Adhesive disease of the abdominal cavity

Abstract

After operations on the abdominal adhesions occur in 80-90% of cases, adhesive disease develops in 12-64% of cases. First about the causes of adhesions said George Punter in 1793. For the first time in the Russian literature on intraperitoneal adhesions mentioned V.P. Dobrovolsky in 1838. According to modern notions, adhesive disease is a separate nosological form, characterized by the formation of intra-abdominal adhesions, as a rule, manifested by recurrent episodes of intestinal obstruction or pain. The basis for the development of peritoneal commissures in abdominal cavity are a complex, diverse violations of the functions of various body systems. Trigger in the development of adhesion formation in abdominal cavity considered: mechanical, physical, infectious, implant, chemical factors and congenital anomalies (bands of lane, membranes of Jackson and others). As a result of inflammation of the peritoneum dystrophic process, accompanied by desquamation of the mesothelium and other connective tissue layers of the peritoneum, there is an allocation of exudate, coagulation of protein components and formation of fibrinous adhesions, which under normal fibrinolytic activity within 24-72 hours lysed. There are four degrees of prevalence of adhesions: grade I – local adhesions, occupying not more than 1/3 of one floor; II degree – additionally determined by single spikes in other areas. III and IV degree – adhesions, occupying 1/3 and 2/3 of the abdominal cavity, respectively. The clinical picture of adhesive disease is expressed aching pain in the abdomen, changing its character with the change of body position; periodic bloating, unstable chair; vomiting during exercise or after violation of the diet, the phenomena of complete or partial adhesive intestinal obstruction. Diagnostic informativeness of traditional x-ray methods is only 50-60%. The most informative is the use of contrast enterography and ultrasound examination of the abdomen with a directed study of problem areas of the abdomen. Prevention of adhesions is an important problem of practical surgery. Methods of preventing the formation of adhesions are the following: reduction of abdominal trauma, reducing inflammation in the area of operations, reducing the likelihood of deposition of fibrin in the free abdominal cavity, the suppression of postoperative paresis of the intestine, delimitation of the damaged serosal surfaces and interfere with adhesion by applying a protective film on the mesothelium. Application drugs does not negate the careful attitude to the tissues and accurate surgical interventions. Conservative treatment includes: electrophoresis lidazy, hydrocortisone, application of paraffin, ozokerite on the anterior abdominal wall, injection antispasmodics, nasogastric drainage, staging of hypertension and cleansing enemas and others. Indications for operative intervention are: absence of effect of conservative treatment, the deterioration of the patient, the symptoms of acute intestinal obstruction. The following types of surgery: enteroclysis, the imposition of intestinal anastomosis with or without bowel resection laparoscopic lysis of adhesions, entropicalia.