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1 . 2022

Evaluation and surgical correction of intra-abdominal hypertension in patients with postoperative peritonitis

Abstract

Aim – to improve the results of surgical treatment of patients with postoperative peritonitis with the development of intra-abdominal hypertension and abdominal compartment-syndrome by differentiated use of various options for decompression of the abdominal cavity.

Material and methods. The analysis of surgical treatment of 96 patients with postoperative peritonitis, the course of which was complicated by the development of the abdominal compartment-syndrome due to intra-abdominal hypertension, was carried out. To analyze the degree of involvement of the small intestine and colon in the increase in intra-abdominal pressure, 38 patients underwent CT. The volume of the abdominal cavity was assessed using the MultiVox Dicom Viewer computer program. Based on the obtained results of computed tomography, a differentiated approach  to surgical decompression of the abdominal cavity has been developed, including the technologies of "open abdomen", nasointestinal intubation, and enterostomy.

Results. On admission of patients with postoperative peritonitis with intra-abdominal pressure 16.8±1.3 mm Hg. the volume of the abdominal cavity according to CT reached 3876.2±120.6 cm3, and due to the volume of the loops of the small intestine – 975.7±56.3 cm3. The use of intestinal intubation or enterstomy, along with decompressive laparostomy, after 14 days allowed to reduce the intestinal volume by 88.5%, and the abdominal volume by 37%, which had a positive effect on laboratory parameters: the content of potassium, urea, creatinine, total protein in systemic circulation and enteral contents. The use of nasointestinal intubation in 6% of patients was accompanied by the development of aspiration pneumonia. This complication worsened the course and outcomes of postoperative peritonitis and required the development of an individual approach to the functioning of the probe. Removal of the enterostomy was effective in 64.9% of patients with severe postoperative peritonitis and was used in cases when it was impossible  to perform  an intestinal anastomosis or in cases of purulent-necrotic lesions of the colon.

Conclusion. Decompression of the abdominal cavity in patients with postoperative peritonitis and intraabdominal hypertension, along with the formation of a temporary laparostoma, suggests using of other methods aimed at lowering intraintestinal pressure through the differentiated use of intestinal intubation or enterostomy.

Keywords:postoperative peritonitis; intraabdominal hypertension; abdominal compartment-syndrome; intestinal intubation; enterostomy

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Zharikov A.N., Lubyansky V.G., Aliev A.R. Evaluation and surgical correction of intra-abdominal hypertension in patients with postoperative peritonitis. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (1): 98–107. DOI: https://doi.org/10.33029/2308-1198-2022-10-1-98-107  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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