ADHESIVE OBSTRUCTION OF THE SMALL INTESTINE: FEATURES OF DIAGNOSIS AND TREATMENT IN THE CONTEXT OF MINIMALLY INVASIVE TECHNOLOGIES
PDF

Keywords

: adhesive obstruction of the small intestine, epidemiology, diagnostic, surgical treatment, open surgery and laparoscopy.

Abstract

The review presents a modern view on the features of the course and treatment of adhesions of the small intestine, based on modern epidemiological data, accepted guidelines for the diagnosis and nature of the treatment of different categories of patients. It is noted that adhesive intestinal obstruction is a symptom complex due to violation of the movement of contents through the intestines due to the presence of adhesions in the abdominal cavity after operations and injuries. Attention is drawn to the peculiarities of diagnostics of various forms of the disease, which include the leading clinical symptoms, data of X-ray methods (X-ray and CT of the abdominal cavity), MRI, assessment of various biomarkers, indicators of the severity of the patient's condition. It is noted that at present the primary task in solving this problem is to study several controversial issues in this area. The main provisions of measures for the treatment of adhesive obstruction of the small intestine, based on the principles of non-surgical treatment in a certain category of patients, the use of surgical interventions strictly according to indications, especially in patients who need to perform repeated operations, were highlighted. Among them, special attention is paid to the features of open and minimally invasive surgical interventions. It is emphasized that at present, minimally invasive surgical interventions perform the main tasks of surgical treatment for adhesive ileus of the small intestine and significantly reduce surgical trauma in comparison with "open" methods of treatment, but these interventions have not widespread in the world yet.

 

https://doi.org/10.35339/ic.8.4.238-246
PDF

References

ten Broek RP, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J, … van Goor H. (2013). Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ,347,f5588. DOI: 10.1136/bmj.f5588

Loftus T, Moore F, VanZant E, Bala T, Brakenridge S, Croft C, … Jordan J. A protocol for the management of adhesive small bowel obstruction. (2015). J Trauma Acute Care Surg,78,13–19, discussion 19-21. DOI: 10.1097/TA.0000000000000491.

von Dembowski T. (1889). Über die Ursachen der peritonealen Adhäsionen nach chirurgischen Eingriffen mit Rücksicht auf die Frage des Ileus nach Laparotomien. Langenbecks Arch Chir,37,745.

Millet I, Ruyer A, Alili C, Curros Doyon F, Molinari N, Pages E, … Taourel P. (2014). Adhesive small-bowel obstruction: value of CT in identifying findings associated with the effectiveness of nonsurgical treatment. Radiology,273,425–432. DOI: 10.1148/radiol.14132872.

Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D … Crowe AM. (2001). Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum,44,822–829, discussion 829-830. DOI: 10.1007/BF02234701.

Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, … Crowe AM. (1999). Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet,353,1476–1480. DOI: 10.1016/S0140-6736(98)09337-4

Scott FI, Osterman MT, Mahmoud NN, Lewis JD. (2012). Secular trends in small-bowel obstruction and adhesiolysis in the United States: 1988-2007. Am J Surg, 204,315–320. DOI: 10.1016/j.amjsurg.2011.10.023.

Okabayashi K, Ashrafian H, Zacharakis E, Hasegawa H, Kitagawa Y, Athanasiou T, Darzi A. (2014). Affiliations Expand Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity. Surg. Today, 44, 405–420. DOI: 10.1007/s00595-013-0591-8

Taylor GW, Jayne DG, Brown SR, Thorpe H, Brown JM, Dewberry SC, … Guillou PJ. (2010). Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial. Br J Surg, 97,70–78. DOI: 10.1002/bjs.6742

Isaksson K, Montgomery A, Moberg AC, Andersson R, Tingstedt B. (2014). Long-term follow-up for adhesive small bowel obstruction after open versus laparoscopic surgery for suspected appendicitis. Ann Surg,259,1173–1177. DOI: 10.1097/SLA.0000000000000322.

Arung W, Meurisse M, Detry O. (2011). Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol,17,4545–4553. DOI: 10.3748/wjg.v17.i41.4545.

Fevang BT, Fevang JM, Søreide O, Svanes K, Viste A. (2003). Delay in operative treatment among patients with small bowel obstruction. Scand J Surg,92,131–137. DOI: 10.1177/145749690309200204.

Burge J, Abbas SM, Roadley G, Donald J, Connolly A, Bissett IP, Hill AG. (2005). Randomized controlled trial of Gastrografin in adhesive small bowel obstruction. ANZ J Surg,75,672–674. DOI: 10.1111/j.1445-2197.2005.03491.x

Kendrick ML. (2009). Partial small bowel obstruction: clinical issues and recent technical advances. Abdom Imaging,34,329–334. DOI: 10.1007/s00261-008-9436-0.

Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, … Jeekel J. (2011). Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery. World J Emerg Surg,6,5. DOI: 10.1186/1749-7922-6-5.

Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, … Catena F. (2013). Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J of Emerg Surg,8, 42. http://www.wjes.org/content/8/1/42

Laméris W, van Randen A, van Es HW, van Heesewijk JP, van Ramshorst B, Bouma WH, … Stoker J. (2009). Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ,338,b2431. doi: 10.1136/bmj.b2431.

Grassi R, Romano S, D’Amario F, Giorgio Rossi A, Romano L, Pinto F, Di Mizio R. (2004). The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults. Eur J Radiol, 50,5–14. DOI: 10.1016/j.ejrad.2003.11.009.

Di Mizio R, Grassi R, Marchese E, Basti M, Di Campli G, Catalano O, … Fanucci A. (1995). “Uncompensated” small bowel obstruction in adults. Ultrasonographic findings of free fluid between loops and its prognostic value. Radiol Med,89,787–791. PMID: 7644729

Trésallet C, Lebreton N, Royer B, Leyre P, Godiris-Petit G, Menegaux F. (2009). Improving the management of acute adhesive small bowel obstruction with CT-scan and water-soluble contrast medium: a prospective study. Dis Colon Rectum,52,1869–1876. doi: 10.1007/DCR.0b013e3181b35c06.

Zielinski MD, Eiken PW, Bannon MP, Heller SF, Lohse CM, Huebner M, Sarr MG. (2010). Small bowel obstruction-who needs an operation? A multivariate prediction model. World J Surg,34,910–919. DOI: 10.1007/s00268-010-0479-3.

Maglinte DD, Reyes BL, Harmon BH, Kelvin FM, Turner WW, Hage JE, … Gage SN. (1996). Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction. AJR Am J Roentgenol,167,1451–1455. DOI: 10.2214/ajr.167.6.8956576.

Wadani HA, Al Awad NI, Hassan KA, Zakaria HM, Alaqeel FO. (2011). Role of water soluble contrast agents in assigning patients to a non-operative course in adhesive small bowel obstruction. Oman Med J,26,454–456. DOI: 10.5001/omj.2011.116

Fidler J. (2007). MR imaging of the small bowel. Radiol Clin North Am,45,317–331. DOI: 10.1016/j.rcl.2007.03.012.

Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D. (2010). Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg,97,470–478.

Di Saverio S, Catena F, Ansaloni L, Gavioli M, Valentino M, Pinna AD. (2008). Water-soluble contrast medium (gastrografin) value in adhesive small intestine obstruction (ASIO): a prospective, randomized, controlled, clinical trial. World J Surg,32,2293–2304. DOI: 10.1007/s00268-008-9694-6.

Abbas SM, Bissett IP, Parry BR. (2007). Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction. Br J Surg,94,404–411. DOI: 10.1002/bjs.5775

Derikx JP, Luyer MD, Heineman E, Buurman WA. (2010). Non-invasive markers of gut wall integrity in health and disease. World J Gastroenterol,16,5272–5279. DOI: 10.3748/wjg.v16.i42.5272

Block T, Nilsson TK, Björck M, Acosta S. (2008). Diagnostic accuracy of plasma biomarkers for intestinal ischaemia. Scand J Clin Lab Invest,68,242–248. DOI: 10.1080/00365510701646264.

Delaney CP, O’Neill S, Manning F, Fitzpatrick JM, Gorey TF. (1999). Plasma concentrations of glutathione S-transferase isoenzyme are raised in patients with intestinal ischaemia. Br J Surg,86,1349–1353. DOI: 10.1046/j.1365-2168.1999.01245.x

Lieberman JM, Sacchettini J, Marks C, Marks WH. (1997). Human intestinal fatty acid binding protein: report of an assay with studies in normal volunteers and intestinal ischemia. Surgery,121,335–342. DOI: 10.1016/s0039-6060(97)90363-9.

Kanda T, Fujii H, Tani T, Murakami H, Suda T, Sakai Y, … Hatakeyama K. (1996). Intestinal fatty acid-binding protein is a useful diagnostic marker for mesenteric infarction in humans. Gastroenterology,110,339–343. DOI: 10.1053/gast.1996.v110.pm8566578.]

Kanda T, Tsukahara A, Ueki K, Sakai Y, Tani T, Nishimura A, … Hatakeyama K. (2011). Diagnosis of ischemic small bowel disease by measurement of serum intestinal fatty acid-binding protein in patients with acute abdomen: a multicenter, observer-blinded validation study. J Gastroenterol,46,492–500. DOI: 10.1007/s00535-011-0373-2. Epub 2011 Feb 5.

Thuijls G, Derikx JP, de Haan JJ, Grootjans J, de Bruïne A, Masclee AA, … Buurman WA. (2010). Urine-based detection of intestinal tight junction loss. J Clin Gastroenterol,44,e14–e19. DOI: 10.1097/MCG.0b013e31819f5652.

van Noord D, Mensink PB, de Knegt RJ, Ouwendijk M, Francke J, van Vuuren AJ, … Kuipers EJ. (2011). Serum markers and intestinal mucosal injury in chronic gastrointestinal ischemia. Dig Dis Sci,56,506–512. DOI: 10.1007/s10620-010-1303-5

Di Saverio S, Catena F, Kelly MD, Tugnoli G, Ansaloni L. (2012). Severe adhesive small bowel obstruction. Front Med,6,436–439. DOI: 10.1007/s11684-012-0221-7

Jancelewicz T, Vu LT, Shawo AE, Yeh B, Gasper WJ, Harris HW. (2009). Predicting strangulated small bowel obstruction: an old problem revisited. J Gastrointest Surg,13,93–99. DOI: 10.1007/s11605-008-0610-z.

Evennett NJ, Petrov MS, Mittal A, Windsor JA. (2009). Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia. World J Surg,33,1374–1383. DOI: 10.1007/s00268-009-0074-7.

Jakob SM, Merasto-Minkkinen M, Tenhunen JJ, Heino A, Alhava E, Takala J. (2000). Prevention of systemic hyperlactatemia during splanchnic ischemia. Shock,14,123–127. DOI: 10.1097/00024382-200014020-00008

Shi H, Wu B, Wan J, Liu W, Su B. (2015). The role of serum intestinal fatty acid binding protein levels and D-lactate levels in the diagnosis of acute intestinal ischemia. Clin Res Hepatol Gastroenterol,2015,39:373–378. DOI: 10.1016/j.clinre.2014.12.005.

Cartwright SL, Knudson MP. (2015). Diagnostic imaging of acute abdominal pain in adults. Am Fam Physician,91,452–459. PMID: 25884745

Farid M, Fikry A, El Nakeeb A, Fouda E, Elmetwally T, Yousef M, Omar W. (2010). Clinical impacts of oral gastrografin follow-through in adhesive small bowel obstruction (SBO) J Surg Res,162,170–176. DOI: 10.1016/j.jss.2009.03.092

Leung AM, Vu H. (2012). Factors predicting need for and delay in surgery in small bowel obstruction. Am Surg,78:403–407. PMID: 22472395

Schraufnagel D, Rajaee S, Millham FH. (2013). How many sunsets? Timing of surgery in adhesive small bowel obstruction: a study of the Nationwide Inpatient Sample. J Trauma Acute Care Surg,74,181–187, discussion 187-189. DOI: 10.1097/TA.0b013e31827891a1.

Diaz JJ, Bokhari F, Mowery NT, Acosta JA, Block EF, Bromberg WJ, … Jerome R. (2008). Guidelines for management of small bowel obstruction. J Trauma,64,1651–1664. DOI: 10.1097/TA.0b013e31816f709e

Guo SB, Duan ZJ. (2012). Decompression of the small bowel by endoscopic long-tube placement. World J Gastroenterol,18,1822–1826. DOI: 10.3748/wjg.v18.i15.1822

Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M. (1994). Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial. Surgery,115,433–437. PMID: 8165534

Abbas S, Bissett IP, Parry BR. (2007). Oral water soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database Syst Rev,3,CD004651. DOI: 10.1002/14651858.CD004651.pub3.

Chen SC, Yen ZS, Lee CC, Liu YP, Chen WJ, Lai HS, … Chen WJ. (2005). Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial. CMAJ,173,1165–1169. DOI: 10.1503/cmaj.1041315

Fukami Y, Kurumiya Y, Mizuno K, Sekoguchi E, Kobayashi S. (2014). Clinical effect of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction. Br J Surg,101,433–437. DOI: 10.1002/bjs.9389

Duron JJ, Silva NJ, du Montcel ST, Berger A, Muscari F, Hennet H, … Hay JM. (2006). Adhesive postoperative small bowel obstruction: incidence and risk factors of recurrence after surgical treatment: a multicenter prospective study. Ann Surg,244,750–757 DOI: 10.1097/01.sla.0000225097.60142.68.

Szeliga J, Jackowski M. (2017). Laparoscopy in small bowel obstruction – current status – review. Videosurgery Miniinv,12(4),455–460 DOI: https://doi.org/10.5114/wiitm.2017.72330

Sallinen V, Wikström H, Victorzon M, Salminen P, Koivukangas V, Haukijärvi E, … Mentula P. (2014). Laparoscopic versus open adhesiolysis for small bowel obstruction - a multicenter, prospective, randomized, controlled trial. BMC Surg,14,77. DOI: 10.1186/1471-2482-14-77.

Lombardo S, Baum K, Filho JD, Nirula R. (2014). Should adhesive small bowel obstruction be managed laparoscopically? A National Surgical Quality Improvement Program propensity score analysis. J Trauma Acute Care Surg,76,696–703. DOI: 10.1097/TA.0000000000000156.

Byrne J, Saleh F, Ambrosini L, Quereshy F, Jackson TD, Okrainec A. (2015). Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes. Surg Endosc,29,2525–2532. DOI: 10.1007/s00464-014-4015-7.

Kelly KN, Iannuzzi JC, Rickles AS, Garimella V, Monson JR, Fleming FJ. (2014). Laparotomy for small-bowel obstruction: first choice or last resort for adhesiolysis? A laparoscopic approach for small-bowel obstruction reduces 30-day complications. Surg Endosc,28,65–73. DOI: 10.1007/s00464-013-3162-6

Vettoretto N, Carrara A, Corradi A, De Vivo G, Lazzaro L, Ricciardelli L, … Zago M. (2012). Laparoscopic adhesiolysis: consensus conference guidelines. Colorectal Dis,14,e208–e215. DOI: 10.1111/j.1463-1318.2012.02968.x.

Di Saverio S. (2014). Emergency laparoscopy: a new emerging discipline for treating abdominal emergencies attempting to minimize costs and invasiveness and maximize outcomes and patients’ comfort. J Trauma Acute Care Surg,77,338–350. DOI: 10.1097/TA.0000000000000288.

Copyright for articles published in the journal is regulated by the License Agreement for the use of a scientific article in the journal, which is concluded between the author of the article (Licensor) and Kharkov National Medical University (Licensee, publisher of the journal "Inter Collegas"). The licensor grants to the Licensee a non-exclusive non-exclusive license for the use of the article (a license that does not exclude the use of the article by the Licensor and the issuance of licenses to others for use of this article) on the terms and for the period specified in the contract. The licensor (the author of the article) grants the Licensee the right to reproduce the article (publication in the journal "Inter Collegas", publication, duplication, duplication or other reproduction of the article without limiting the circulation of copies, each copy of the article must contain the name of the Licensor; Of general information, including the publication of the article in full or in part on the Internet on the journal page, the right to use the metadata of the article (titles, full names of authors, annotations, bibliography eskih materials) through the dissemination and communication to the public, processing and systematization, as well as inclusion in various databases and in-formational system).

The licensor grants the licensee the right to transfer, store and process his personal data (full name, scientific degree, academic title, place of work and position, contact information of the authors) with the purpose of including them in the database in accordance with the Law of Ukraine No. 2297 - VI "on protection of personal data" from 01.06.2010.

Personal data and metadata of the article are provided for their storage and processing in various databases and information systems, including them in analytical and statistical reporting, creating sound relationships between the objects of works of science, literature and art with personal data, etc. on unlimited territory. The licensee has the right to transfer the specified data for processing and storage to third parties provided that such a fact is notified with the provision of information about the third party (name and address) to the Licensor.