Peritoneal Commissures Complicated by Acute Intestinal Obstruction: Determination of the Criteria to Make Diagnosis and Indicate Operative Treatment

Abdomen peritoneal adhesions have not been studied yet. Its growth correlates directly with the growth of different elective and urgent coeliac surgeries. With this kind of surgeries, frequency of adhesions formation varies from 76% to 91%. Such problem predetermines the development of the sequellae such as acute adhesive small intestinal obstruction. Therefore, the case fatality rate may run up to 55%, according to some authors, whereas repeated adheolysis occurs in 30-69% cases. The percentage of mistakes during the diagnosis of acute adhesive small intestinal obstruction has been remained very high (16-34%). In the majority of surgical hospitals the main instrumental control to diagnose intestinal obstruction is to make roentgenologic investigation, whereas ultrasound investigation is still not widespread. Up to the present day the criteria to diagnose the acute adhesive intestinal obstruction have not been developed. The solution of such questions will provide the opportunity to improve the quality of diagnosis and treatment of abdomen peritoneal adhesions which were complicated with acute adhesive intestinal obstruction. The aim of the paper is to determine the criteria to diagnose and indicate operative treatment for the patients with abdomen peritoneal adhesions which were complicated with acute intestinal obstruction. Materials and methods. The work is based on the analysis of the results from diagnosis and operative treatment of 52 people who suffered from acute intestinal obstruction. The diagnosis of acute intestinal obstruction included anamnesis such as physical, laboratory, roentgen and ultrasound examinations. Results. The definitive clinical picture of acute intestinal obstruction could be seen among 24 (46,2%) patients, 22 (42,3%) patients had mild symptoms, and 6 (11,5%) patients had obliterated signs. 48 (92,3%) patients had various surgeries which were associated with abdominal cavity and retroperitoneal organs, 11 (21,2%) had such surgeries twice or more, and 7 (13,5%) had experienced adheolysis regarding acute adhesive intestinal obstruction. 4 (7,7%) people had never surgeries which were associated with abdominal cavity. 2 (3,9%) people had been diagnosed with irreducible umbilical hernia with adhesions in the area of hernial orifice, other 2 (3,9%) suffered from intraabdominal injury in past medical history. Roentgenologic signs of acute adhesive intestinal obstruction were found only among 28 (53,8%) patients, and for 24 (46,2%) patients this examination did not show results. During ultrasound investigation acute adhesive intestinal obstruction was determined among 46 (88,5%) patients, and in 6 (11,5%) cases it was found within next 203 hours of case follow-up. Ultrasound signs of intestinal obstruction: motility decrease while breathing with anchoring of small bowel fillet with adhesions together and towards anterior abdominal wall. During primary and secondary ultrasound free fluid was found in various segments of abdominal cavity among 16 (30,8%) patients. There was no case when it was possible to determine it roentgenologically. And according to our results this can be considered as the indication for an emergency surgical measure. Conservative therapy was done for 20 (38,5%) cases, surgical treatment was used for 32 (61,5%) patients. Conlusions. The usage of transabdominal ultrasound investigation within comprehensive diagnosis of acute intestinal obstruction allows determining the presence of intestinal obstruction at early stage comparing to the roentgenologic method. Ultrasound criteria complex during the process of repeated dynamic studies also provides an opportunity to define indications concerning surgical treatment.