Differential diagnostics and treatment of post-operative dynamic ileus
Annotation. Diagnostics and treatment of patients with long-term existing intestinal paresis in post-operative period with the frequency from 3.5 to 75% is an actual problem of abdominal surgery. Functional violations of intestinal motility demanding conservative therapy can be in one of case the cause of prolonged paresis, in other case – complications of surgery itself or pathologic state appearing independently but demanding relaparotomy. The objective criteria of differential diagnostics of prolonged paresis and dynamic ileus as a consequence of complications demanding surgery are absent by now. Aim of the study — identification and determination of reliable diagnostic criteria of differential diagnostics of “prolonged paresis” and other complications demanding surgery in the way of relaparotomy. 52 patients of the main group with dynamic ileus and its causes confirmed by ultrasound were included into the study; 50 patients with diagnosed dynamic ileus by combination of clinical and radiological methods of study were included into the comparison group. The study demonstrated that ultrasound method is most significant in differential diagnostics of dynamic ileus and its causes. Radiological study is uninformative in early post-operative period as it is done in horizontal position and the abdomen in these terms contains free gas (relaparotomy, presence of drainages). The use of the suggested method in the main group allowed determination of the causes of prolonged paresis and indications for relaparotomy: in 9 (17.2%) patients BO was found on the 3-4th day, post-operative peritonitis — in 3 (5.7%) cases, interstitial abscess — in 1 (1.9%). In 38 (73%) cases dynamic ileus was resolved conservatively. In the comparison group BO was found in 8 (16%) patients on the 7th day, post-operative peritonitis — in 4 (8%) cases, in 5 (10%) cases of the comparison group relaparotomy was done in vain. Thus ultrasound method is the main diagnostic method in early post-operative period in patients with prolonged paresis with the help of which differential diagnostics of mechanical and dynamic ileus can be done and indications for relaparotomy in the given category of patients can be determined. Decrease of post-operative mortality from 6 to 0% was the result of ultrasound method.
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