RU2244514C2 - Ultrasonic diagnosis method for diagnosing acute early stage small intestine obstruction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying primary and repeated ultrasonic examination of abdominal cavity and evaluating symptoms. Patient drinks or receives as infusion more than 1 l of water or physiological salt solution cooled to 4-5° C in portions with 15 min long pauses during 30-60 min before carrying out repeated ultrasonic examination.

EFFECT: high reliability of early stage diagnosis.

Description

The invention relates to medicine, namely to methods for dynamic ultrasound diagnostics of acute mechanical small bowel obstruction in the early stages of its development.

A known method of ultrasound diagnosis of acute mechanical small bowel obstruction in the early stages of its development (see Doroshev I.A. Ultrasound investigation in the diagnosis of acute mechanical intestinal obstruction: disc ... candidate of medical sciences. M., 1994, 138 S.), consisting in the primary and subsequent ultrasound examination of the abdominal cavity and evaluation of the emerging symptoms. The known method involves subsequent ultrasound every 2-3 hours with an assessment of the emerging symptoms: expansion of the lumen of the small intestine, a change in the structure of the intestinal wall, a change in the nature of peristaltic movements, an increase in intraluminal fluid deposition.

However, the main ultrasonic signs: an increase in the intraluminal deposition of fluid in the loops of the small intestine, an expansion of the lumen of the small intestine, a change in the structure of the intestinal wall, visualization of thickened folds of the mucosa, a change in the nature of peristaltic movements - weakening of peristalsis, stasis of contents - appear at quite late stages of development of acute mechanical small bowel obstruction . The early stages of the development of acute mechanical small bowel obstruction due to the lack of a clear sequestration of fluid and gases in the adducting section of the small intestine, the absence of inflammatory and destructive changes in the intestinal wall present great difficulties in the differential diagnostic plan.

In this regard, the known method does not provide a sufficiently reliable diagnosis in the early stages of the disease. In addition, this diagnostic method requires at least 3-4 hours of the course of the pathological process to change these parameters with their ultrasound imaging, delays the correct diagnosis and speedy, timely surgical treatment.

The proposed method solves the problem of diagnosing acute mechanical small bowel obstruction in the early stages of its development. The technical result obtained in this case consists in increasing the reliability of the diagnosis of the disease at the early stages of the development of acute mechanical small bowel obstruction and, accordingly, accelerating the diagnosis with the maximum accuracy of the study.

The introduction of cold water or physiological solution to the patient allows not only to note an increase in the number of anatomical areas in which intestinal loops with increased liquid contents are determined after fluid intake, but also to fix the expansion of the diameter of the intestinal loop above the level of a mechanical obstacle, as well as to fix the amplification of the pendulum-like movement of the contents of the intestinal loops after receiving water above the level of the obstacle with a predominant displacement vector of antiperistaltic orientation.

The specified technical result is achieved by the fact that in the method of ultrasound diagnostics of acute mechanical small bowel obstruction in the early stages of its development, which consists in the initial and subsequent ultrasound examination of the abdominal cavity and the assessment of symptoms that appear, the patient drinks or is given at least one liter before repeated ultrasound examination of the abdominal cavity chilled to 4-5 ° C water or saline in portions after 15 minutes for 30-60 minutes.

The proposed method is as follows.

Upon admission to the hospital with a directive diagnosis of “Acute intestinal obstruction”, the patient is examined in the emergency room and sent for an initial ultrasound examination of the abdominal cavity. If the study is not informative or the ultrasound symptoms detected are ill-advised, the patient is hospitalized and immediately after admission to the ward of the surgical department, the patient drinks at least 1 liter of water or saline cooled to 4-5 ° C. The patient drinks the liquid portionwise: after 15 minutes for 30-60 minutes. The amount of fluid drunk by the patient in each serving may be different depending on the individual capabilities of each patient. In the presence of vomiting, the patient is forcibly injected with fluid through the delivered nasogastric tube also in portions: after 15 minutes for 30-60 minutes. Moreover, before the introduction of the probe from the stomach, its contents are previously evacuated. After the introduction of fluid to the patient, the probe is pinched (removed). After administering 1 liter of fluid to the patient and after 60 minutes from the start of fluid intake, the patient undergoes repeated ultrasound examination of the abdominal cavity.

The liquid cooled to 4-5 ° C as it moves up to the level of a mechanical obstruction in the small intestine, without being fully absorbed, causes stimulation of peristalsis. Once in the adducting loops of the small intestine, the fluid causes an expansion of their lumen, which is recorded by ultrasound in the form of an increase in the symptom of intraluminal deposition of fluid and an expansion of the diameter of the intestine (an increase in the small intestinal contents by 1.0 liter, depending on the level of the obstacle, gives an extension of the lumen of the adducting loops by 1 -1.5 cm). In addition, there is an increase in the pendulum-like movement of fluid in the adducting loop of the small intestine above the zone of mechanical obstruction with the appearance of a general antiperistaltic orientation (a symptom of antiperistaltics is also recorded during ultrasound examination). The appearance of these symptoms confirms the diagnosis of acute mechanical small bowel obstruction and allows surgeons to determine the patient’s treatment tactics within 1-1.5 hours from the moment the patient enters the hospital.

Clinical examples

Patient Donnikov A.P., 18 years old, was admitted to the Volgograd ambulance hospital on March 12, 1999, with the directive diagnosis “Adhesive disease, acute intestinal obstruction”.

From the anamnesis it was found that at the age of 5 years he underwent abdominal surgery for destructive appendicitis, peritonitis. Subsequently, the patient was repeatedly disturbed by abdominal pains that stopped on their own. I did not seek medical help for these pains. The last attack of pain began 6 hours before admission after a heavy meal. At admission, he complained of aching pains throughout the abdomen, pains periodically assumed a cramping nature. Vomiting was single at the onset of pain, there was no vomiting. The chair was on the eve of the onset of pain. Objectively, the condition was regarded as satisfactory. On the abdomen is the median postoperative scar. The abdomen is slightly painful, without peritoneal phenomena. Peristalsis is enhanced, but without pathological noise. There are no phenomena of endotoxemia. During the initial ultrasound examination, 2-3 loops of intestines with heterogeneous liquid contents, echopositive inclusions and amorphous masses (intestinal chyme) were identified in the left hypochondrium, the diameter of the intestine was 2-2.5 cm, the thickness of the intestinal wall was 1-2 mm, changes in the motility of the small intestine not found. On the basis of ultrasound, a conclusion was made about the absence of acute intestinal obstruction. Nevertheless, taking into account the history of the disease and the nature of the clinical data at admission, the patient was hospitalized in the surgical department with a diagnosis of Adhesive disease of the abdominal cavity, suspicion of adhesive intestinal obstruction. Upon admission to the ward of the surgical department, the patient drank 1.0 liter of water cooled to 4-5 ° C. Water intake was portioned, every 15 minutes for 45 minutes. After this, the patient was sent for a second ultrasound examination. A total of 60 minutes passed from the moment of the first to the second study. In a second study, the patient was visualized in the right iliac region and the left hypochondrium of the intestinal loop with intestinal chyme. Loops of the intestines expanded to 3 cm. Marked increased pendulum peristalsis with a pronounced antiperistaltic orientation. Based on this ultrasound picture, the doctor issued the conclusion “Acute mechanical small bowel obstruction”. Within the next hour after intensive preparation for surgery, the patient was urgently operated on. The diagnosis of surgery was confirmed

Patient I. Novikov, 54, was admitted to the Volgograd Emergency Hospital, 07.08.2000, with a direct diagnosis of Acute pancreatitis.

From the anamnesis it was found that 3 years ago he was operated on for destructive purulent pancreatitis with peritonitis. The postoperative period was complicated by early adhesive intestinal obstruction. Subsequently, attacks of abdominal pain with nausea, vomiting were repeatedly noted, and he was twice hospitalized in a surgical hospital. Antipancreatic therapy was performed. The last attack of pain was noted 2 days before admission. The appearance of pain is associated with the intake of alcohol and rich fatty foods. He was treated independently with antispasmodics. But the last 5 hours of pain have changed - they have become cramping in nature, and therefore sought medical help. Upon admission, she complains of cramping pains throughout the abdomen, repeated vomiting, bloating. General condition upon receipt of moderate severity. AD-100/60 mmHg, pulse - 90 beats. in minutes The tongue dries up. The abdomen is moderately swollen, painful on palpation in the epigastrium. Peritoneal phenomena were not detected. Auscultatory peristalsis is weakened. In blood tests, moderate endotoxemia. During the initial ultrasound examination of the abdominal cavity, signs of acute pancreatitis, intraluminal deposition of fluid in the loops of the intestines in 2 anatomical areas, the diameter of the loops of the intestines was 2 cm were diagnosed. Acute pancreatitis, suspicion of adhesive small bowel obstruction was diagnosed. The patient was urgently hospitalized in the surgical department, where infusion antipancreatic therapy was started. Due to repeated vomiting, the patient was given a nasogastric tube, the stomach was washed to clean washings, after which 1.0 liter of physiological saline cooled to 4-5 ° C was introduced into the probe. The solution was introduced portionwise every 15 minutes in 60 minutes, after which the probe was pinched. After the solution was administered to the patient, a second ultrasound was performed. The study revealed intraluminal deposition in 4 anatomical regions (in the left half of the abdominal cavity), increased pendulum movement of the chyme with a common antiperistaltic orientation, expansion of the diameter of the small intestine to 3.5 cm. The diagnosis of Acute small bowel obstruction was made. The diagnosis was an indication for emergency surgery. An acute commissural high enteric obstruction was found during surgery.

Claims (1)

The method of ultrasound diagnosis of acute mechanical small bowel obstruction in the early stages of its development, which consists in the initial and repeated ultrasound examination of the abdominal cavity and the assessment of symptoms that appear, characterized in that the patient drinks or is given at least one liter chilled to 4- before repeated ultrasound examination of the abdominal cavity 5 ° C of water or saline in portions after 15 minutes for 30-60 minutes.