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Year 2018 Vol. 26 No 2

GENERAL & SPECIAL SURGERY

A.YA. KOROVIN, M.B. ANDREEVA, D.V. TURKIN, N.A. TRIFANOV

COMPLEX TREATMENT OF PATIENTS WITH ACUTE MESENTERIC ISCHEMIA AND PERITONITIS

Kuban State Medical University,
Krasnodar,
The Russian Federation

Objective. To develop surgical tactics in acute mesenteric ischemia and purulent peritonitis and to find ways to improve the results of treatment of this complicated pathology.
Methods. 118 cases of acute mesenteric ischemia complicated by diffuse peritonitis were analyzed. For urgent diagnosis of the pathology, computed tomography was used. In the first group (n=72), one-step procedures were applied – the intestinal resection and embolthrombectomy with application of the primary anastomosis. Reoperations were performed «on demand». In the second group (n=46), operations were of a separate nature, along with thrombembolectomy and intestinal resection at the stages of the programmed relaparotomy, delayed interintestinal anastomoses were used. The maximum number of relaparotomies in both groups was 3. The gradual treatment outcomes were assessed during the first day hospital mortality and integrated rates of severity of the sepsis APACHE II and SOFA, the peritonitis index of Mannheim (IPM) and the abdominal cavity index (IAC) in the intervals between relaparotomies. At the final stage, hospital mortality was compared in the groups of patients.
Results. The mortality rate after the first operation in the groups was 43.6% and 41.3%, respectively. Reduction in the severity of abdominal sepsis was registered at the time of the third relaparotomy, in the second SOFA group <8, the IPM decreased by 16%, and the IAC by 27%. Significant differences in IPM and IAC indicators were registered only with the third relaparotomy, and the tendency of the positive dynamics of peritonitis course was traced in the second group of observations. Hospital lethality exceeded the staged predicted values and constituted 87.5% in the first, and 84.8% in the second group.
Conclusions. Surgical tactics, including the use of obstructive bowel resections with the delayed anastomosis after restoration of mesenteric hemocirculation and relief of the reperfusion syndrome at the stages of the programmed relaparotomy, contributes to improving the treatment results of acute mesenteric ischemia and diffuse peritonitis.

Keywords: acute mesenteric ischemia, superior mesenteric artery occlusion, CT-angiography, diffuse peritonitis, abdominal sepsis
p. 179-187 of the original issue
References
  1. Kosinets VA. Influence of new pathogenetic reasonable scheme of complex treatment of widespread purulent peritonitis on the course of inflammatory process. Khirurgiia Zhurn im NI Pirogova. 2012;(8):69-73. (in Russ.)
  2. Sazhin VP, Avdovenko AL, Iurishchev VA. Current trends in surgical treatment of peritonitis. Khirurgiia Zhurn im NI Pirogova. 2007;(11):36-39. (in Russ.)
  3. Shugaev AI, Vovk AV. Ostrye narusheniia arterial’nogo mezenterial’nogo krovoobrashcheniia. Vestn Khirurgii im II Grekova. 2005;164(4):112-15. (in Russ.)
  4. Düber C, Wüstner M, Diehl SJ, Post S. Emergency diagnostic imaging in mesenteric ischemia. Chirurg. 2003 May;74(5):399-406. [Article in German]
  5. Baeshko AA, Klimuk SA, Iushkevich VA. Prichina i osobennosti porazhenii kishechnika i ego sosudov pri ostrom narushenii bryzheechnogo krovoobrashcheniia. Khirurgiia Zhurn im NI Pirogova. 2005;(4):57-63. (in Russ.)
  6. Maskin SS, Golbraykh VA, Derbenzeva TV, Karsanov AM, Ermolaeva NK, Lopasteysky DS. Programmed and emergency relaparotomy in the treatment of diffuse peritonitis. Vestn VolgGMU. 2012;(4):105-107. (in Russ.)
  7. Gostishchev VK, Sazhin VP, Avdovenko AL. Peritonit. Moscow, RF: Geotar-med; 2002. 240 p. (in Russ.)
  8. Baeshko AA, Klimuk SA, Yushkevich VA. Acute disorders of mesenteric circulations: the etiology, risk factors and incidence of lesions. Angiologiia i Sosud Khirurgiia. 2004;10(4):99-13.
  9. Edwards MS, Cherr GS, Craven TE, Olsen AW, Plonk GW, Geary RL, Ligush JL, Hansen KJ. Acute occlusive mesenteric ischemia: surgical management and outcomes. Ann Vasc Surg. 2003 Jan;17(1):72-79.
  10. Park WM, Gloviczki P, Cherry KJ Jr, Hallett JW Jr, Bower TC, Panneton JM, Schleck C, Ilstrup D, Harmsen WS, Noel AA. Contemporary management of acute mesenteric ischemia: Factors associated with survival. J Vasc Surg. 2002 Mar;35(3):445-52.
  11. Klimovich IN, Maskin SS, Dubrovin IA, Karsanov AM, Derbentseva TV. Endovideokhirurgiia v diagnostike i lechenii posleoperatsionnogo peritonita. Vestn Khirurgii im II Grekova. 2015;174(4):113-16. (in Russ.)
  12. Alhan E, Usta A, çekiç A, Saglam K, Türky?lmaz S, Cinel A. A study on 107 patients with acute mesenteric ischemia over 30 years. Int J Surg. 2012;10(9):510-3. doi: 10.1016/j.ijsu.2012.07.011.
  13. Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology. 2003 Oct;229(1):91-8. Epub 2003 Aug 27. doi: 10.1148/radiol.2291020991.
  14. Björck M, Acosta S, Lindberg F, Troeng T, Bergqvist D. Revascularization of the superior mesenteric artery after acute thromboembolic occlusion. Br J Surg. 2002 Jul;89(7):923-27.
  15. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287.
Address for correspondence:
350063, The Russian Federation,
Krasnodar, Sedin Str., 4,
Kuban State Medical University,
Department of the Faculty
Surgery with the Course of Anesthesiology
and Intensive Care,
Tel. mobile: + 7 988 244-69-44,
e-mail: kuman52@mail.ru,
Korovin Alexander Ja.
Information about the authors:
Korovin Alexander Ja., MD, Professor, Head of the Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0002-7986-4455
Andreeva Marina B., PhD, Assistant of the Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0002-5705-0063
Turkin Denis V., PhD, Assistant of the Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0002-8454-2346
Trifanov Nikolay A., Post-Graduate Student of Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0001-9006-6860
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