RU2449743C1 - Method of treating early adhesive intestinal obstruction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to abdominal surgery. Intestinal obstruction is eliminated, small intestine is decompressed by nasogastrojejunal intubation with further drainage of jejunum to 60-70 cm depth from stomach. Inbtestine loops are laid in vertical layers, whose length corresponds to the distance from root of mesentery to opening to pelvis minor. Chlorvinyl tube is passes first through mesentery of proximal arches of small intestine loops and through edges of greater omentum at the same level. Tube ends are brought outside by puncture of abdominal wall on line of intersection of rib arches with anterior axillary lines and fixed to skin by interrupted sutures.

EFFECT: method of treating adhesive intestinal obstruction is characterised by quickness and simplicity of implementation, light trauma.

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Description

The invention relates to medicine, namely to abdominal surgery. The improper location of the omentum in relation to the loops of the small intestine is most often one of the common causes of the development of early adhesive intestinal obstruction; to eliminate this complication, not only the loops of the small intestine, but also the omentum are fixed in a given position.

A known method of fixing intestinal loops by stitching their walls with suture material: the Noble method of intestinal replication (Noble) for the treatment of adhesive disease, described in the work of I.M.Matyashin and A.M.Gluzmann: Handbook of surgical operations. - Kiev, Zdorovya, 1979. - p.203-204.

The disadvantages of the known method are technical difficulties, limitation of peristalsis of the intestinal wall with the development of chyme stagnation in the intestinal lumen, the risk of puncture and perforation of the wall with the development of peritonitis or intestinal fistula, the progression of the interloop adhesions, the possibility of dropping intestinal loops into the pelvis, the formation of uncontrolled adhesions with big stuffing box.

Prototype.

As a prototype, we took the above-described Noble method of intestinal replication (Noble) for the treatment of adhesive disease, described in the work of I.M.Matyashin and A.M.Gluzmann: Handbook of surgical operations. - Kiev, Zdorovya, 1979. - p.203-204. The essence of the known method consists in the following: the small intestine is freed from adhesions, laid in parallel vertical rows (each row is about 20 cm long) and mesentery leaves are sewn with a continuous suture using chrome catgut. With the same thread, a continuous seroserous suture sutures adjacent walls along their mesenteric edge.

The purpose of the invention

The aim of the invention is the treatment of early adhesive intestinal obstruction by fixing the loops of the small intestine and omentum in a given position in the postoperative period.

SUMMARY OF THE INVENTION

The method is illustrated in figure 1, which shows a diagram of a method of treating early adhesive intestinal obstruction.

In Fig. 1, 1 indicates intubation of the small intestine through the gastrostomy according to Yu.M. Dederer, 2 indicates the stomach, 3 denotes the large intestine, 4 denotes a fixing vinyl chloride tube drawn through the avascular mesentery of the proximal arches laid in vertical rows of loops of the small intestine , 5 denotes a large omentum through which the fixation tube passes, 6 denotes the abdominal wall, 7 denotes the mesentery of the small intestine, 8 denotes the small intestine, the loops of which placed in vertical rows, position 9 indicates a probe intubating the small intestine through the gastrostomy according to Yu.M. Dederer, position 10 indicates the liver, position 11 indicates a puncture of the abdominal wall to the right and left along the line of intersection of the middle axillary line with the costal arch, through which it is led out the ends of the vinyl chloride tube, which is pulled and its ends are fixed to the skin with interrupted sutures.

The essence of the proposed method is as follows: first eliminate intestinal obstruction. Then, novocaine blockade of the mesentery root of the small intestine is performed.

A nasogastrointestinal probe is installed. Produce total decompression of the small intestine. Loops of the small intestine after decompression lead to the abdominal wall. Then the loops of the small intestine are laid in vertical rows, the length of which corresponds to the distance from the lower edge of the mesentery root to the entrance to the small pelvis (this distance is strictly individual for each patient). Then, at the end of a long curved clamp from left to right in the avascular zones put on the mesentery of the proximal knees of the loops of the small intestine, which were previously laid in vertical rows. The mesentery is put on the end of a long curved clamp, departing from the mesenteric wall of the intestine by 3-4 cm. The end of this clamp captures a vinyl chloride tube with a diameter of 3 mm and pulls this tube through the mesentery of the small intestine from right to left. Then the ends of the vinyl chloride tube are passed through the corresponding edges of the large omentum, laid in front of the loops of the small intestine. After that, the ends of the vinyl chloride tube are led out through punctures of the abdominal wall to the right and left along the line of intersection of the middle axillary line with the costal arch. Then the tube is pulled, and its ends are fixed with interrupted sutures to the skin. The operation is completed with a final lavage of the abdominal cavity and drainage of the small pelvis through a puncture of the abdominal wall in the right iliac region.

An example of a specific implementation of the method.

Patient B., 35 years old, was admitted to the emergency surgery clinic for the third time with the clinic of acute adhesive intestinal obstruction three days after the onset of the disease with complaints of severe cramping abdominal pain, nausea and repeated vomiting that did not bring relief, bloating, and no gas, lack of stool. A history of three operations: appendectomy (1), regarding adhesive obstruction (2). A / D - 125/80 mm Hg Pulse 90 beats. in minutes The abdomen is swollen, asymmetrical, is not involved in the act of breathing. Percussion determined tympanitis in all departments. Auscultatory listening to episodes of increased peristalsis. The “splash noise", the positive symptoms of Valya, Shchetkin-Blumberg are determined. With a digital examination of the rectum, a positive symptom of the Obukhov hospital. On the survey roentgenogram of the abdominal organs, standing, multiple Kloiber bowls are visible. The intestinal contents are secreted by the nasogastric tube. After preoperative preparation, a mid-median laparotomy was performed with excision of the old postoperative scar. In the abdominal cavity up to 300 ml of serous-hemorrhagic effusion, which is aspirated by an electric pump. The loops of the small intestine are inflated to 6-7 cm in diameter, overflowed with liquid and gas, the wall is hyperemic and thinned. Performed novocaine blockade of the mesentery root of the small intestine (0.5% -80.0 ml). A nasogastrointestinal probe was installed to a depth of 70-80 cm from the tracheal ligament, decompression of the small intestine was performed. During the audit, 60 cm from the ileocecal angle, a commissural conglomerate from loops of the small intestine and large omentum was diagnosed. Below this zone, the bowel loops are empty. Adhesions are dissected, obstruction is eliminated, a resection of the right edge of the greater omentum is performed. The loops of the small intestine are brought to the abdominal wall, laid in vertical rows with a length corresponding to the distance from the root of the mesentery to the level of entry into the small pelvis. From left to right, the mesentery of the upper knees of the laid loops is alternately worn on the end of a long curved clamp. Then the end of the clamp captures the end of the vinyl tube with lateral holes with a diameter of 3 mm and is drawn from right to left through the mesentery of the small intestine. The ends of the tube are drawn through the corresponding edges of the greater omentum and brought to the abdominal wall through punctures of the abdominal wall in the projection zone of the intersection of the anterior axillary lines with the costal arch on both sides. The large omentum is straightened and laid anterior to the loops of the small intestine. The ends of the drainage tube are fixed, after its tension to straighten, with interrupted sutures to the skin. The small pelvis is drained through a puncture of the abdominal wall in the right iliac region. Layered sutures were applied to the wound of the abdominal wall.

The postoperative period proceeded safely. The patient received conventional complex treatment. Peristalsis recovered on the second day after the operation, the gases began to depart from the third day, independent stool was on the fourth day. Separated from the drainage is not marked from the second day. The drainage from the pelvis was removed on the third day, the NGH on the fourth day, the intestinal loops fixing the drainage on the seventh day. The wound healed primarily, the sutures were removed on the seventh-ninth day. Discharged in satisfactory condition on the tenth day after the operation.

The treatment results were tracked for 3 years. The patient feels well, does not notice abdominal pains, and stool is regular. Diet does not comply.

Signs of the invention, distinctive from the prototype.

- Loops of the small intestine are stacked in vertical rows,

- the length of the loops corresponds to the distance from the lower edge of the root of the mesentery to the entrance to the small pelvis (this distance is strictly individual for each patient).

- Then, at the end of a long curved clamp from left to right in the avascular zones, put on the mesentery of the proximal knees of the loops of the small intestine, which were previously laid in vertical rows.

- The mesentery is put on the end of a long curved clamp, departing from the mesenteric wall of the intestine by 3-4 cm

- for intestinal fixation use a vinyl chloride tube.

- The end of the clamp captures a vinyl chloride tube with a diameter of 3 mm and drag this tube through the mesentery of the small intestine from right to left. Then the ends of the vinyl chloride tube are passed through the corresponding edges of the large omentum, laid in front of the loops of the small intestine.

- After that, the ends of the vinyl chloride tube are led out through punctures of the abdominal wall to the right and left along the line of intersection of the middle axillary line with the costal arch. Then the tube is pulled until it straightens and its ends are fixed with interrupted sutures to the skin.

The technical result obtained by using the proposed method.

The proposed method of intestinal fixation as a method of treating early adhesions of intestinal obstruction is quick and easy to perform, low invasiveness. The developed method allows additional drainage of interloop spaces and prevents the development of interloop abscesses, completely prevents drooping of loops into the pelvic cavity and moving them to the upper floor of the abdominal cavity, without limiting the motility of the intestinal wall.

The present invention can be used to treat adhesive disease and its complications in both emergency and elective surgery without any negative consequences for the life and health of the patient. The method is highly effective prevention and good long-term results.

Literature

Noble Intestinoplication Method for the treatment of adhesive disease: a method for fixing intestinal loops by stitching their walls with suture material, described by I.M. Matyashin and A.M.Gluzmann: Handbook of surgical operations. - Kiev, Zdorovya, 1979. - p.203-204.

Claims (1)

A method of treating adhesive intestinal obstruction, including laying the intestine in a certain position, characterized in that they eliminate intestinal obstruction, decompressing the small intestine by nasogastric neural intubation, followed by drainage of the jejunum to a depth of 60-70 cm from the stomach, removing the small intestine to the abdominal wall, laying its loops in vertical rows, the length of which corresponds to the distance from the root of the mesentery to the entrance to the pelvis, holding a vinyl chloride tube with a diameter of 3 mm at first through the mesentery roksimalnyh arches intestinal loops laid in vertical rows, then over the edges of the greater omentum at the same level excretion tube ends outwardly through puncture the abdominal wall along the line of intersection with the front rib arcs axillary lines and their fixation to the skin with interrupted sutures.

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