DOI: 10.25881/BPNMSC.2019.98.79.008

Authors

Zemlyanoj V.P.1, Singaevskij A.B.1, 2, Nesvit E.M.1, Vrublevskij N.M.3, Ostapenko D.A.3

1 North-Western State Medical University named after I.I.Mechnikov, St. Petersburg

2 City Hospital № 15, St. Petersburg

3 City Hospital № 40, St. Petersburg

Abstract

The article investigated the main clinical manifestations of acute postoperative perforative ulcers of the small bowel, studied the possibilities of their instrumental diagnosis. The study revealed that today the incidence of acute postoperative perforative ulcers of the small bowel increased by 8 times compared with the end of the XX century. Among the patients in whom this complication occurred, patients who required emergency surgical treatment prevailed (67,7%). Perforations of the small bowel arose as the first complication after surgery (41.9%), and after other complications developed earlier (58,1%). In 56,8% of cases, the fact of perforation of the small bowel was manifested by the presence of the enteric discharge in the drains from the abdominal cavity or in a laparotomy wound. Among all patients, only 27,0% had positive peritoneal symptoms, which made diagnosis extremely difficult. In 30,5% this complication was not manifested clinically and was detected during the execution of a programmed relaparotomy. Ultrasound examination of the abdominal cavity in the diagnosis of this complication was uninformative. In some cases, computer tomography has proven to be an effective method for diagnosing these complications. The complexity of the diagnosis of acute perforated ulcers, frequent recurrence and high mortality (74,2%) require special alertness of surgeons.

Keywords: acute perforated ulcers of the small bowel, relaparotomy, peritonitis, sepsis, postoperative complications.

References

1. Vishnevskaya AN, Stegniy KV, Rapovka VG. Laparoscopy in diagnosing and treating post-operative peritonitis. Pacific medical journal. 2011;(1):34–36. (In Russ).

2. Volkov VE, Volkov SV. Erozivno-yazvennye porazheniya zhludochno-kishechnogo trakta v rannem posleoperatsionnom periode. Vestnik Chuvashskogo Universiteta. 2005;(2):50–56. (In Russ).

3. Gol’braikh VA, Maskin SS, Bobyrin AV, et al. Ostrye perforativnye yazvy tonkoi kishki u bol’nykh s rasprostranennym gnoinym peritonitom. Bulletin of Experimental and Clinical Surgery 2012;(5):51–53. (In Russ).

4. Zharikov AN, Lubyansky VG. Surgical treatment of postoperative complications concerning acute adherent intestinal obstruction. Meditsina i obrazovanie v Sibiri. 2014;(4):35. (In Russ).

5. Kriger AG, Shurkalin BK, Glushkov PS, Andreitsev IL. Diagnostika i lechenie posleoperatsionnykh vnutribryushnykh oslozhnenii. Khirurgiya. Zhurnal im. N.I. Pirogova. 2003;8:19–23. (In Russ).

6. Saenko VF, Belyanskii LS, Markulan LYu, Gorshevikova EV. Taktika khirurgicheskogo lecheniya posleoperatsionnogo razlitogo gnoinogo peritonita. Klinicheskaya khirurgiya. 1996;(2–3):49–50. (In Russ).

7. Sobolev VE. Diagnostika i khirurgicheskoe lechenie rannikh posleoperatsionnykh vnutribryushnykh oslozhnenii. Vestn Khir Im I I Grek. 2007;166(2):110–113. (In Russ).

8. Tomnyuk ND, Zdzitovetsky DE, Danilina HP, et al. Small intestine carcinoid as a cause of acute intestinal obstruction. Siberian medical review. 2013;(2):100–102. (In Russ).

9. Bensignor T, Lefevre JH, Creavin B, et al. Postoperative peritonitis after digestive tract surgery: surgical management and risk factors for morbidity and mortality, a cohort of 191 patients. World J Surg. 2018;42(11):3589–3598. doi: 10.1007/s00268-018-4687-6.

10. Kirshtein B, Roy-Shapira A, Domchik S, et al. Early relaparoscopy for management of suspected postoperative complications. J Gastrointest Surg. 2008;12(7): 1257–1262. doi: 10.1007/s11605-008-0515-x.

11. Martínez-Casas I, Sancho JJ, Nve E, et al. Preoperative risk factors for mortality after relaparotomy: analysis of 254 patients. Langenbecks Arch Surg. 2010;395(5): 527–534. doi: 10.1007/s00423-009-0538-0.

12. Mulier S, Penninckx F, Verwaest C, et al. Factors affecting mortality in generalized postoperative peritonitis: multivariate analysis in 96 patients. World J Surg. 2003;27(4):379–384. doi: 10.1007/s00268-002-6705-x.

13. Riché FC, Dray X, Laisné MJ, et al. Factors associated with septic shock and mortality in generalized peritonitis: comparison between community-acquired and postoperative peritonitis. Crit Care. 2009;13(3):R99. doi: 10.1186/cc7931.

For citation

Zemlyanoj V.P., Singaevskij A.B., Nesvit E.M., Vrublevskij N.M., Ostapenko D.A. Clinical features and possibilities of diagnosis of acute postoperative perforative ulcers of the small bowel. Bulletin of Pirogov National Medical & Surgical Center. 2019;3(14):43-46. (In Russ.) https://doi.org/10.25881/BPNMSC.2019.98.79.008