RU2223037C1 - Method for carrying out studying for earlier diagnostics of both type and level of adhesive intestinal obstruction - Google Patents

Abstract

FIELD: medicine, abdominal surgery. SUBSTANCE: the method includes introduction of barium suspension with roentgenocontrast capsule into small intestine followed by roentgenography and diagnostics of both type and level of intestinal obstruction according to the character of delayed movement of contrast mass and roentgenocontrast capsule. The latter should be installed into probe's lumen, probe has got two fixed ligatures at its distal end, one should direct a probe into initial departments of jejunum with the help of fibrogastroduodenoscope, then it should be supplied with 150-200 ml barium suspension. This innovation enables to shorten time and reliability of diagnostics for both type and level of intestinal obstruction that helps to accelerate detecting curative tactics and improve results of therapy in patients with the abovementioned pathology. EFFECT: higher efficiency of studying. 1 cl, 1 dwg, 3 ex

Description

 The present invention relates to medicine, namely to abdominal surgery, and can be used for early diagnosis of the type and level of acute adhesive intestinal obstruction (ASCI).

 The main goal of the diagnostic process in ASCI is to establish its type and level as soon as possible, which determines the tactics for further treatment of this disease. A common diagnostic method for ASCI is an overview radiography of the abdominal organs followed by x-ray control of the passage of barium suspension given orally through the gastrointestinal tract. However, this method has several drawbacks, namely: OSKN is often accompanied by vomiting and barium suspension is evacuated from the stomach with vomit; Diagnosis with this technique usually takes from 12 to 24 hours.

 It is known that endoscopic catheter contrast enterography is used for the early diagnosis of intestinal obstruction, which allows to reduce the time of diagnosis for intestinal obstruction (D.M. Krasilnikov, D.M. Mirgasimova, M.M. Minnegaliyev and others. Diagnosis and treatment of patients with acute intestinal obstruction. Materials of the IX All-Russian Congress of Surgeons - Volgograd, 2000 - S. 180-181), however, this method does not allow to identify the level of obstacles in a dynamic OSKN.

 The prototype of the invention is a method for the diagnosis of stenosis of the small intestine using barium suspension with radiopaque capsule. The principle of diagnosis is based on determining the delay in the progression of the capsule from a contrast suspension when administered orally (V.V. Plechev, V.M. Timerbulatov, R.Z. Latshov et al. A comprehensive diagnostic method and surgical treatment of peritoneal commissural disease. Methodical recommendations. - Ufa-Yekaterinburg, 1999 - S. 11-12). This method is quite informative, but not without drawbacks, such as the duration of the study and the possibility of evacuating barium suspension with an radiopaque capsule from the stomach along with vomit.

 The technical result of the invention is to reduce the time and increase the reliability of the diagnosis of the type and level of ASCS with the introduction of barium suspension with radiopaque capsule in the initial sections of the small intestine.

 The technical result is achieved by the fact that a barium suspension with an radiopaque capsule is introduced into the initial sections of the small intestine through a probe conducted into the jejunum using an endoscope, a subsequent radiographic examination is carried out after 2 hours and the type and level of delay in the advancement of barium suspension and the radiopaque capsule are diagnosed intestinal obstruction.

 The drawing shows a diagram of the introduction of barium suspension with a gelatin-barium capsule into the jejunum.

 This method is performed as follows. After the initial examination of the patient, if there is suspicion of an SCF, the patient is placed a probe in the stomach 1 and its contents are evacuated. Then a probe 2 is inserted into the stomach 1, having nylon ligatures 3 at the distal end, into which a radiopaque capsule 4 is placed. Next, fibrogastroscopy is performed, in which the nylon ligatures 3 of probe 2 inserted into the stomach 1 are captured by the manipulator of the fibrogastroscope 5, after which the probe 2 using fibrogastroscope 5 is carried out by the ligament of Treitz into the jejunum 6. Through a probe 2, a barium suspension in an amount of 150-200 ml is introduced using a Janet 7 syringe. In this case, the radiopaque capsule 4 is squeezed out and enters the jejunum 6 together with barium suspension. Probe 2 and endoscope 5 are removed. Subsequently, an X-ray examination is performed 2 hours after the introduction of barium suspension with an X-ray contrast capsule.

According to the results of an X-ray examination, the type and level of OSKN is diagnosed; determine further treatment tactics:
1. The radiopaque capsule in the composition of barium suspension continues to move along the gastrointestinal tract - there are phenomena of dynamic intestinal obstruction. Perhaps the continuation of conservative treatment.

 2. The radiopaque capsule in the barium suspension stopped moving along the gastrointestinal tract - there are phenomena of mechanical intestinal obstruction. Emergency surgical treatment is indicated.

 3. The radiopaque capsule stopped moving along the gastrointestinal tract, while the barium suspension continues its movement - there are phenomena of intestinal stenosis with the development of partial (dynamic) adhesive intestinal obstruction. Continuation of conservative treatment with subsequent examination in the clinic and planned surgical treatment is indicated.

 After theoretical justification and testing of the method, the latter is introduced into the clinic. Performed 10 studies using this method. Using it allowed for 2 hours in all examined patients to differentiate the form of obstruction (dynamic or mechanical), determine its level and choose further treatment tactics. There were no complications associated with the use of this method.

 Example 1. Patient N., 34 years old, was admitted to the clinic 6 hours after the onset of the disease with complaints of cramping abdominal pain, nausea, single vomiting. A history of cesarean section 8 years ago. The disease is associated with excessive consumption of vegetables. On a survey radiograph of the abdominal organs, multiple Kloiber bowls are determined. The patient is suspected of having OSKN. After washing the stomach, a special probe is installed in it, which has capron ligatures at the distal end, in the lumen of which a radiopaque capsule is placed. Fibrogastroscopy was performed, in which the capron ligatures of the probe were captured by the endoscope manipulator. The probe with the help of an endoscope was carried out for the ligament of Treitz into the initial sections of the small intestine. A jane syringe filled with barium suspension is attached to the outer end of the probe. 200 ml of barium suspension was introduced into the probe using a Janet syringe, while the radiopaque capsule entered the small intestine along with the barium suspension, which was monitored using an endoscope. Started infusion therapy. After 2 hours, a control x-ray study was performed. At the same time, it was revealed that barium suspension is located in the terminal parts of the ileum, the cecum and the ascending colon, the capsule does not differentiate separately, single Kloiber cups are determined.

 Based on the clinic and the results of an X-ray examination, a diagnosis was made: acute dynamic intestinal obstruction. Conservative treatment continued. Barium suspension was evacuated from the gastrointestinal tract naturally after 12 hours. An ultrasound revealed signs of acute pancreatitis. During the treatment, the clinical manifestations of the disease were stopped. Subsequently, pneumoperitoneography was performed, in which no viscero-parietal adhesions were detected in the abdominal cavity. The patient was discharged from the hospital on the 7th day in satisfactory condition with recommendations.

 Example 2. Patient C., 39 years old, was admitted to the clinic 24 hours after the onset of the disease with complaints of cramping abdominal pain, nausea, repeated vomiting, and stool and gas retention. A history of 3 years ago, suturing perforated duodenal ulcers. Multiple Kloiber bowls and swollen loops of the small intestine, mainly in the upper floor of the abdominal cavity, are determined on a panoramic radiograph of the abdominal organs. The proposed method is applied similarly to the previous example. A control x-ray examination after 2 hours revealed: barium suspension in the proximal small intestine, the capsule does not differentiate separately, the number of Kloiber bowls does not decrease.

 On the basis of the clinic and the results of the X-ray examination, the diagnosis was made: acute adhesive mechanical intestinal obstruction and indications for emergency surgical treatment were established. An operation was performed on which a pronounced adhesion process was detected in the abdominal cavity with the formation of an inflection of the small intestine 80 cm distal to the Terez ligament and the development of obstruction. Produced viscerolysis with the elimination of obstruction. The patient was discharged from the hospital on the 9th day with recovery.

 Example 3. Patient X. 33 years old was admitted to the clinic 24 hours after the onset of the disease with complaints of cramping abdominal pain, bloating, nausea, dry mouth, and stool and gas retention. A history of appendectomy with drainage of the abdominal cavity due to destructive appendicitis three years ago. On a survey radiograph of the abdominal organs, multiple Kloiber bowls are determined. The proposed diagnostic method was applied analogously to Example 1. A control X-ray examination after 2 hours revealed: barium suspension in the terminal parts of the ileum, cecum and ascending colon, the capsule differentiates separately in the small intestine, the number of Kloiber bowls progressively decreases.

 According to the results of an X-ray examination and the clinic, the diagnosis was made: acute adhesive dynamic intestinal obstruction against the background of stenosis of the small intestine. Conservative treatment was continued, during which the clinical manifestations of the disease were stopped. Barium suspension was evacuated from the gastrointestinal tract naturally after 20 hours. During further examination, pneumoperitoneography was performed, in which loops of the small intestine fixed to the anterior abdominal wall were found in the lower floor of the abdominal cavity. Indications for surgical treatment are established. The patient was operated on according to deferred indications without discharge from the hospital on the 7th day after admission. An operational finding was the presence of an adhesion process in the right ileal region with fixation of two ileal loops and a large omentum to the postoperative scar. Performed viscerolysis with the prevention of relapse of the disease. The patient was discharged from the hospital with recovery on the 8th day after the operation and on the 15th day from the moment of admission.

 The implementation of the proposed method in practice allows to reduce the time of diagnosis, establish the type and level of AJS and determine the treatment tactics, which improves the results of treatment of patients with this pathology.

Claims (2)

1. A method of conducting research for early diagnosis of the type and level of acute adhesive intestinal obstruction, including the introduction of barium suspension into the small intestine with an radiopaque capsule, subsequent radiography and diagnostics of the type and level of intestinal obstruction by the nature of the delay in the advancement of the contrast mass and radiopaque capsule, characterized in that a radiopaque capsule is installed in the lumen of the probe having two fixed ligatures at the distal end, the probe using a fibrogastroduodenoscope conduct in the initial sections of the jejunum, after which 150-200 ml of barium suspension is introduced into it. 2. The method according to claim 1, characterized in that the barium suspension is introduced into the probe using a Janet syringe.