Цель исследования-улучшение результатов хирургического лечения абсцессов брюшной полости различной локализации с помощью дренирования под УЗ-наведением. Материал и методы. Проанализировано 103 клинических наблюдения в период с 2012 по 2017 г., потребовавших чрескожного дренирования внутрибрюшных абсцессов под УЗ-наведением. Из исследования исключены пациенты, которым выполнено дренирование внутриорганных и забрюшинных абсцессов вследствие панкреонекроза. Результаты. Полностью выздоровел 101 (98%) из 103 пациентов в течение 10-73 дней. Выводы. Дренирование под УЗ-наведением является эффективным самостоятельным способом лечения абсцессов. Метод продемонстрировал высокую эффективность, доступность и безопасность, а также позволил избежать открытого доступа. Он может быть надежной альтернативой открытым хирургическим вмешательствам и широко использоваться в экстренных хирургических стационарах. Ключевые слова: дренирование под УЗ-наведением, абсцесс брюшной полости.
Standardized algorithm reduces time of treatment, incidence of postoperative complications, mortality and the risk of recurrent inflammatory complications of colic diverticular disease. Also postoperative quality of life was improved.
Small bowel obstruction (SBO) is 3-4% of all abdominal acute diseases. Small bowel obstruction due to bezoars is rare (2-4%), and is detected mainly in patients with predisposing risk factors: gastrointestinal motility disorders, psychiatric diseases, enzymatic insufficiency, previous bariatric surgery, diabetes mellitus and hypothyroidism complicated by gastroparesis. The leading role in the verification of small bowel obstruction in patients without surgical interventions on the abdominal organs should be given to computed tomography. According to the literature, the mortality from SBO due to bezoar may reach 30%. We present an unusual clinical case of recurrent small bowel obstruction with severe intestinal disease and septic shock induced by multiple phytobezoars and complicated with severe pseudomembranous colitis. Moreover, in our opinion, laparoscopic access can be used both for diagnostic and therapeutic purposes in patients with acute small bowel obstruction.
Purpose. To identify and evaluate the effectiveness of sonographic signs of intestinal ischemia in patients with strangulated small bowel obstruction.Materials and methods. For the period 2017–2019, 115 patients with SIO were treated at the N.V. Sklifosovsky Federal Research Institute of Emergency Medicine. There were 64 women (55.6%) and 51 men (44.4%). The mean age was 62 ± 15 years. In all patients, the diagnosis was verified intraoperatively. All patients underwent ultrasound examination of the abdominal cavity in B-mode with the assessment of blood flow of the intestinal wall in the mode of CDI. Patients were divided on the basis of intraoperative data into 2 groups. The first group: 63 (54.8%) patients with signs of ischemia of the strangulated loop of the intestine. The second group consisted of 21 (18.1%) patients in whom intestinal necrosis was detected. The comparison group included 31 (26.7%) patients with adhesive small bowel obstruction without intestinal strangulation.Results. The most informative signs of ischemia of the strangulated intestine of the loop are infiltrative changes of its mesentery. In the second and third groups 9 (14.3%) and 12 (57.1%) participants, respectively, showed severity of intestinal ischemia, compared with 1 participant (3.2%) in the first group. The next informative criterion is the thickening of more than 0.4 cm and edema of the intestinal wall. In the second and third groups 30 (47.6%) and 14 (66.6%), in the comparison group 4 (12.9%), akinesis of the strangulated loop and paresis of the entire small intestine also directly correlated with intestinal ischemia. The absence of differentiation of intestinal wall layers occurs in (23.8%), the absence of blood flow in the intestinal wall in the CDI mode (19%), gas inclusions in the intestinal wall (4.3%).Conclusion. The assessment of sonographic symptoms allows to diagnose the presence of ischemic changes in the intestinal wall and perform surgery before the development of necrosis in the early period. In cases of late admission of the patient to the hospital, with the onset of intestinal necrosis and the associated erased clinical picture, ultrasound allows to establish indications for surgery before the development of peritonitis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.