CHARACTERISTICS OF DIAGNOSTICS AND SURGICAL TREATMENT OF ADULT INTUSSUSCEPTIONS

Aim. The aim of this study was to improve the diagnostics and surgical treatment of adult intussusceptions. Material and Methods. Analysis of clinical features and results of diagnostics and surgical treatment of bowel intussusception in a 55-year-old patient by doctors of the 1- st surgical department of Lviv Regional Clinical Hospital are presented. Results and Discussion. A 55-y.o. woman presented to the 1- st surgical unit of Lviv Regional Clinical Hospital at 1340 on 26.10.2014 with complaints of abdominal pain, nausea, vomiting and body temperature up to 37,3°C for 5 days. The admission diagnosis of intestinal tumor and mechanical bowel obstruction was made. She had the same symptoms since February 2014, thus underwent an open appendectomy on 31.03.2014 in the Central District Hospital. But the patient's condition was not improving;severity, and had dry tongue, distended abdomen and shallow breathing with minimal abdominal wall movement. There was a painful mass 4×10 cm in size in the right mesogastric and iliac regions. Her blood pressure was 110/ 70 mm Hg. Complete blood count (26.08.2014): RBCs - 3,4×1012/l, hemoglobin - 110 g/l, WBCs - 6,4×109/l, eosinophils - 0%, bands - 2%, segs - 61%, lymphocytes - 28%, monocytes - 9%, erythrocyte sedimentation rate - 11 mm/hour. Biochemical blood profile: total protein - 76 g/l, total bilirubin - 11,8 μmol/l, glucose - 7,0 mmol/l, Ê - 5,0 mmol/l, Na - 139 mmol/l, amylase - 17,5 g/l per hour, AST - 26,2 U/l, ALT - 12,8 U/l. Coagulation test: prothrombin time - 16'', prothrombin index - 106%, fibrinogen - 2,66 g/l. Abdominal ultrasound (26.08.2014) revealed fluid collection in the abdominal cavity, bowel loops dilated (50- 60 mm) and filled with stagnant contents, and pendular peristalsis. There was also a hyperechoic bundle-like mass of high-density in the scar area. A plain X-ray of the abdomen (26.08.2014) revealed air-filled bowel loops and Kloiber's cups. The surgery was performed on 26.08.2014 at 1535-1635 with preoperative diagnosis of neoplasm in the abdominal cavity and acute bowel obstruction. After midline laparotomy surgical exploration revealed about 300 ml of clear odorless serohemorrhagic exudate in the abdominal cavity. Mechanical intestinal obstruction was caused by the intussusception of terminal ileum, cecum and proximal one third of the ascending colon. There were dilated gas-filled bowel loops proximal to the site of intussusception and collapsed distal loops. Reduction of the intussusceptum that comprised terminal ileum, cecum and proximal one third of the ascending colon was performed. Cecum and proximal one third of the ascending colon were fixed to the right lateral abdominal wall with a knotted suture, as well as the terminal ileum to the ascending colon. The abdominal and pelvic cavity were cleaned and drained. Layered closure of the wound. Aseptic dressing. The postoperative diagnosis of mechanical mixed bowel obstruction and intussusception of terminal ileum, cecum and proximal one third of the ascending colon was made. Her postoperative period was uneventful. Treatment included infusion therapy, Metoclopramid, Emcef, Zibor. She was discharged home on 02.09.2014 in good condition. Conclusions. Infrequency of the pathology, lack of panoramic thinking of Central District Hospital doctors as well as their focusing only on the common possible cause of acute abdomen (acute appendicitis), and bowel obstruction at admission made preoperative diagnostics of the intussusception complicated. Midline laparotomy, reduction of terminal ileum, cecum and proximal one third of the ascending colon and fixation of cecum and proximal one third of the ascending colon to the right lateral abdominal wall as well as the terminal ileum to the ascending colon became an adequate surgery and led to patient's recovery. Keywords: intussusception, clinic, diagnostics, surgical treatment, results