X-ray diagnostics

Radiographic diagnosis of acute intestinal obstruction. After 6 hours from the onset of the disease, there are radiographic signs of intestinal obstruction. Pneumatosis of the small intestine is the initial symptom, normally the gas is contained only in the colon. Later in the intestine, fluid levels (the "Clauber Bowl") are determined. Levels of fluid localized only in the left hypochondrium, speak of high obstruction. Fine and colonic levels should be distinguished. At intestinal levels, vertical dimensions prevail over horizontal, semilunar folds of the mucosa are visible; In the large intestine the horizontal dimensions of the level prevail over the vertical, the gaustration is determined. Radiocontrast studies with barium giving through the mouth with intestinal obstruction are impractical, this contributes to complete obstruction of the narrowed segment of the gut. The use of water-soluble contrast preparations in case of obstruction promotes the sequestration of the fluid (all radiopaque preparations are osmotically active), their use is possible only if they are injected through the naso-intestinal probe with aspiration after the study.

An effective means of diagnosing colonic obstruction and in most cases of its cause is an irrigoscopy. Colonoscopy in colonic obstruction is undesirable, as it leads to the entry of air into the leading loop of the gut and may contribute to the development of its perforation.

Treatment of mechanical intestinal obstruction begins with conservative measures, including aspiration of gastric contents, siphon enemas, intravenous fluid administration. It should be remembered that the introduction of only crystalloid solutions with obstruction only contributes to the sequestration of the fluid, it is necessary to introduce plasma-substituting solutions, protein preparations in combination with crystalloids. The effectiveness of conservative treatment is determined on the basis of clinical (preservation of pain syndrome indicates lack of effect) and X-ray data (disappearance of intestinal fluid levels). Preservation of clinical or (and) radiographic signs of the disease dictates the need for surgical intervention.

Principles of surgical treatment of acute intestinal obstruction.

1. Eliminate a mechanical obstacle or create a workaround for intestinal contents. With small intestinal obstruction, one should strive to eliminate the cause of obstruction (up to the resection of the intestine) with the application of intercusive anastomosis. In colonic obstruction, the cause of the obstruction must be eliminated; The imposition of cross-sectional intestinal anastomoses leads to insufficiency of the sutures and peritonitis. Only with right-sided localization of the colon tumor in young patients with unresolved intestinal obstruction is possible right-sided hemicolectomy with ileotransverzoanastomosis. In other cases, two- and three-stage operations are advisable.
2. Removal of necrotic and suspicious areas of the intestine. Signs of impracticality see Herniated injured.
3. Unloading the dilated bowel: helps restore microcirculation in the wall of the intestine, muscle tone and peristalsis. Unloading can be achieved by nasogastric, gastro- or cecostomic intubation of the small intestine during surgery.
4. Prior to the operation, premedication with antibiotics is necessary (the daily dose of the broad-spectrum antibiotic is administered intravenously 30-40 minutes before the operation), which it is advisable to combine with metronidazole.
5. After the operation, carrying out detoxication therapy, correction of water-electrolyte disorders, stimulation of the motor-evacuation function of the gastrointestinal tract.