Resume. Postoperative abdominal hernia is considered the most common complication in abdominal surgery. Aim. To acquaint medical practitioners with the clinical case of diagnosis and treatment of impaired postoperative contraperture true abdominal hernia on the background of a closed abdominal injury. Materials and methods. We present a clinical case of our own observation of the clinical course, diagnosis and treatment of impaired postoperative contraperture true abdominal hernia with necrosis of the loop of the small intestine and necrosis of the large omentum, acute strangulation small intestinal obstruction, general serous-fibrinous peritonitis, adhesive peritoneal disease of the 2nd degree at patient with closed abdominal trauma. Results. The patient with a closed abdominal injury, the results of the examination and treatment of which are given in the article, in the anamnesis - cholecystoectomy 39 years ago. The preliminary diagnosis: closed abdominal trauma, peritonitis. Intraoperatively, a case of true postoperative abdominal hernia of rare localization - contraperture hernia. It was taking into account the patient's complaints, medical history, results of physical examination, the results of laboratory and instrumental methods of research available at the time of examination. The clinical interest is not only the rarity of the birth of this pathology, but also the history of the disease, diagnostic search, clinical picture and treatment tactic. Conclusions. In this case, the patient was probably a hernia carrier for many years, and the injury only provoked the infringement. The patient sought medical help late, as result of which the picture of peritonitis was obvious. This made it possible to quickly decide on the need for surgical treatment. Otherwise, the likelihood of a tactical error is not excluded. We believe this case is interesting because one should always remember about the possible surgical pathology against the background of a closed abdominal trauma.
The aim of this study was to evaluate changes in the level of erythrocyte metabolism under conditions of hypoxia in patients with traumatic disease in polytrauma depending on the components of intensive care (IC). Materials and methods. A prospective study was carried out in 88 patients suffering from polytrauma in the period from 2015 to 2017. All the patients were divided into 2 groups, comparable by severity of trauma and condition. A special feature of the examined patients was the staged surgical correction in all cases according to the Damage Control concept. Patients from the Control group received an intensive care according to the standard local clinical protocol in polytrauma. Patients randomized to the FDP group were treated with infusion of D-fructose-1,6-diphosphate sodium hydrate in addition to the standard care. Hemodynamic parameters and cellular metabolism indicators were monitored: on admission to the operating room, after 24 hours, on day 3, 5 and 14. Results. The signs of hypovolemia were equally severe in both groups on admission to the operating room. The FDP group demonstrated more rapid stabilization of hemodynamics and improved myocardial contractility at the 3rd day of IC. The monitoring of acid-base balance and carbohydrate metabolism showed the presence of compensated metabolic acidosis and energy deficiency. High indexes of lactate/pyruvate indicated a sharp imbalance in the ratio of aerobic/anaerobic metabolic processes. The analysis of ATP dynamics displayed impaired mitochondrial ATP production and inhibition of the glycolytic pathway of energy release. Conclusions. Complementary systemic inflammatory response with the elevation of lactate level by the 5th day occurred in patients with traumatic disease who underwent staged surgical correction. Optimization of intensive care resulted in a faster restoration of the balance between aerobic and anaerobic metabolic processes, an increase in the level of ATP and the rate of 2,3-DPG production in erythrocytes contributing to adequate oxygen supply to the tissues, supporting cellular respiration and preventing the development of oxidative tissue damage, as well as helped to maintain compensatory mechanisms and reduce cellular hypoxia ensuring adequate metabolism of vital organs.
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