SURGICAL TREATMENT OF ACUTE SMALL BOWEL OBSTRUCTION: INDICATIONS ASSOCIATED WITH STRANGULATION AND EARLY MORTALITY AFTER SURGERY. PRELIMINARY DATA FROM A RETROSPECTIVE STUDY

Abstract

Acute small bowel obstruction (ASBO) continues to be one of the most difficult problems of emergency abdominal surgery. Materials and methods. The results of treatment of 123 patients aged 18–80 years with ASBO were evaluated. Patients were divided into two groups: 1st - with a positive result (survivors, n = 101), 2nd — with an unfavourable result (non-survivors, n = 22). Results. All these patients underwent emergency surgery: the adhesive disease was the main cause in 101 (82.1 %) patients with ASBO, small bowel obstruction in gallstones was in 2 (1.6 %) and volvulus was the cause in 20 (16.3 %) ) patients. Small bowel ischemia developed in 49 (39.8 %) patients: reversible in 21 (42.9 %) and irreversible in 28 (57.1 %) patients; generalized peritonitis was present in 24 (19.5 %) patients, in 18 (75 %) of them abdominal sepsis was presented according to the criteria of Sepsis-3. After the operation, 22 patients (17.9 %) died, which were analyzed: in the early stages (first 72 hours), seventeen patients (77.3 %) and others (22.7 %) - from the third to the seventh day of the postoperative period. Studies have shown that only three laboratory parameters (blood leukocytes, lactate and C-reactive protein) and one instrumental (involving the mesentery of the small intestine, free fluid in the abdomen during CT) with a probability of 80 % or more were significantly associated with strangulated ASBO, as well as six indicators with the same probability were associated with early mortality after surgery. In both groups, the main operation in 95 (77.2 %) patients was adhesiolysis, transnasal tube of the small intestine and drainage of the abdominal cavity. The choice of access for surgery (laparoscopy or laparotomy) (P = 0.000), as well as the duration of surgery (P = 0.038), affected the results of the treatment in patients under analysis, although the types of operations performed did not significantly affect the results in these groups patients (P = 1.000). Immediate results in patients depended on the development of intra-abdominal complications after surgery (P = 0.024) and the need for early re-operation (P = 0.006). The development of postoperative complications, such as cardiovascular dysfunction (P = 0.000) and respiratory dysfunction (P = 0.000), also affected the treatment outcomes in these patients. Conclusion. It was confirmed that three laboratories and one instrumental parameter were indicated of strangulated ASBO before surgery and the six parameters studied were predictors of early mortality before surgery with a probability of 80 % or more.