Differential diagnostics and treatment of post-operative dynamic ileus


  • V.V. Nepomnyaschy Kharkov Medical Academy of Post-Graduate Education
Keywords: dynamic ileus, post-operative paresis, peritonitis, differential diagnostics, ultrasound examination.

Abstract

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.

References

1. Boiko, V. V., Tymchenko, N. V., Boichuk, I. P., & Bieliavskyi, O. V. (2014). Faktory ryzyku vynyknennia pisliaoperatsiinoho parezu kyshechnyka u patsiientiv, shcho operovani na tovstii kyshtsi [Risk factors for postoperative bowel paresis in patients undergoing colon surgery]. Kharkivska khirurhichna shkola – Kharkiv Surgical School, 2 (65), 47–50.

2. Zanevskij, V. P., Kulagin, A. E., & Rovdo, I. M. (2011). Narusheniya motorno-evakuatornoj funkcii kishechnika posle vnutribryushinnyh operacij: uchebno-metodicheskoe posobie [Disorders of the motor-evacuation function of the intestine after intraperitoneal operations: a training manual]. Minsk: BGMU.

3. Miminoshvili, O. I., & Korchagin, E. P. (2011). Endolimfaticheskoe kombinirovannoe lechenie posleoperacionnogo pareza kishechnika u bolnyh s rasprostranennym peritonitom [Endolymphatic combined treatment of postoperative intestinal paresis in patients with advanced peritonitis]. Vestnik neotlozhnoj i vosstanovitelnoj mediciny – Bulletin of emergency and rehabilitation medicine, 12(4), 427–430.

4. Solovev, I. A., & Kolunov, A. V. (2013). Posleoperacionnyj parez kishechnika: problema abdominalnoj hirurgii [Postoperative intestinal paresis: the problem of abdominal surgery]. Hirurgiya. Zhurnal im. N.I. Pirogova – Surgery. Magazine named after N.I. Pirogova, 11, 46–52.

5. Benedykt, V. V., Hnatiuk, M. S., & Mihenko, B. O. (2003). Osoblyvosti likuvannia pisliaoperatsiinoi kyshkovoi neprokhidnosti u khvorykh na perytonit [Features of treatment of postoperative intestinal obstruction in patients with peritonitis]. Khirurhiia Ukrainy – Surgery of Ukraine, 4, 124–127.

6. Bondarev, R. V., Orehov, A. A., Chibisov, A. L., & Selivanov, S. S. (2013). Optimizaciya kompleksnogo lecheniya spaechnoj bolezni bryushnoj polosti [Optimization of the complex treatment of adhesive diseases of the abdominal cavity]. Kharkivska khirurhichna shkola – Kharkov Surgical School, 1, 112–114.

7. Radzikhovskyi, A. P., Myronenko, O. I., & Kurilishyn, V. P. (2009). Aspekty klinichnoho perebihu ta likuvannia rannoi zlukovoi pisliaoperatsiinoi neprokhidnosti kyshkovoho traktu [Aspects of clinical course and treatment of early post-operative bowel obstruction of the intestinal tract]. Visnyk Ukrainskoi stomatolohichnoi akademii – Bulletin of the Ukrainian Dental Academy, 9, 4(2), 81–82.

8. Shalkov, Yu. L. (2011). Parezy i paralechi zheludochno-kishechnogo trakta [Paresis and paralysis of the gastrointestinal tract]. H.: Kollegium.

9. Mythen, M. D. (2009). Postoperative gastrointestinal tract disfunction: an overview of causes and management strategies. Cleveland clinicjornal of medicine, 76(4), 66–71. doi: 10.3949/ccjm.76.s4.11.
Published
2019-12-30
How to Cite
Nepomnyaschy, V. (2019). Differential diagnostics and treatment of post-operative dynamic ileus. Reports of Vinnytsia National Medical University, 23(4), 672-676. https://doi.org/https://doi.org/10.31393/reports-vnmedical-2019-23(4)-19