Evolution of diagnosis and surgical treatment of intra-abdominal infiltrates, abscesses of primary and postoperative origin in patients
DOI:
https://doi.org/10.15574/PS.2021.72.15Keywords:
destructive appendicitis, cholecystitis, perforated gastric ulcer and 12-duodenal ulcer, adhesive leakage, strangulated hernias, diagnosis and treatmentAbstract
Purpose – to improve the results of surgical treatment of patients with intra-abdominal infiltrates and abscesses through the introduction of the latest imaging methods and surgical technologies.
Materials and methods. In the clinic of the Department of Surgical Diseases No 1, on the basis of the Surgery Center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019 218 patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 (49.08%) male patients, 111 (50.92%) female patients. Depending on the time of hospitalization (by years), the patients were divided into two groups: the control group (CG) (2006–2012) 117 (53.67%) patients and the study group (SG) (2013–2019) 101 (46.33%) patients. The SG used the latest imaging technologies and improved methods of surgical treatment.
Results. The patients were divided into two groups: primary in 191 (87.61%) and secondary postoperative infiltrates and abscesses in 27 (12.39%). The causes of primary infiltrates and abscesses were: complicated forms of appendicitis in 74 (33.94%), perforated stomach and duodenal ulcer in 48 (22.02%), complicated forms of cholecystitis in 69 (31.65%). Postoperative infiltrates and abscesses were observed in 27 (12.39%) patients who underwent urgent surgery: adgeolysis of adhesive ileus in 14 (6.42%) and complicated hernias of various localization in 13 (5.97%). Postoperative complications were diagnosed in 43 (19.72%) patients, of whom 34 (15.59%) from the surgical wound and 29 (15.18%) of the abdominal cavity, who required relaparotomy or laparoscopy, with destructive appendicitis in 10 (13.51%), perforated gastric ulcer and 12 duodenal ulcer in 6 (12.5%), destructive cholecystitis in 9 (13.04%), adhesive intestinal obstruction in 13 (19.12%) and with strangulated and complicated hernias in 14 (17.28%) of the examined patients. During relaparotomy, incompetence of the intestinal wall and intestinal sutures was established in 11 out of 32 patients, an ileostomy was imposed in 7, and cecostomy in 1 patient. Actually, in the control group, 8 (6.84%) patients died on the background of ongoing peritonitis, thrombosis of mesenteric vessels and multiple organ failure and concomitant ailments and in the study group 4 (3.96%) patients died.
Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis of 69 (36.13%) patients, 48 (25.13%) had laparotomy and 21 (11.00%) had laparoscopic examination. The use of the latest imaging and treatment technologies: Doppler ultrasonography, hydrojet scalpel and laparoscopy in 64 (33.51%), allowed to have better near and long-term results and to reduce postoperative mortality from 6.84% to 3.96%, with an average of 5.5%.
The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies.
The authors declare no conflicts of interests.
References
Ausania F, Guzman Suarez S, Alvarez Garcia H, Senra del Rio P, Casal Nunez E. (2015, Apr). Gallbladder perforation: morbidity, mortality and preoperative risk prediction. Surg Endosc. 29 (4): 955-960. Epub 2014 Aug 27. https://doi.org/10.1007/s00464-014-3765-6; PMid:25159627
Balogun Olanrewaju Samuel, Osinowo Adedapo, Afolayan Michael, Olajide Thomas, Lawal Abdulrazzak, Adesanya Adedoyin. (2019, Jan-Mar). Acute Perforated Appendicitis in Adults: Management and Complications in Lagos, Nigeria. Ann Afr Med. 18 (1): 36-41. PMC6380116. https://doi.org/10.4103/aam.aam_11_18; PMid:30729931 PMCid:PMC6380116
Di Saverio et al. (2020). Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery. 15: 27. doi. org/10.1186/s13017-020-00306-3.
Fomin PD, Usenko OIu, Bereznytskyi YaS. (2018). Nevidkladna khirurhiia orhaniv cherevnoi porozhnyny (standarty orhanizatsii ta profesiino oriientovani alhorytmy nadannia medychnoi dopomohy). K.: Biblioteka «Zdorovia Ukrainy»: 354.
Jansen Stefan, Stodolski Maciej, Zirngibl Hubert, Godde Daniel, Ambe Peter C. (2018, Feb 23). Advanced gallbladder inflammation is a risk factor for gallbladder perforation in patients with acute cholecystitis. World Journal of Emergency Surgery. 13: 9. https://doi.org/10.1186/s13017-018-0169-2; PMid:29467816 PMCid:PMC5819242
Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. (2009). Perforated Peptic Ulcer: Clinical Presentation, Surgical Outcomes, and the Accuracy of the Boey Scoring System in Predicting Postoperative Morbidity and Mortality. World J Surg. 33: 80-85. https://doi.org/10.1007/s00268-008-9796-1; PMid:18958520
MOZ Ukrainy. (2016). Unifikovanyi klinichnyi protocol ekstrenoi, pervynnoi ta vtorynnoi (spetsializovanoi) medychnoi dopomohy. Hostryi apendytsyt. Kyiv: 75.
Rusak PS. (2006). Maloinvazyvni tekhnolohii v likuvanni abstsesiv cherevnoi porozhnyny u ditei. Khirurhiia dytiachoho viku. III; 4 (13): 23-25.
Rusak PS. (2013). Likuvannia abstsesiv cherevnoi porozhnyny iz zastosuvanniam laparoskopii. Khirurhiia Ukrainy. 3 (47): 71-76.
Rusak PS. (2018). Minimally invasive technologies in the treatment of abdominal abscesses in children. Paediatric surgery. Ukraine. 3 (60): 61-65. https://doi.org/10.15574/PS.2018.60.61
Rybalchenko VF, Demydekno YuH. (2019). Termometrychna panel perednoi cherevnoi stinky ta prohnostychnyi aksyliarnoabdominalnyi koefitsiient. Neonatolohiia, khirurhiia ta perynatalna medytsyna. 9; 3 (33): 86-94. https://doi.org/10.24061/2413-4260.IX.3.33.2019.5
Rybalchenko VF, Demydenko YuH, Yarmak SIa. (2018). Termometrychna panel perednoi cherevnoi stinky u ditei z infiltratamy, abstsesamy apendykuliarnoho pokhodzhennia ta prohnostychnyi aksyliarno-abdominalnyi koefitsiient. Paediatric surgery. Ukraine. The materials of conference. 2 (59): 96.
Sartelli Massimo, Chichom-Mefire Alain, Catena Fausto. (2017). The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intraabdominal infections. World Journal of Emergency Surgery. Article number 29. 12 (12): 36.
Skyba VV, Rybalchenko VF, Ivanko OV, Zinchuk АG, Badakh VM, Bocharov VP. (2017). The surgical treatment of an abdominal сavity infiltrations among adolescents using jet hydro scalpel. Paediatric surgery. Ukraine. 1 (54): 32-38. https://doi.org/10.15574/PS.2017.54.32
Skyba VV, Rybalchenko VF, Ivanko OV, Demydenko YuH, Badakh VM, Bocharov VP. (2017). Khirurhichne likuvannia zapalnykh i spaikovykh protsesiv cherevnoi porozhnyny u pidlitkiv iz vykorystanniam strumenevoho hidroskalpelia. Zdorove rebenka. 12; 1: 68-74. URL: http://nbuv.gov.ua/UJRN/Zd_2017_12_1_14. https://doi.org/10.22141/2224-0551.12.1.2017.95029
Salomone DI, Saverio Mauro, Podda Fausto Catena. (2020) Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery. 15; 27. https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3#citeas
Zaremba YeKh, Zaremba VS, Rak NO, Hirniak OT, Zaremba OV, Burmai SV. (2020). Peryvezykalnyi infiltrat zhovchnoho mikhura z poshyrenniam na pidpechinkovyi prostir (klinichnyi vypadok). Praktykuiuchyi likar. 3-4: 10-15.
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