[Intussusception followed by intestinal obstruction in adults]. / Invaginatsionnaia kishechnaia neprokhodimost' u vzroslykh.

AIM: To evaluate the effectiveness of complex preoperative diagnostics and medication of intussusception followed by intestinal obstruction in adults with the choice of surgical repair and analysis of the outcomes depending on the causes of intussusception. MATERIAL AND METHODS: 15 intussusception patients aged 19 - 86 years were enrolled. Mean age was 52.7 years. Patients were hospitalized within 12 hours - 1-2 weeks after onset of the disease. Diagnosis was established on the basis of complaints, anamnesis, objective and additional survey. All patients underwent abdominal X-ray and ultrasound. Intestinal obstruction at admission was diagnosed in all patients, and only 1 (6.7%) of them had intussusception. RESULTS: Medication and additional survey contributed to detection of intussusception followed by intestinal obstruction in 13 (86.7%) out of 15 patients prior to surgery. All patients underwent urgent or delayed surgery. Small intestine resection was performed in 9 patients, 2 patients underwent resection of small intestine with submucosal tumor (1) and Meckel's diverticulum (1) after intussusception repair. Right-sided hemicolectomy was performed in 3 patients, sigmoid colon resection with lymph nodes dissection - in 1 patient. The cause of intussusception followed by intestinal obstruction were epithelial and stromal tumors (9), less often metastasis of melanoma (2), Meckel's diverticulum (1) and functional bowel disorders (1). Postoperative complications arose in high risk patients hospitalized after 24 hours from onset of the disease and present concomitant diseases and malignancies. 1 (6,7%) patient died.

[MORPHOLOGICAL CHANGES IN THE SMALL INTESTINE ASSOCIATED WITH STRANGULATION OF MECHANICALLY OBSTRUCTED BOWEL].

AIM: To estimate the degree and prevalence of pathomorphological changes in the small intestine at different distances from the visible necrosis boundary depending on acute mechanical obstruction for the choice of the optimal extent of resection. MATERIALS AND METHODS: Small intestine fragments for morphological study were obtained from 52 patients aged 17-83 (mean 47 ± 17) years after emergency resection of mechanically obstructed necrotic bowel. Strangulation caused by obstructive adhesion was diagnosed in 48%, constricted hernia in 38.5%, torsion in 13.5% of the cases. Tissue morphology was studied by histological staining and light microscopy at 5 cm intervals between the sections. RESULTS: The degree and prevalence of pathomorphological changes in the small intestine depended on the severity of obstruction and increased with its decompensation. CONCLUSION: The extent of resection in proximal and distal directions from the visible boundary of necrosis must be chosen on an individual basis depending on the degree of compensation of mechanical intestinal obstruction. The absence of extensive resection especially in the proximal direction allows to reduce the frequency of short bowel syndrome with malabsorption in the late postoperative period.

[Enteral nutrition as a method of correction of protein energetic insufficiency in patients with perforating gastric and duodenal ulcer].

The results of examinations and treatment of 338 patients operated by reason of perforated gastric and duodenal ulcer (PGDU). It was established, that parenteral and oral nutrition in PGDU patients after traditional surgical operation did not improve patients' trophic state. Performance of early enteral nutrition with Pevzner's diet and nutritive maintenance during all postoperative period in patients, operated by low-invasive methods, has favorable influence on patients' trophic state.

[Enteral nutrition in the complex treatment of patients with mechanical jaundice in gallstone disease].

The article summarizes the results of the examination and treatment of 99 patients with mechanical jaundice (MJ) related to gallstone disease (GSD). The patients were distributed into three groups according to three degrees of the dysfunction of the greater duodenal papilla (GDP) sphincter. Group 1 consisted of 52 patients with transitory MJ (degree I), Group 2 consisted of 32 patients with stable MJ remaining after coping with the pain attack (degree II), and Group 3 consisted of 15 patients with MJ and cholangitis (degree III). Trophic status disturbances and the effects of balanced clinical nutrition on the results of surgical treatment were assessed in all the patients. The severity and duration of jaundice were found to influence the severity of trophic changes. Clinical nutrition (sipping and enteral tube feeding) favored survival after papilla-sparing surgery in patients with MJ related to gallstone disease.

[Treatment tactics of patients with pyloroduodenal stenoses].

Overall 172 patients aged 29 to 87 years with stenosis of stomach pyloric part and duodenum were studied. The complications of gastric or duodenal ulcer (119), cancer of stomach (49) and pancreas (4) were the cause of stenosis. All the patients were divided into 3 groups: 1st group consisted of 43 patients who has undergone urgent surgery due to stenosis with bleedings and perforations without additional protein-energetic treatment before operation; 2nd group - 65 patients who were prepared preoperatively with complete parenteral nutrition; 3rd group - enteral tube feeding with balanced mixtures before surgery (64 patients). The best results were achieved in the patients with preoperative enteral tube feeding; it allowed to reduce lethality from 25.5 and 16.3% at 1st and 2nd group to 0% ant 3rd group.