Complex treatment of acute adhesive small bowel obstruction

Purpose. Improving the results of complex treatment of acute adhesive small bowel obstruction. Material and methods. The results of complex treatment of 50 patients with acute adhesive small bowel obstruction are presented. In 46 (92%) observations out of 50 (100%) patients, the causes of acute adhesive small bowel obstruction were various pathologies of the abdominal organs, which in the anamnesis underwent surgical interventions of various nature and volume, and in 4 (8%) cases it arose primarily, without performing surgical interventions. Results. Patients with acute adhesive small bowel obstruction (n = 50) in 30 (60%) cases in the presence of a single cicatricial band and a local adhesive process underwent videolaparoscopic adhesiolysis with drainage of the abdominal cavity. In 13 (26%) cases with limited non-extended intestinal necrosis with hemorrhagic peritonitis, videolaparoscopic-assisted adhesiolysis, resection of the small intestine with side-to-side anastomosis with drainage of the abdominal cavity were performed. In 7 (14%) cases, during diagnostic laparoscopy, the presence of a widespread adhesive process, gross cicatricial changes and intestinal necrosis of more than 20 cm with the presence of widespread purulent-fibrous peritonitis was stated, in which access conversion was performed - laparotomy followed by total adhesiolysis. In the early postoperative period, complex pathogenetic conservative therapy was carried out, including the use of serotonin adipate 1.0 ml 3 times a day, mexidol 2.0 intravenously 2 times a day, tivortin 100.0 ml intravenously 1 time per day, as well as the drug enoxatil, 0.6 ml s / c 1 time per day for 5-7 days. Conclusion. To restore the motor-evacuation function of the small intestine and prevent the risk of recurrence of adhesive intestinal obstruction, along with laparoscopic adhesiolysis, it is necessary to carry out complex pathogenetic treatment with the inclusion of an antioxidant and antihypoxant, serotonin adipinate and enoxatil.