RU2281694C1 - Method for studying the state of abducting small-intestinal loop in patients with double-stem enterostomas - Google Patents

Abstract

FIELD: medicine, abdominal surgery, proctology.

SUBSTANCE: one should carry out ultrasound small-intestinal testing through anterior abdominal wall. Before testing it is necessary to apply a Foley catheter into the abducting loop for the depth of about 5-7 cm, a container at the end of catheter should be blown with air at the volume of 20.0 ml. Ultrasound scanning of peristomal area should be carried out to detect the site of Foley catheter's container position that helps to determine localization of the abducting small-intestinal loop. Then it is necessary to introduce 100.0-150.0 ml physiological solution of room temperature by the catheter into intestinal lumen followed by ultrasound studying the abducting small-intestinal loop. One should evaluate the diameter of intestinal lumen, the thickness of intestinal wall, the character of peristaltic movements, observe liquid passage along inactive loop and time for its entering large intestine, compare the data obtained with normative values for small intestine. The innovation enables to visualize the abducting small-intestinal loop and evaluate its state, the absence of obstacles for future passage of intestinal content.

EFFECT: higher efficiency.

2 ex

Description

The invention relates to medicine, abdominal surgery, proctology, can be used in the recovery phase of the surgical treatment of patients with double-barreled enterostomy.

A known method of studying the condition of the abduction loop of the small intestine in patients with double-barreled enterostomy by performing post-stomal enterographin: a water-soluble contrast medium is introduced into the abduction loop of the intestine and an x-ray is performed until the contrast enters the blind and ascending intestine. (Vorobey A.V. Algorithm for examining patients with entero- and colostomy // News of radiation diagnosis. - 2000. - No. 1 - P.4-7.)

The disadvantage of this method is the effect of ionizing radiation, which limits the use of this method, in addition, if patients have contraindications to radiation exposure, this study cannot be carried out.

The closest set of essential features to the claimed invention is the method of transabdominal ultrasound examination of the small intestine (Schupakov, Litvyakova. Clinical ultrasound diagnosis). A sequential ultrasound examination of the small intestine is carried out, while the loops of the small intestine are normally visible indistinctly in the form of arched structures of small diameter.

The prototype and the claimed invention has the following essential features: transabdominal ultrasound examination of the intestine.

The disadvantage of the prototype is that the abduction loop of the small intestine is most often not visualized by ultrasound, and it is difficult to differentiate the abduction and abduction loops of the intestine during imaging, since they are located in the same area, as a result of which it is not possible to conduct a study of this intestine.

The invention is aimed at solving the problem of developing a method for studying the condition of the abduction loop of the small intestine in patients with double-barreled enterostomy.

The solution to this problem provides the possibility of using a simple, non-invasive and objective method of ultrasound examination of the condition of the small intestine outlet loop in patients with double-barreled enterostomy, not associated with radiation exposure and absolutely harmless and not burdensome for patients, which, if necessary, allows it to be used in patients repeatedly.

To achieve this technical result, the claimed invention a method for studying the condition of the abduction loop of the small intestine includes the following essential features.

The study of the abduction loop of the small intestine in patients with double-barreled enterostomy is carried out by ultrasound scanning of the abduction loop of the small intestine after preliminary filling it with a liquid medium. The liquid content in the discharge loop of the small intestine makes it easy to visualize it with ultrasound and assess the condition. To do this, before the study, a Foley catheter is inserted into the outlet loop of the small intestine to a depth of 5-7 cm, the balloon is inflated at the end of the catheter with 20.0 ml air, an ultrasound scan of the peristomal region is performed, the location of the Foley catheter balloon is determined by which the location of the outlet loop is established of the small intestine, then 100.0-150.0 ml of physiological solution of room temperature is injected into the intestinal lumen via a catheter, after which an ultrasound examination of the discharge loop of the small intestine and ivayut diameter of the intestinal lumen, intestinal wall thickness, the nature of bowel movements, the fluid passage of trace loop is disabled and the time of its arrival in the colon, compared to the data obtained with normative parameters for the small intestine.

In relation to the prototype, the claimed invention has the following essential features: before carrying out an ultrasound, the discharge loop of the small intestine is filled with liquid medium, for this the Foley catheter is installed in the discharge loop of the small intestine to a depth of 5-7 cm, the balloon is inflated at the end of the catheter, inserted through the catheter 100.0-150.0 ml of physiological saline into the intestine, ultrasound scanning is performed and the diameter of the intestinal lumen, wall thickness, the nature of peristaltic movements are evaluated, the passage of fluid awn on off loop and its time of arrival in the colon.

There is the following causal relationship between the distinguishing features and the technical result: an ultrasound examination of the discharge loop of the small intestine after preliminary filling it with liquid medium allows not only to easily visualize this section of the intestine, but also to assess its condition: measure the diameter of the lumen, wall thickness, determine the nature peristaltic movements, evaluate the passage of fluid along the discharge loop and the time it enters the large intestine.

According to the information available to the authors, the set of essential features characterizing the essence of the claimed invention is not known from the prior art, which allows us to conclude that the invention meets the criterion of "novelty."

According to the authors, the essence of the claimed invention does not follow explicitly from the prior art for a specialist, since the aforementioned possibility of examining the discharge loop of the small intestine in patients with double-barreled enterostomy does not come out of it, which allows us to conclude that it meets the criterion of "inventive step".

The set of essential features characterizing the essence of the claimed invention can, in principle, be repeatedly used in medicine to obtain a technical result consisting in the possibility of using an affordable, non-invasive method of ultrasound examination of the small loop of the intestine in patients with double-barreled enterostomy, not associated with radiation exposure and safe for patients, enabling ultrasound to easily visualize the discharge loop of the small intestine, which allows us to conclude that the invention meets the criterion of "industrial applicability".

The proposed method is as follows.

The study was carried out on a LOGIQ ^TM α200 apparatus, a SONY UP-895 MOW video printer was used, a 7.5 MHz sensor and a convex sensor with a frequency of 3.5 MHz were used for acoustic contact. The scanning angle was chosen arbitrarily, which was controlled on the monitor. The study was performed in the position of the patient lying on his back. Before the study, a Foley catheter was inserted into the outlet loop of the double-barreled enterostomy to a depth of 5-7 cm (depending on the thickness of the anterior abdominal wall and the length of the small intestine protruding above the skin, the end of the catheter should be under the aponeurosis of the anterior abdominal wall). The balloon at the end of the catheter was inflated with 20.0 ml air. An ultrasound scan was performed and the localization of the can of Foley catheter was determined, which made it possible to establish the location of the outlet loop of the small intestine. Then, 100.0-150.0 ml of physiological saline solution at room temperature was injected into the intestinal lumen through a catheter. Ultrasonic transverse and longitudinal scanning of the outlet loop was performed. The image visualized on the screen in the form of a moving picture was stopped at a certain place using the "freeze frame" function, and then a more detailed study of the echogram was made. The image was recorded on black and white thermal contrast paper. We evaluated: the diameter of the lumen of the intestine, the thickness of its wall, the nature of peristaltic movements, the passage of fluid through the intestines, the time it was received in the large intestine. The obtained data were compared with normative indicators for the small intestine (intestinal wall thickness 1-3 mm, lumen diameter 2.0-3.0 cm).

Example 1

Patient B., 27 years old, was hospitalized in the surgical department of the Clinical Emergency Hospital, medical history No. 2273, with complaints of a functioning ileostomy. From the anamnesis it is known that 2 months ago he was operated on for: penetrating gunshot wounds of the abdomen with damage to the large intestine. The operation was completed by the removal of a double-barreled ileostomy.

He was hospitalized for the recovery phase of treatment with a diagnosis of Loop columnar ileostomy.

On examination: a double-barreled ileostomy is localized in the right iliac region, the intestinal mucosa is pink, peristalsis is periodically visible, the intestinal section rises 4 cm above the skin. The skin around is moderately hyperemic.

An ultrasound scan was performed on the patient: the skin around the stoma and the scanning sensor were treated with gel. A Foley catheter was inserted into the outlet stoma loop to a depth of 6 cm, and a balloon at the end of the catheter was inflated with 20.0 ml of air. An ultrasound scan was carried out, the location of the can was determined. About 120.0 ml of physiological saline solution of room temperature was introduced into the outlet loop via a catheter. An echogram for longitudinal scanning defines a bowel loop in the form of a cylinder with a clear contour of the walls and liquid content in the lumen, the thickness of the intestinal wall is 2.1 mm, peristalsis is clearly visible, the fluid is gradually evacuated into the large intestine, after 1.5 minutes of fluid in the lumen of the outlet loop the small intestine is not detected. With transverse scanning, a loop of the intestine is visualized in the form of a rounded formation with clear contours of the walls and liquid contents in the lumen. The duration of the study was 10-12 minutes.

Example 2

Patient C., 53 years old, was hospitalized in the surgical department of the Clinical Emergency Hospital, medical history No. 362, with complaints of a functioning ileostomy. From the anamnesis: 2 months ago was operated on for acute mechanical small bowel obstruction, the operation ended with the removal of a double-barreled separate ileostomy.

He was hospitalized for the recovery phase of treatment with a diagnosis of Double-barreled separate columnar ileostomy.

On examination: a double-barreled ileostomy is located in the right iliac region, the intestinal mucosa is pink, the intestinal section rises 5 cm above the skin. The skin around is not changed.

An ultrasound scan was performed on the patient: a Foley catheter was inserted into the outlet stoma loop to a depth of 6 cm, a balloon at the end of the catheter was inflated with 20.0 ml of air. An ultrasound scan was carried out, the location of the can was determined. About 100.0 ml of physiological saline solution of room temperature was introduced into the outlet loop via a catheter. An echogram for longitudinal scanning shows a bowel loop in the form of a cylinder with a clear contour of the walls and liquid content in the lumen, the thickness of the intestinal wall is 2.6 mm, peristalsis is traced, the fluid is gradually evacuated into the large intestine, after 2 minutes the fluid was evacuated from the lumen of the discharge loop of the small intestine completely into the large intestine. With transverse scanning, a loop of the intestine is visualized in the form of a rounded formation with clear contours of the walls and liquid contents in the lumen. The duration of the study was 12-14 minutes.

Thus, the proposed method for studying the abduction loop of the small intestine in patients with double-barreled enterostomy is technically simple, safe for the patient, allows visualizing the abduction loop of the small intestine, assessing its condition, the absence of an obstacle for future passage of intestinal contents, which is important at the stage of surgical rehabilitation of patients with double-barreled enterostomy.

Claims (1)

A method for examining the condition of the abduction loop of the small intestine in patients with double-barreled enterostomy, including ultrasound examination of the small intestine through the anterior abdominal wall, characterized in that before the investigation, the Foley catheter is inserted into the abduction loop of the small intestine to a depth of 5-7 cm, the balloon is inflated with air at the end of the catheter volume of 20.0 ml, an ultrasound scan of the peristomal region is carried out, the location of the canister of the Foley catheter is determined, by which the localization of the discharge small intestine, then 100.0-150.0 ml of physiological saline solution is injected into the intestinal lumen through a catheter, after which an ultrasound examination of the outlet loop of the small intestine is performed and the diameter of the intestinal lumen, the thickness of the intestinal wall, the nature of peristaltic movements are evaluated, fluid passage is monitored on the disconnected loop and the time of its entry into the large intestine, compare the data obtained with the normative indicators for the small intestine.