Modern approaches to diagnosis and surgical treatment of patients with acute obstructive intestinal obstruction

The OBJECTIVE of the study was to improve the results of surgical treatment of patients with acute obturation intestinal obstruction of tumor and non-tumor origin by improving the algorithm for perioperative diagnosis and treatment of complications.

METHODS AND MATERIALS. A single-center retrospective-prospective study of the results of treatment of patients with acute obturation intestinal obstruction (n=249) was conducted. The comparison group (n=125) was represented by a retrospective sample of patients whose examination and surgical treatment were carried out in accordance with the established procedure for providing medical care. Observation group (n=124): patients whose examination and surgical treatment were supplemented by assessment of the degree of compensation for acute obturation intestinal obstruction, the use of specialized scales, computer monitoring of intra-abdominal pressure and intraoperative assessment of microcirculation in the wall of the colon in patients with acute obturation intestinal obstruction (AOIO) using original methods.

RESULTS. In the observation group, the time from admission to the hospital to surgical treatment was less than in the comparison group and amounted to 6.00 (Q1–Q3: 4.00–8.00) hours and 10.00 (Q1– Q3: 6.00–12.00) hours, respectively, (p <0.0001), mainly due to patients with a subcompensated form. Mortality in patients with acute obturation intestinal obstruction of tumor origin in the observation group was 11 (12.94 %) patients, in the comparison group – 16 (18.18 %) patients; non-tumor origin in the observation group – 8 (20.51 %), comparison – 10 (27.03 %) patients. Based on the conducted studies, an algorithm for perioperative diagnosis and treatment of complications was proposed.

CONCLUSION. The differentiated choice of surgical tactics for acute obturation intestinal obstruction makes it possible to optimize the timing of surgical intervention, reduce the number of postoperative complications, as well as mortality in patients with acute obturation intestinal obstruction of tumor and non-tumor origin.

1. Bagdasarov V. V., Bagdasarova E. A., Eleev A. A. The effect of transtumoral decompression on central hemodynamics and intra-abdominal pressure in patients with acute obstructive colonic obstruction. Sovremennaja nauka: aktual’nye problemy teorii i praktiki. Serija: Estestvennye i tehnicheskie nauki. 2021;3:249-255. (In Russ.). https://doi.org/10.37882/2223–2966.2021.03.03.

2. Volkov D. V., Tarasenko V. S., Malickaja E. V., Minenko K. S. The influence of nasointestinal intubation in patients with intestinal obstruction on the activity of free radical processes. Orenburgskij medicinskij vestnik. 2022;10(1(37)):28–31. (In Russ.).

3. Achkasov S. I., Bagatelija Z. A., Bagnenko S. F. et al. Acute colonic obstruction of tumor etiology (K56.6; C18, C19, C20), adults. Koloproktologija. 2023;22(2):10–31. (In Russ). https://doi.org/10.33878/2073-7556-2023-22-2-10-31.

4. Totikov Z. V., Totikov V. Z., Remizov O. V. et al. Optimization of the diagnostic algorithm for acute obstructive colonic obstruction of tumor origin. Koloproktologija. 2020;19(3(73)):72–79. (In Russ.). https://doi.org/10.33878/2073-7556-2020-19-3-72-79.

5. Aliev F. Sh., Aliev V. F. Organ dysfunction as a risk factor for postoperative complications of surgical treatment of tumor colonic obstruction. Voprosy onkologii. 2022;68(6):775–779. (In Russ.). https://doi.org/10.37469/0507-3758-2022-68-6-775-779.

6. Tjagunov A. E., Fedorov A. V., Nechaj T. V. et al. Surgical practice for small intestinal obstruction in the Russian Federation. Results of a national survey of surgeons. Hirurgia. Zhurnal im. N. I. Pirogova. 2022; 5:5–17. (In Russ.). https://doi.org/10.17116/hirurgia20220515.

7. Catena F., De Simone B., Coccolini F., Di Saverio S., Sartelli M., Ansaloni L. Bowel obstruction: a narrative review for all physicians. World Journal of Emergency Surgery. 2019;14(1):1–8. https://doi.org/10.1186/s13017-019-0240-7.

8. Charyshkin A. L., Keshjan Je. A. Results of treatment of patients with acute obstructive intestinal obstruction. Kreativnaja hirurgija i onkologija. 2021;1:15–19. (In Russ.). https://doi.org/10.24060/2076-3093-2021-11-1-15-19.

9. Xi Y., Xu P. Global colorectal cancer burden in 2020 and projections to 2040. Translational oncology. 2021;14(10):101174. https://doi.org/10.1016/j.tranon.2021.101174.

10. Kamalova S., Abdiev O., Hanov S. Acute adhesive intestinal obstruction. Eurasian Journal of Medical and Natural Sciences. 2022;2(11):144–147. (In Russ.). https://doi.org/10.5281/zenodo.7180482.

11. Clinical guidelines «Acute non-tumor intestinal obstruction». Obshherossijskaja obshhestvennaja organizacija «Rossijskoe obshhestvo hirurgov». Moscow, 2021. 52 p. (In Russ.).

12. Kolgaeva M. M., Daudova A. A. Acute adhesive obstructive small intestinal obstruction. Modern treatment and diagnostic tactics. Aktual’nye voprosy sovremennoj nauki. 2021:119–123. (In Russ.).

13. Sigua B. V., Kotkov P. A., Kalandarova D. H., Zemljanoj V. P. Systematic review of the clinical effectiveness of different periods of non-operative treatment in patients with acute adhesive intestinal obstruction. Zhurnal im. N. V. Sklifosovskogo «Neotlozhnaja medicinskaja pomoshh’». 2023; 12(1):99–109. (In Russ.). https://doi.org/10.23934/2223-9022-2023-12-1-99-109.

14. Stjazhkina S. N., Galimova H. I., Minahmetova R. S. Ahkjamova Ch. R. Adhesive intestinal obstruction. Modern Science. 2020;3–2:101–105. (In Russ.).

15. Schlick C. J. R., Liu J. Y., Yang A. D. et al. Pre-operative, Intra-operative and Postoperative factors associated with post-discharge venous thromboembolism following colorectal cancer resection. Journal of Gastrointestinal Surgery. 2020;24(1):144–154. https://doi.org/10.1007/s11605-019-04354-2.

16. Zakaev K. Ju., Zurnadzh’janc V. A., Kchibekov Je. A. et al. Analysis of morbidity and mortality in patients with acute colonic obstruction of tumor origin (based on clinical materials). Astrahanskij medicinskij zhurnal. 2022;17(2):44–53. (In Russ.). https://doi.org/10.48612/agmu/2022.17.2.44.53.

17. Vojtushko A. S., Vojnjush A. V. Intra-abdominal hypertension syndrome: concept and first clinical observation. Sbornik materialov konferencii studentov i molodyh uchenyh, posvjashhennyj 80-letiju so dnja rozhdenija professora Boltrukevicha Stanislava Ivanovicha. 2020:112–113. (In Russ.).

18. Glushkov N. I., Zemljanoj V. P., Sigua B. V. et al. The role of intraabdominal hypertension and regional hemodynamics in the diagnosis and treatment of acute intestinal obstruction. Sovremennye problemy nauki i obrazovanija. 2019;1:41. (In Russ.).

19. Kalicova M. V., Totikov V. Z., Totikov Z. V., Medoev V. V. Algorithm for diagnosis and treatment of acute adhesive intestinal obstruction. Vestnik Dagestanskoj gosudarstvennoj medicinskoj akademii. 2019;S2:118–119. (In Russ.).

20. Nikiforov S. A., Nurullina A. R., Popova N. M., Ivanova G. S. Characteristics of multiple organ failure syndrome in patients with cancer pathology. Modern Science. 2020;11–3:287–291. (In Russ.).

21. Chyngysheva Zh. A., Nijazov B. S., Naziraliev R. T. et al. Modern view on the diagnosis and treatment of acute intestinal obstruction in gerontological patients (literature review). Bjulleten’ nauki i praktiki. 2022;8(7):261–292. (In Russ.). https://doi.org/10.33619/2414-2948/80/24.

22. Sajdaliev D. M., Hasanov N. Sh. Improving the outcome of surgical treatment of patients with acute intestinal obstruction in conditions of peritonitis. Endless Light in Science. 2022;2019:161. (In Russ.).

23. Karachun A. M., Panajotti L. L., Petrov A. S. Selection of the optimal volume of lymph node dissection in the surgical treatment of colon cancer: clinical trial protocol. Tazovaja hirurgija i onkologija. 2017;2:11–19. (In Russ.). https://doi.org/10.17650/2220-3478-2017-7-2-11-19.

24. Samarcev V. A., Gavrilov V. A., Shakirov M. R. et al. Patent № 2021611514. «IAPPEE» Intraabdominal pressure program of expert examination. (In Russ.).

25. Samarcev V. A., Gavrilov V. A., Shakirov M. R. et al. Patent № RU 2791696 C1. Sposob monitoringa vnutribrjushnogo davlenija. (In Russ.).

26. Samarcev V. A., Gavrilov V. A., Parshakov A. A. et al. Patent № RU 2814562 C1. Sposob intraoperacionnoj diagnostiki narushenija mikrocirkuljacii obodochnoj kishki pri zlokachestvennyh novoobrazovanijah. (In Russ.).