Intensive care in severe acute bowel obstruction (clinical lecture)

Abstract

Most patients with severe acute small bowel obstruction in the early postoperative period require treatment in the intensive care unit. The main principles of intensive care are identifying major vital function disorders, their rapid correction, as well as supporting the functions of the affected organs and systems. The leading pathophysiological disorders that require intensive correction during small bowel obstruction are impaired intestinal barrier function (for bacteria and toxins), hypovolemia, hypotension and microcirculation disorders, primarily in the abdominal organs, fluid and electrolyte and acid-base disorders. Such disorders, in turn, could cause repeated development of intra-abdominal hypertension with impaired perfusion of the abdominal organs. Thus, the efficiency of intensive care for dynamic acute bowel obstruction primarily depends on the speed of correction of fluid and electrolyte disorders and restoration of intestinal blood flow, normalization of gut parietal digestion rather than on the quantity of the drugs that stimulate bowel movement. The primary method of gut microcirculation restoration is the ROSE approach to fluid resuscitation. The main criteria of the intensive care efficiency should be control of intra-abdominal pressure and timely treatment of intra-abdominal hypertension.