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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