RU2396906C1 - Method of early diagnostics of acute intestinal obstruction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery. Set task is achieved by the following: patient is administered per os 150-200 ml of water solution of 40-50 g of "Fortrans" preparation. After that 2 hours after preparation introduction control X-ray examination of abdominal cavity organs is carried out and pathognomic sign of acute intestinal obstruction hydroaerial levels or increase of their number in comparison with data, obtained at arrival.

EFFECT: method ensures early diagnostics in patients with suspision of acute intestinal obstruction, which will aloow to prevent its transition into more unfavourable stage and considerably reduce probability of development of said disease complications.

2 ex

Description

A known method for the diagnosis of acute intestinal obstruction by ultrasound (Tarasenko EI / Diagnosis of acute small bowel obstruction. // Annals of surgery. - 2007. - No. 4 - P.61-65).

However, the known method allows you to verify the diagnosis and begin surgical treatment on average 10 hours after the patient enters the hospital.

The objective of the invention is to accelerate the diagnostic search in patients with suspected acute intestinal obstruction, which will prevent its transition to a more unfavorable stage and significantly reduce the likelihood of complications of acute intestinal obstruction.

The problem is achieved in that the method of early diagnosis of acute intestinal obstruction is carried out by oral administration of 150-200 ml of an aqueous solution of 40-50 g of the drug "Fortrans". This dosage of the drug is not recommended by the manufacturer and was selected empirically, the main selection criteria were: 1) the dose of the drug is sufficient for the formation of Kloiber bowls; 2) the possibility of oral administration of Fortrans in such a dosage by patients in a severe somatic condition and having a reduced threshold for sensitivity of the gag reflex, 3) minimal technical difficulties for the surgeon with possible subsequent surgical intervention. 2 hours after taking the drug, 1 control x-ray examination of the abdominal organs is performed and a pathognomonic sign of acute intestinal obstruction, the Kloiber's cup, is revealed.

The method is as follows.

In patients with clinical signs of acute intestinal obstruction, the gastric contents are evacuated with a thick gastric tube, after which the patient takes 150-200 ml of an aqueous solution of 40-50 g of the Fortrans drug per os, and after two hours a control x-ray of the abdominal organs is performed. If Kloiber's bowls are found or their number is increased compared with the data obtained upon admission to the hospital, they diagnose acute intestinal obstruction and resort to its operative resolution.

Example 1. Patient R., 75 years old, was admitted to the surgical department with complaints of paroxysmal abdominal pain, general weakness, dry mouth. The condition of the patient is moderate.

Abdominal R-scopy: fluid levels in the swollen colon.

Preliminary diagnosis: acute colonic obstruction.

To clarify the diagnosis and determine further therapeutic tactics, the proposed method is applied. The gastric contents are evacuated with a thick gastric tube, the patient per os takes 150-200 ml of an aqueous solution of 40-50 g of the “Fortrans” preparation, after two hours the patient undergoes an X-ray examination of the abdominal organs.

R-control: negative dynamics - bloating of the colon and the number of colonic levels increased.

Based on this method, a diagnosis of acute colonic obstruction is made. The patient underwent surgery. Discharged on the 16th day after the operation. Histological examination of the surgical material: highly differentiated adenocarcinoma.

Example 2. Patient I., 34 years old, was admitted to the surgical department with complaints of intense pain in all parts of the abdomen, lack of stool for 2 days, repeated vomiting. A patient has a history of surgery for gastric ulcer. At the time of admission, the patient's condition is moderate.

R-scopy of the abdominal organs: in the right iliac region, the intestines are swollen with air with horizontal fluid levels (2 pcs.)

Preliminary diagnosis: acute adhesive intestinal obstruction.

To clarify the diagnosis and determine further therapeutic tactics, the proposed method is applied. The gastric contents are evacuated with a thick gastric tube, the patient per os takes 150-200 ml of an aqueous solution of 40-50 g of the “Fortrans” preparation, after two hours the patient undergoes an X-ray examination of the abdominal organs.

R-control: at the level of L3-L4 bodies, the intestines are swollen with air, Kloiber's bowls are not detected. Based on this method, the diagnosis was made: adhesive disease, partial adhesive small bowel obstruction.

Conducted conservative therapy (antispasmodics, analgesics, infusion therapy). The pain syndrome is stopped, nausea, no vomiting. The belly is opal. Painless on palpation. Gases go away, the stool is normal. The correctness of the diagnosis is confirmed clinically and radiologically. Thus, laparotomy was avoided in a patient who did not need surgical treatment.

The proposed method allows to reduce the time spent on a diagnostic search in patients with acute intestinal obstruction, to reduce the likelihood of developing severe complications of acute intestinal obstruction, often avoids surgery and resolve obstruction in a conservative way.

Claims (1)

A method for the early diagnosis of acute intestinal obstruction, characterized in that the patient is prescribed per os 150-200 ml of an aqueous solution of 40-50 g of the Fortrans drug, then two hours later a control x-ray examination of the abdominal organs is performed and if Kloiber bowls are found or their number increases in comparison with the data obtained at admission, they diagnose acute intestinal obstruction and resort to its operative resolution.