use of endoscopic and instrumental imaging methods allowed accurate diagnosis, and the use of laparoscopic access made it possible to perform minimally invasive correction of pathology in this patient. Conclusions. Gallstone disease is one of the most common surgical pathologies. Bouvere syndrome is a rare complication of the latter. Clinical symptoms are less specific, so the use of additional instrumental examinations allows accurate preoperative diagnosis. Due to the low efficiency of endoscopic methods of correction surgery is the main tool. The increase in scientific publications on the use of laparoscopic and video-assisting techniques makes it possible to argue about the relatively high efficiency of the latter in the correction of this pathology. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: Gallstone disease, acute intestinal obstruction, Bouveret syndrome.
Non-occlusive mesenteric ischemia is a relatively rare but extremely complex pathology in terms of diagnosis. A wide range of reasons for the development of non-occlusive impression dramatically complicates the diagnosis and differentiation with other abdominal pathology. The vast majority of publications in the domestic literature on acute disorders of mesenteric blood flow, mostly address the problems of diagnosis and treatment of occlusive types of mesenteric ischemia, while the topic of non-occlusive ischemia remains insufficiently covered. Given that in half of the cases NOMI is diagnosed at the stage of irreversible necrotic changes of the intestine – there is a real need to generalize the root causes and mechanisms of neoclustive mesenteric ischemia, modern methods of diagnosis and treatment. Purpose – to analyze of the causes, prevalence, classification, diagnosis and treatment of non-occlusive disorders of mesenteric blood flow. This research, based on literature review, showed that acute non-occlusive mesenteric ischemia (NOMI) is associated with poor prognosis due to the lack of accurate diagnostic measures. First of all, clarity regarding biochemical markers. Therefore, the research and development of the latter is seen as a priority. Contrast methods of examination (computed tomography, angiography) are the only possible diagnostic tools. Pharmacological correction is fundamental and presupposes the use of drugs with a vasodilating effect systemically or locally (catheter-associated). An important issue is the development of pharmacological agents that allow targeted action on the pathogenetic mechanisms of the development of NOMI. A multidisciplinary approach involving a specialized doctor, a surgeon, an X-ray endovascular surgeon and an intensive care physician in the treatment of a patient with suspected NOMI is the foundation for the success of therapy. The question of the use of laparoscopy remains controversial, given the invasiveness of the method and the difficulty of interpreting the changes detected in the early phase of the disease. No conflict of interests was declared by the authors. Key words: acute mesenteric ischemia, non-occlusive disorders of mesenteric blood flow.
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