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
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.
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