Effect of Violations Regional Hemodynamics and Microcirculation of the Intestinal Wall on the Occurrence of Acute Perforation of the Small Intestine

Abstract


Relevance One of the main causes of postoperative diffuse peritonitis (PDP) are acute perforation of the various divisions of the small intestine and failure interintestinal enteroenteroanastomosis. The occurrence of these complications significantly reduces the severity of the patients and contributes to mortality up to 60 – 90%. The purpose of the study To study the influence of hemodynamic mesenteric circulation and microcirculation of the intestinal wall on the occurrence of acute perforation of the small intestine. Materials and methods For registration of normal blood flow values 16 volunteers routinely performed transabdominal ultrasound duplex scanning of the celiac trunk (TC), the superior mesenteric artery (AMS) and its branches (ram). In comparison, 20 patients with PDP duplex scanning of the same pools performed intraoperatively during the first sanation relaparotomy, including 6 before and after intestinal intubation. Subsequently, the dynamics of changes of blood flow in the specified pools in all patients with PDP was carried out with repeated intraoperative ultrasound duplex scanning (IUDS) during 2 or 3 programmed rehabilitation abdomen. The second stage using laser doppler flowmetry intraoperative (ILDF) were determined normal microcirculation wall of the small intestine. For this were examined in 10 patients operated on in a planned way and no signs of peritonitis. In comparison, the same investigation was carried out with 10 patients during the first PDP relaparotomy (including 6 before and after intestinal intubation), and the dynamics during programmed sanations abdomen. Results and their discussion Transabdominal and intraoperative ultrasound duplex scanning visceral abdominal vessels of volunteers and patients with PDP showed that the maximum values of blood flow velocity (Vmax, Vd, TAMAX) in both groups recorded at TC and AMS with a significant reduction of the periphery against the background of increasing peripheral resistance index (RI). When comparing the same levels of blood flow in volunteers and patients with PDP at AMS and ram it was noted a significant decrease significantly peak systolic (Vmax), increase in end-diastolic (Vd) blood flow velocity, TAMAX, as well as reduced RI in patients with PDP. However, the IUDS level branches AMS performed after intestinal intubation in patients with PDP, revealed a significant increase in RI and reduced TAMAX. These changes are interpreted as microcirculation disturbances manifested visual appearance petechial hemorrhages in the intestinal wall overstretched, with a reduction in central hemodynamics during this period due to reperfusion syndrome. In assessing ILDF wall of the small intestine in patients with PDP compared with the volunteers had significant microcirculatory disorders, manifested by reduced microcirculation, standard deviation, performance index microcirculation bypass indicator. In evaluating these parameters in patients with PDP 36 hours during programmed relaparotomy had significantly their growth. At the same time, the analysis of the amplitude - frequency spectrum ILDF performed after intestinal intubation in patients with first relaparotomy in patients with PDP index was decreased with increasing the efficiency of microcirculation index bypass due to an increase of neurogenic and myogenic tone of blood vessels, which indicates a lean microvasculature and worsening of metabolic disorders in the intestinal wall. Conclusion Using IUDS ILDF and visceral arteries in patients with PDP reveals significant violations mesenteric circulation and microcirculation, more pronounced at the level of branches of the AMS. Registration of changes in mesenteric blood flow in patients with PDP after intestinal intubation allows to fix the further deterioration of microcirculatory pool associated with the occurrence of reperfusion syndrome. On the background of the planned sanations abdomen in patients with PDP, along with relief of the inflammatory process, there is significant improvement in the mesenteric circulation and microcirculation. Key words Acute bowel perforation, postoperative peritonitis, microcirculation, intraoperative duplex scanning, intraoperative laser doppler flowmetry

Altai State Medical University, 40 Lenina Ave., Barnaul, 656038, Russian Federation

Author for correspondence.
Email: zhar67@mail.ru
Ph.D., assistant prof. of department of hospital surgery, Altai State Medical University, Barnaul

Altai State Medical University, 40 Lenina Ave., Barnaul, 656038, Russian Federation

Email: lvg51@mail.ru

MD, Prof., head of department of
hospital surgery, Altai State Medical University,
Barnaul

Regional Clinical Hospital, 1 Liapidevskogo Str., Barnaul, 656024, Russian Federation

Email: hospital@hospital.e4u.ru
doctor of functional diagnostics Regional Clinical Hospital, Barnaul;

Regional Clinical Hospital, 1 Liapidevskogo Str., Barnaul, 656024, Russian Federation

Email: hospital@hospital.e4u.ru
doctor of functional diagnostics Regional Clinical Hospital, Barnaul;

  1. Barkhatov I.V. Otsenka sistemy mikrotsirkulyatsii krovi metodom lazernoy dopplerovskoy flouometrii. [Evaluation of blood microcirculation by laser Doppler flowmetry]. Klinicheskaya meditsina, 2013; 11: 21-27.
  2. Gel'fand B.R., Gur'yanov V.A., Mamontova O.A. Profilaktika stress - povrezhdeniy zheludochno - kishechnogo trakta u bol'nykh v kriticheskikh sostoyaniyakh. [Prevention of stress - damage to the gastro - intestinal tract in patients in critical sostoyaniyakh]. Infektsii v khirurgii, 2007; 5 (2): 14-20.
  3. Gol'braykh V.A., Maskin S.S., Bobyrin A.V. Ostryye perforativnyye yazvy tonkoy kishki u bol'nykh s rasprostranonnym gnoynym peritonitom. [Acute perforated ulcer of the small intestine in patients with generalized purulent peritonitis]. Byulleten' eksperimental'noy i klinicheskoy khirurgii, 2012; 5 (1): 51-53.
  4. Dzhadzhiyev A.B. Sostoyaniye mikrotsirkulyatsii v stenke kishki pri obturatsionnoy kishechnoy neprokhodimosti i yeye vliyaniye na vybor ob"yema i kharaktera operatsii. [Condition of microcirculation in the intestinal wall with obstructive ileus and other influence on the choice of volume and character of an operation]. Diss ... kand. med. nauk. 2009; 120.
  5. Dubova Ye.A., Shchegolev A.I. Angiodisplaziya tonkoy kishki. [Angiodysplasia of small intestine.]. Rossiyskiy zhurnal gastroenterologii, gepatologii i koloproktologii, 2007; 2: 84-88.
  6. Ignashov A.M., Den Bo, Perley V.Ye. Sravnitel'naya kharakteristika transabdominal'nogo i intraoperatsionnogo dupleksnogo skanirovaniya v otsenke rezul'tatov dekompressii chrevnogo stvola. [Comparative characteristics of transabdominal and intraoperative duplex scanning in the evaluation of the celiac trunk decompression results]. Meditsinskiy akademicheskiy zhurnal, 2012; 12: 15-21.
  7. Kanshin N.N. Nesformirovannyye kishechnyye svishchi i gnoynyy peritonit (khirurgicheskoye lecheniye). [Unformed intestinal fistulas and purulent peritonitis (surgical treatment)] M .: PROFIL'. 2007; 160.
  8. Kubyshkin V.A., Shishin K.V. Erozivno-yazvennoye porazheniye verkhnikh otdelov zheludochno-kishechnogo trakta v rannem posleoperatsionnom periode. [Erosive and ulcerative lesions of the upper gastrointestinal tract in early postoperative period]. Khirurgiya. Konsilium Medicum, 2004; 1: 17-20.
  9. Petrishchev N.N. Disfunktsiya endoteliya. Prichiny, mekhanizmy, farmakologicheskaya korrektsiya. [Endothelial dysfunction. Causes, mechanisms and pharmacological correction]. Pod red. N.N. Petrishcheva. SPb .: SPbGMU, 2003; 148.
  10. Popova T.S., Tamazashvili T.SH., Shestopalov A.Ye. Sindrom kishechnoy nedostatochnosti v khirurgii. [Syndrome of intestinal failure in surgery]. M., 1991; 240.
  11. Savel'yev V.S. Filimonov M.I., Gel'fand B.R. Programmirovannyye relaparotomii v lechenii rasprostranennogo peritonita, varianty takticheskikh resheniy. [Programmable relaparotomy in the treatment of diffuse peritonitis, variants of tactical decisions]. Infektsii v khirurgii, 2009; 7 (4): 26-31.
  12. Timerbulatov SH.V., Sagitov R.B., Sultanbayev A.U. Diagnostika ishemicheskikh povrezhdeniy kishechnika pri ostrykh khirurgicheskikh zabolevaniyakh organov bryushnoy polosti. [Diagnosis of ischemic bowel injury in acute surgical diseases of the abdominal cavity].Klinicheskaya i eksperimental'naya khirurgiya, 2012; 3: 40-52.
  13. Khokholya V.P. Ostryye erozii i yazvy organov pishchevareniya u khirurgicheskikh bol'nykh. [The sharp erosion and ulcers of the digestive organs in surgical patients]. Khirurgiya, 1988; 3: 44-50.
  14. Khripun A.I., Shurygin S.N., Mironkov A.B. Programmirovannyye relaparotomii v lechenii ostroy okklyuzii verkhney bryzheyechnoy arterii. [Programmable relaparotomy in the treatment of acute occlusion of the superior mesenteric artery]. Khirurgiya, 2009; 12: 34-37.
  15. Shapovalov K.G., Sizonenko V.A., Burdinskiy Ye.N. Izmeneniya komponentov sosudistogo tonusa i pokazateley mikrotsirkulyatsii pri otmorozheniyakh nizhnikh konechnostey. [Changes in the components of vascular tone and microcirculation indices in frostbite of lower limb]. Vestnik khirurgii im. I.I. Grekova, 2008; 3: 67-68.
  16. Afridi S.P., Malik F., Ur-Rahman S.Spektr-perforatsiya peritonita v Pakistane: 300 sluchayev zapadnogo opyta [Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience]. World J. Emerg. Surg., 2008; 8; 3: 31.
  17. Alhazzani W., Alshahrani M., Moayyedi P.Profilaktika yazyv iz-za stressa u bol'nykh v kriticheskom sostoyanii: Obzor dokazatel'stv. [Stress ulcer prophylaxis in critically ill patients: Review of the evidence]. Pol. Arch. Med. Wewn., 2012; 122: 107–114.
  18. Cheatham M.L.Abdominal'nyy sindrom otsekov: patofiziologiya i opredeleniya. [Abdominal Compartment Syndrome: pathophysiology and definitions]. Scand. J. Trauma Resusc. Emerg. Med., 2009; 17(1): 109.
  19. Nikolskij V.I., Sergackij K.I.Etiologiya i patogenez ostrykh gastroduodenal'nykh yazv oslozhnonnykh krovotecheniyem. [Etiology and pathogenesis of acute gastroduodenal ulcerations complicated by bleeding]. (review of literature). 2009; 4: 53–64.

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