ADHESIVE DESEASE (morbus adhaesivus) — the term used for designation of the states connected with formation of commissures in an abdominal cavity at a number of pathological processes after damages and surgeries.
Page. began to mention often in literature since the end 19 and the beginnings of 20 centuries in connection with development of abdominal surgery. The IV All-Russian congress of surgeons noted sharp increase in its frequency in the 70th 20 century. The most frequent reason of S. the inflammation of a worm-shaped shoot and appendectomy are (apprx. 43%), diseases and operations on bodies of a small pelvis and operation for impassability of intestines are on the second place (apprx. 30%). In a pathogeny of education commissures (see) the leading value belongs to inflammatory changes of a peritoneum (see. Peritonitis ), sometimes with development of an extensive perivisceritis — inflammations of a visceral peritoneum. Bruises of a peritoneum or a serous cover, impact on them of nek-ry chemical substances (iodine, alcohol, antibiotics, sulfanamide drugs, talc, etc.) also promote intensive formation of commissures. Commissures develop at a hemoperitoneum, especially at infection of the streamed blood. Value of an injury of a peritoneum, cooling or its overheating in S.'s development is experimentally proved. Existence of foreign bodys (napkins, drainages) in an abdominal cavity is also followed by formation of commissures. Occasionally S. develops as a result of such congenital anomalies as plane unions between intestinal loops (Lane's tyazh) or unions between parts of a colon (Jackson's membrane). At an injury long paresis of intestines is important, at Krom favorable conditions for unions owing to long contact of blemished surfaces of loops of a gut among themselves and with a parietal peritoneum are created.
In some cases formation of commissures gets the progressing current, the reasons to-rogo are not quite established, however value of extensiveness of inflammatory process and virulence of microbic flora does not raise doubts. In these cases there are deformations of intestines, normal motility and evacuation of intestinal contents is broken.
Scales of commissural process in an abdominal cavity can be different: from total distribution on all surface of a peritoneum before education separate tyazhy (shtrang), the intestinal loops fixed in 2 points and causing a prelum. As a rule, commissural process is more expressed in a zone of the former operation on abdominal organs. Often loops of intestines are soldered to a postoperative hem or fixed to walls of a postoperative hernial bag.
On a wedge. to a current distinguish acute, intermittent and chronic S.
The acute form is shown by sudden or gradual development of a pain syndrome, strengthened peristaltics (see), vomiting, rise in temperature. Pains can have the increasing character. At a blood analysis the leukocytosis, the accelerated ROE is found. At increase of intestinal impassability (see. Impassability of intestines ) there is vomiting contents of a small bowel, symptoms of irritation of a peritoneum, tachycardia appear. At further increase of the phenomena of impassability swelling of intestines and lack of its vermicular movement is observed (see. Peritonitis ), the daily allowance decreases diuresis (see), arterial hypotension develops (see. Hypotension arterial ), it is observed cyanosis (see), Crocq's disease (see), thirst, drowsiness, prostration, a hypoproteinemia (see. Proteinemia ), disturbance of water exchange — in the beginning extracellular, and then and intracellular dehydration (see. Dehydration of an organism ). It is broken mineral metabolism (see): sharply the level of potassium and sodium in blood decreases that is shown by clinically general weakness, hypotension, easing or disappearance of reflexes. Disturbances proteinaceous and a water salt metabolism define weight of a condition of the patient and depth of intoxication.
At an intermittent form C. painful attacks appear periodically, intensity of pain is various, there are dispeptic frustration, the phenomena of discomfort, locks. Patients with this form C. are repeatedly hospitalized in surgical departments.
Hron. form C. it is shown by the aching abdominal pains, feeling of discomfort, locks, weight reduction of a body and periodic attacks of acute intestinal impassability.
Acute S. it is possible to suspect on the basis of the anamnesis (operation or an injury of an abdominal cavity) and characteristic a wedge, pictures. The laparoscopy is in most cases contraindicated. At a blood analysis find a leukocytosis, S-reactive protein, the accelerated ROE. At rentgenol. a research note a pnevmatization of intestinal loops and fluid levels in them (so-called bowls of Kloyber). At administration of barium through a mouth establish the slowed-down passing of a contrast suspension on intestines, up to its stop at the level of an obstacle. Radiodiagnosis of an intermittent and chronic form C. is based on identification at polyposition research (see) various a type of deformations, unusual fixing, changes of situation and contours, unions with an abdominal wall or the next bodies of the body (bodies) involved in process. Technique of a research and feature rentgenol. pictures depend on the nature of commissural process (a limited or widespread perivisceritis), degree of its expressiveness and localization (see. Perigastritis , Perihepatitis , Periduodenitis , Episplenitis , Pericholecystitis ).
For identification of commissures of a small bowel resort to introduction of a baric suspension via the probe (see. Intestines ), and at replace — to irrigoskopiya (see). The unions of internals with an abdominal wall arising because of the undergone operations or wounds of a stomach come to light at a research in lateroposition better.
Commissures of intestines lead to permanent deformation of a gut, change of usual provision of its loops, restriction of passive and active mobility and narrowing of a gleam of various degree, sometimes with suprastenotichesky expansion of a gut, a meteorism and disturbance of a passage of a baric suspension. Contours of the narrowed site accurate, uneven, jagged, with the characteristic sharp-pointed ledges changing the form and the sizes in the course of the research, especially at the dosed compression or inflating by gas.
The kinks caused by unions and narrowings of a gut cause corresponding rentgenol. picture. At a spayaniya among themselves of the adjoining next loops it can be formed I do not straighten - shchayasya time of a research a so-called double-barreled gun. The nature of similar deformation is defined in the conditions of a double contrast study of a gut better. At the same time study a condition of a relief of a mucous membrane and elasticity of walls, especially in the flexing area and excesses of a gut. Folds of a mucous membrane in similar cases though are deformed, overwound and change the usual direction or smooth out, however unlike tumoral process are traced throughout, without breaking. Tells about commissural process also lack of rigidity of a wall of a gut that is peculiar to a malignant tumor.
Treatment, depending on indications, can be conservative or operational. Indications to operation can arise at a bad attack of commissural impassability of intestines (the immediate or urgent surgery) or at a recurrent current of S. (planned operation). At an immediate surgery make an adhesiotomy, a resection of the nekrotizirovanny site of a gut. At hron. to a form C. carry out Nobl's operation or her modifications (see. Noblya operation ).
To predict S.'s current. it is almost impossible. At a frequent recurrence of S. patients lose working capacity. The forecast is more favorable at single commissures.
Prevention consists in timely performance of an operative measure at acute diseases of abdominal organs without use of rough drainages and tampons; washing of an abdominal cavity, carrying out peritoneal dialysis (see) and an intensive antibioticotherapia at peritonitis.
For prevention of formation of commissures use of anticoagulants, novocaine, Prednisolonum with novocaine is offered. Apply Dimecolinum to stimulation of motility of intestines, to-ry enter 3 — 4 times a day intramusculary. Positive influence of viutribryushinny administration of fibrinolysin in mix with a hydrocortisone and polyvinylpirrolidone is experimentally proved. Recommend administration of sperm oil, the combined use of solution of a hydrocortisone, fibrinolysin, streptomycin, novocaine. All these methods, judging by a wedge, to observations, would not provide reliable prevention of S.
Bibliography: Adelmann, To surgical pathology and therapy an organon of food, I. Short circuit of guts in an abdominal cavity, Voyen. - medical zhurn.,'ch. 92, book 2, page 99, 1865; M and I am V. S. t and r and N - e r of A. A. Some questions of tactics and a mistake at treatment of commissural intestinal impassability, Owls. medical, No. 10, page 29, 1968; N e with t e r e N to about THAT. And. and L and Friday e in V. V. The diseases caused by Mekkel's diverticulum, Surgery, No. 10, page 50, 1976, bibliogr.; With and m about N I am K.S's N. Adhesive desease, M., 1966, bibliogr.; Fanardzhyan V. A. Radiodiagnosis of diseases of a digestive tract, t. 2, Yerevan, 1904; Chukh r and e N-jk about D. P., White I. S. and Bondarenko V. A. Adhesive desease, Kiev, 1972; Hunter J. Versuche iiber das Blut die Entziindung und die Schusswunden, Bd. 1 — 2, Lpz., 1797; S a n n e 1 1 a N. A. Early and late obstruction of the small bowel after abdominoperitoneal resection, Amer. J. Surg., v. 130, p. 270, 1975; S with h a r-m and M. M., N an i r S. K. a. Gupta G. L. Postoperative mechanical intestinal obstruction, J. Indian med. Ass., v. 60, p. 293, 1973; Teschendorf W., Anacker H. u. Thurn P. Rontge-nologische Differentialdiagnostik, Bd 2, Stuttgart, 1978; W e 1 i n S. W e-1 i n G. The double contrast examination of the colon, Stuttgart, 1976.
Yu. A. Nesterenko; A. H. Kishkovsky (rents.).