SU1158164A1 - Method of treatment of acute ileus - Google Patents

Abstract

A method of treating acute thin-intestinal stool, characterized in that, in order to simplify the method, a probe is injected into the proximal small intestine, the intestinal contents are sucked out, and a liquid suspension of barium sulphate is injected from 200 to 250 mm of water. Art. under radiological control.

Description

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ABOUT)

The invention relates to medicine, namely gastroentero yugia, and can be used for the treatment of acute small bowel obstruction.

A known method of X-ray examination with the introduction of a contrast agent through the mouth in case of suspected acute small bowel obstruction 1.

The disadvantage of this method is the slow delivery of contrast material from the stomach into the duodenal lobe and the slow movement of the contrast agent through the intestines.

A known method for the surgical treatment of acute mechanical intestinal obstruction, which consists in the fact that the obstruction is eliminated by surgery 2.

The disadvantages of surgical treatment of acute small bowel obstruction are traumatic and postoperative mortality is high.

The purpose of the invention is to simplify the method.

The goal is achieved by the fact that according to the method of treating acute small-intestinal impassability to the patient, a probe is inserted into the proximal small intestine, the intestinal contents are sucked out, the barite sulfate is injected into the liquid under pressure of 200-250 mm of water. Art. under radiological control.

The proposed method is carried out as follows.

In a patient immediately before the enterography, with a probe inserted into the proximal small intestine, active decompression is carried out using a Janet syringe or surgical suction pump. Then through the same probe under a pressure of 200-250 mm of water. Art. 500 to 2000 ml of 20% barium suspension prepared with physiological solution are injected and dynamic X-ray observation is carried out for 20-90 minutes. At the same time, if in the process of investigation in the small intestine fluid rapidly accumulates, the gas and the pressure rises, then the contents, it (together with the contrasting substance) is pumped out through the probe, after which the liquid barium suspension is reintroduced.

Example 1. The patient was admitted to the hospital with complaints of cramping abdominal pain, nausea, vomiting. There is a delay in stool. Gases did not escape. In childhood, he suffered a shrapnel wound to the abdominal cavity, which was accompanied by eventration of the intestine. The abdomen is swollen, sharply painful in the postoperative scar. Symptoms of peritoneal irritation are absent.

X-ray examination.

28.10.80-10.15 - X-ray diffraction survey. In individual loops of the small intestine, mainly in the left upper abdominal cavity, a small amount of gas and liquid is detected. At the same time, gas is also detected in the colon.

Conclusion: suspected adhesions of the colorectal colorectal obstruction.

The insufficiently clear clinical and radiological data of obstruction served as the basis for performing probe enterography, combined with the decompression of a fine search.

Through a probe inserted by the naso-gastric route through the Treitz linkage, 500 ml of liquid pestle content was pumped out and 1000 ml of a 20% barium suspension prepared in physiological saline were injected.

The picture taken after 10 minutes reveals a cone-shaped narrowing of the jejunum in the left upper half of the abdominal cavity. The loops of the intestine, located proximal to this area, evenly expand Rena.

With repeated radiography, 20 minutes after the start of the study, an increase in suprastenic enlargement of the small intestine is observed. At the same time, there is an increase in abdominal pain and an increase in pressure in the small intestine (monometry was performed using a special duct in the probe used).

A repeated decompression of the small intestine was carried out, during which 800 ml of liquid and suspension were removed. The patient's condition immediately improved. The pains have decreased. After termination of decompression, a radiography of the abdominal cavity was again performed. It is established that

5, the width of the end loops has noticeably decreased. However, there was no significant progress in the gut contrast.

Again, through the same probe, it was injected into the small intestine under a pressure of 500 ml of a 20% barium suspension and immediately (60 minutes after the start of the study) a survey image was taken which determined the uniform filling of almost the entire small intestine with a contrast agent.

5 In the photograph taken after another 20 missions (1 hour and 20 minutes from the start of the study), most of the contrast material is in a thick heap. At the same time, the straightening of the contours of the individual intestinal loops and the presence of linear clearing in the limited area between the loops of the jejunum and the ileum intestine (in the area delimited by the metal circle), indicating a adhesive process, is noted. After probe enterography, combined with re-decompression of the small intestine, the patient's condition improved dramatically, and after a day he was discharged from the clinic without surgery.

Thus, in the above observation, the use of probe enterography in combination with repeated probe decompression of the small intestine made it possible to determine the nature of the pathological process for 1 hour and 20 minutes, as well as to achieve by conservative resolution of acute mechanical obstruction, which developed against the background of adhesive disease due to gross violation of the diet.

Our use of probe enterography according to the described method in 83 patients with the appearance of acute mechanical small bowel obstruction in 24 (29%) cases led to the resolution of obstruction. The analysis of the pictures taken at the same time showed that active decompression followed by the introduction of a bari liquid suspension under pressure leads to the elimination of a functional impairment in the places of bends of intestinal loops or to "pushing through their contents causing an obstruction.

After elimination of the revealed obstacle, the contrast medium usually quickly fills all the loops of the small intestine and passes into the large intestine. At the same time, as a rule, an improvement in the general condition of the patient is noted: pain disappears, gases disappear, etc.

The advantages of the proposed method

Treatment of acute mechanical intestinal obstruction is the ability to achieve a quick cure by a conservative way, without serious surgical intervention.

When performing probe enterography in combination with active decompression of the small intestine, in 83 patients with intestinal obstruction phenomena, no complications associated with this procedure were observed.

Claims (1)

METHOD FOR TREATING ACUTE INTESTINAL OBSTACLE, characterized in that, in order to simplify the method, a probe is inserted into the proximal part of the small intestine, intestinal contents are aspirated, and a liquid suspension of barium sulfate is injected under pressure from 200 to 250 mm of water. Art. under radiological control.