Journal of Experimental and Clinical SurgeryJournal of Experimental and Clinical SurgeryВестник экспериментальной и клинической хирургии2070-478X2409-143XVoronezh State Medical University named after N.N. Burdenko11210.18499/2070-478X-2013-6-1-90-99Original articlesОригинальные статьиUnknownAcute Adrenal Insufficiency in the Acute Intestinal ObstructionОстрая надпочечниковая недостаточность при острой тонкокишечной непроходимостиСапинМ.Р.

MD, professor, RaMS, head Department of human anatomy of the First Moscow State Medical university named after Sechenov

д.м.н., проф., академик РАМН, зав. кафедрой анатомии человека Первого Московского государственного медицинского университета имени и.М.Сеченова

author@vestnik-surgery.comМилюковВ.Е.

MD, professor of the department of human anatomy of the Medical Faculty of the First Moscow State Medical university named after i.M. Sechenov, professor of the department of Military Surgery of the State Extension Course institute for the Medical practitioners of the Ministry of Defence of the Russian Federation

д.м.н., проф., кафедра анатомии человека лечебного факультета Первого Московского государственного медицинского университета имени и.М.Сеченова, проф. кафедры военно-полевой хирургии института усовершенствования врачей Министерства обороны Российской Федерации

Milyucov@mail.ruДолговЕ.Н.

Chief of the FSi 1586 MCh of the Ministry of Defence

начальник 1586 ВКг Министерства обороны Российской Федерации

author@vestnik-surgery.comБогдановА.В.

Chief of the Receiving and Sorting office of the Military unit, lieutenant-Colonel

начальник приемно-сортировочного отделения в/ч 23220, подполковник м/с

alexvbogdan73@mail.ruМуршудоваХ.М.

Clinical Resident of the First Moscow State Medical university named after i.M. Sechenov

аспирантка кафедры анатомии человека лечебного факультета Первого Московского государственного медицинского университета имени и.М.Сеченова

hot_az_heart@mail.ruНгуенK.K.

postgraduate Student of the department of human anatomy of the Medical Faculty of the First Moscow State Medical university named after i.M. Sechenov

аспирант кафедры анатомии человека лечебного факультета

cuongthao2002@yahoo.comПолунинС.В.

348 head of surgical department of the military hospital of the Ministry of Defense of the Russian Federation in the Republic of Tajikistan, Dushanbe

начальник хирургического отделения 348 военного госпиталя Министерства обороны Российской Федерации в Республике Таджикистан, г. Душанбе

author@vestnik-surgery.comI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationПервый Московский государственный медицинский университет им. И.М.Сеченова, Москва, Российская ФедерацияI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationГосударственный институт усовершенствования врачей Министерства обороны Российской Федерации, Москва, Российская ФедерацияState Medical Institute for the Ministry of Defence of the Russian Federation, Moscow, Russian FederationПервый Московский государственный медицинский университет им. и.М.Сеченова, Москва, Российская ФедерацияState Medical Institute for the Ministry of Defence of the Russian Federation, Moscow, Russian FederationГосударственный институт усовершенствования врачей Министерства обороны Российской Федерации, Москва, Российская Федерация240320136190992704201627042016Copyright ©; 2013, ., ., ., ., ., ., .Copyright ©; 2013, Сапин М., Милюков В., Долгов Е., Богданов А., Муршудова Х., Нгуен K., Полунин С.2013., ., ., ., ., ., .Сапин М., Милюков В., Долгов Е., Богданов А., Муршудова Х., Нгуен K., Полунин С.http://creativecommons.org/licenses/by-nc-nd/4.0https://vestnik-surgery.com/journal/article/view/112

Acute small bowel obstruction (SBO), remains one of the difficult and unresolved problems in the emergency room. It is actually a collection of different pathological aggregate united by a common feature - impaired patency of the intestinal tube. At all stages of small bowel obstruction, along with the progression of symptoms caused by impaired barrier function of the intestinal wall, are inherent clinical symptoms involved in this common suffering organs and systems. A number of clinical manifestations of small bowel obstruction has similar symptoms to one of the most serious, life-threatening complications in their patient's endocrine disorders - acute adrenal insufficiency (AAI). In search of the causes of deviations performance of vital organs and systems in the small bowel obstruction, will not receive a full, without study of morphological and functional changes involved in the process of organs and systems, including the adrenal glands. Opportunity to examine these issues can only provide an experimental study of morphological and functional adrenal gland in the dynamics of small bowel obstruction.

Острая тонкокишечная непроходимость (ОТКН), остается одной из сложных и нерешенных проблем в неотложной хирургии. Она фактически представляет собой совокупность различных патологических процессов, объединенных общим признаком - нарушением проходимости кишечной трубки, т.к. на всех стадиях развития ОТКН, наряду с симптоматикой обусловленной прогрессированием нарушения барьерной функции стенки кишки, этому заболеванию присущи клинические симптомы вовлеченных в общее страдание органов и систем. Ряд клинических проявлений ОТКН имеет схожие симптомы с одной из самых серьезных, угрожающих жизни больного по своим осложнениям, эндокринной патологией - острой надпочечниковой недостаточностью (ОНН). В поисках причин отклонений показателей работы жизненно важных органов и систем при ОТКН не будет получено исчерпывающих ответов без изучения морфофункциональных преобразований вовлекаемых в этот процесс органов и систем, включая надпочечники. Возможность для изучения этих вопросов может предоставить только экспериментальное морфофункциональные исследование надпочечников в динамике развития ОТКН.

acute adrenal insufficiencyострая надпочечниковая недостаточность1. Abramov A.Iu., Larichev A.B., Volkov A.V. [Treatment results of acute intestinal obstruction]. Tezisy dokladov vserossiiskogo s"ezda khirurgov [abstracts of all-Russian Surgical Congress]. Volgograd, 2000, 211 p. - (in Russian).2. Altiev B.K., Atadzhanov Sh.K., Isabaev Sh.B. Problemy diagnostiki i lecheniya ostroj spaechnoj kishechnoj neprohodimosti. [The problems of the diagnosis and treatment of acute adhesive intestinal obstruction]. Vestnik ekstrennoi meditsini, 2010; 1: 88-91 - (in Russian).3. Bagnenko S.F., Sinenchenko G.I., Chupris V.G. Laparoskopicheskaya diagnostika i lechenie ostroj spaechnoj kishechnoj neprohodimosti. [Laparoscopic diagnosis and treatment of acute adhesive intestinal obstruction]. Vestnik khirurgii imeni I.I. Grekova, 2009; 1: 27-39. - (in Russian).4. Bardakhch'ian E.A., Kharlanova N.G., Lomov Iu.M. Ul'trastrukturnye osnovy poliorgannoj nedostatochnosti v patogeneze ehndotoksinovogo shoka. [The ultrastructural basis of multiple organ failure in the pathogenesis of endotoxin shock]. Patologicheskaia fiziologiia i eksperimental'naia terapiia, 1999; 3: 22-25 - (in Russian).5. Bashmakov A.B., Glumov V.Ia., Bazhenov E.l. e.a. Funkcional'naya morfologiya nadpochechnikov pri ostrom ehksperimental'nom peritonite v ontogeneze. [Functional morphology in acute adrenal experimental peritonitis in ontogenesis]. Sbornik otech. serial. 1991: 160-164 - (in Russian).6. Borisov A.E., Krasnov l.M., Fedorov E.A. e.a. Hronicheskaya i ostraya nadpochechnikovaya nedostatochnost' v hirurgicheskoj praktike. [Chronic and acute adrenal insufficiency in surgical practice]. Vestnik khirurgii imeni I.I. Grekova, 2006; 165(6): 59-62. - (in Russian).7. Bulatov V.P., Sultanova l.M., Trofimova I.Sh. e.a. Osobennosti differencial'noj diagnostiki nadpochechnikovoj nedostatochnosti.[Features of the differential diagnosis of adrenal insufficiency]. Aktual'nye problemy detskoi endokrinologii, 1999; 66-69. - (in Russian).8. Vozniuk N.E., Kochetova V.S. Adrenokortikal'naya nedostatochnost'.[Adrenocortical insufficiency]. Vestnik novykh meditsinskikh tekhnologii, 2000; 7(1): 75-77 - (in Russian).9. Volkov A.N. Ostraia kishechnaia neprokhodimost': uchebnoe posobie [acute intestinal obstruction]. Cheboksary, 2007; 88 p. - (in Russian).10. Gostishchev V.K., Sazhin V.P., Avdovenko A.L. Peritonit [peritonitis]. Moscow, 2002, 240 p. - (in Russian).11. Grinev M.V., Kurygin A.A., Khanevich M.D. Ostraya kishechnaya neprohodimost' kak problema neotlozhnoj hirurgii. [Acute intestinal obstruction as an issue of urgent surgery]. Vestnik khirurgii, 1992; 5: 130-138 - (in Russian).12. Davydovich M.G., Trapeznikova A.Iu. Nedostatochnost' kory nadpochechnikov. Adrenokortikal'naya nedostatochnost'. [Adrenocortical insufficiency]. Ufa, 1996; 94 p. - (in Russian).13. Dalenov E.D., Braun A.V. [Functional morphology of the adrenal cortex in the early postoperative period]. Klinikofiziologicheskie aspekty terminal'nykh i ekstremal'nykh sostoianii [Clinical and physiological aspects of terminal and extreme conditions]. Novosibirsk, 1988, pp. 6-9. - (in Russian).14. Dedov I.I., Fadeev V.V., Mel'nichenko G.A. Nedostatochnost' nadpochechnikov: uchebnoe posobie dlia sistemy poslevuzovskogo professional'nogo obrazovaniia vrachei. [Adrenal insufficiency]. Moscow, VunMTs Roszdrava, 2006, 312 p. - (in Russian).15. Dedov I.I., Marova E.I., Vaks V.V. Nadpochechnikovaia nedostatochnost' (etiologiia, patogenez, klinika, diagnostika, lechenie). [adrenal insufficiency (etiology, pathogenesis, clinical features, diagnosis, treatment)]. Moscow, Meditsina, 2000, 57 p. - (in Russian).16. Dedov I.I., Fadeev V.V., Mel'nichenko G.A. Nedostatochnost' nadpochechnikov. [Adrenal insufficiency]. Moscow, Znanie, 2002, 320 p. - (in Russian).17. Dem'ianiuk V.N., Shuvakhina N.A. Izmenenie perifericheskoi nervnoi sistemy pri khronicheskoi nadpochechnikovoi nedostatochnosti. Somatonevrologicheskie sindromy. [Change in the peripheral nervous system in chronic adrenal insufficiency]. Moscow, Rossiiskii universitet druzhby narodov, 1996, 64 p. - (in Russian).18. Zhuravleva N.N. Reakciya holinergicheskoj i simpato-adrenalovoj sistemy v dinamike razvitiya funkcional'noj kishechnoj neprohodimosti.[The reaction of the cholinergic and sympathetic-adrenal system in the dynamics of development of functional bowel obstruction]. Fundamental'nye nauki v khirurgii [Fundamental sciences in surgery], 1993, 265 p. - (in Russian).19. Ivanova l.A. Diagnostika i lechenie ostroi nedostatochnosti kory nadpochechnikov, katekholaminovogo shoka, tireotoksicheskogo kriza, gipofizarnoi komy, giperkal'tsiemicheskogo kriza, gipoparatireoidnogo kriza. Uchebno-metodicheskie rekomendatsii dlia vrachei reanimatologov, endokrinologov. [Diagnosis and treatment of acute adrenal insufficiency, catecholamine shock, thyrotoxic crisis, pituitary coma, hypercalcemic crisis, hypoparathyroid crisis]. Krasnodar, 1996, 16 p.- (in Russian).20. Kostiuchenko K.V. Vozmozhnosti hirurgicheskogo lecheniya rasprostranennogo peritonita. [The possibility of the surgical treatment of diffuse peritonitis]. Vestnik khirurgii imeni I.I. Grekova, 2004; 163(3): 40-43. - (in Russian).21. Larin V.K., Pastushkov A.N., Romanov l.V. i dr. Klinicheskie proyavleniya nadpochechnikovoj nedostatochnosti kak proyavlenie stressovoj reakcii chelovecheskogo organizma. [Clinical aspects of adrenal insufficiency as a manifestation of the stress response of the human body]. pervaia klinicheskaia - zdravookhraneniiu Rossi 1999; 193-194 - (in Russian).22. Lebedinskii K.M. Anesteziia i sistemnaia gemodinamika. Otsenka i korrektsiia sistemnoi gemodinamiki vo vremia operatsii i anestezii. [Anesthesia and systemic hemodynamics. Evaluation and correction of systemic hemodynamics during surgery and anesthesia]. Saint-petersburg., Chelovek, 2000, 200 p. - (in Russian)23. Magomedov M.S.,Myshkin B.K., Khvan Iu. e.a. Diagnostika, profilaktika i lechenie nadpochechnikovoj nedostatochnosti v ehkstrennyh hirurgicheskih bol'nyh. [Diagnosis, prevention and treatment of adrenal insufficiency in emergency surgical patients]. Zdravookhranenie Kazakhstana, 1992; 10: 29-31. - (in Russian).24. Marova E.I., Vaks V. Ostraya nadpochechnikovaya nedostatochnost'. [Acute adrenal insufficiency]. Vrach, 2002; 7: 35-38. - (in Russian).25. Mel'nichenko G.A. Laboratornaya diagnostika nadpochechnikovoj nedostatochnosti. [Laboratory diagnosis of adrenal insufficiency]. Problemy endokrinologii, 1997; 43(5): 39-47. - (in Russian).26. Mel'nichenko G.A. Zamestitel'naya terapiya pervichnoj hronicheskoj nadpochechnikovoj nedostatochnosti. [Replacement therapy of primary chronic adrenal insufficiency]. Vrach, 2006; 11: 10-13. - (in Russian).27. Mel'nichenko G.A., Udovichenko O.V., Shvedova A.E. Endokrinologiia: tipichnye oshibki prakticheskogo vracha. [Endocrinology: common mistakes of a practitioner]. Moscow, prakticheskaia meditsina, 2011; 175 p. - (in Russian).28. Mel'nichenko G.A., Mar'ina T.A., Aleksandrova G.F. Sovremennye aspekty ehtiologii i patogeneza pervichnoj hronicheskoj nadpochechnikovoj nedostatochnosti. [Modern aspects of the etiology and pathogenesis of chronic primary adrenal insufficiency]. Problemy endokrinologii, 2006; 52(6): 45-51 - (in Russian).29. Mimo M., Gorn M., Ursula I. Vodno-ehlektrolitnyj i kislotno-shchelochnoj metabolizm. [Water and electrolyte and acidbase metabolism]. per. s angl M., Binon, 2000; 319 - (in Russian).30. Popova I.S., Iaroshenko I.F., Zhidovinov G.I. Sindrom ehnteral'noj gipertenzii, toksikoza, ehndotoksikoza pri ostroj neprohodimosti kishechnogo trakta. [Syndrome of enteric hypertension, toxemia, endotoxemia in acute obstruction of the intestinal tract]. Vestnik Volgogradskoi med akademii, 2000; 6: 152-155. - (in Russian).31. Radzikhovskii A.P., Kolesnikov E.B., Mendel' N.A. Laparoskopicheskaya diagnostika i lechenie ostroj kishechnoj neprohodimosti. [Laparoscopic diagnosis and treatment of acute intestinal obstruction]. Khirurgiia Ukrainy, 2010; 2: 89-94. - (in Russian).32. Savel'ev V.S. Khirurgicheskie bolezni. [Surgical diseases]. Moscow, gEoTaR-Media, 2006; 608 p. - (in Russian).33. Smirnov V.V., Mavricheva I.S. Nadpochechnikovaya nedostatochnost' u detej. [Adrenal insufficiency in children]. Lechashchii vrach, 2005; 5: 59-62. - (in Russian).34. Fadeev V.V. Nadpochechnikovaia nedostatochnost' (klinika, diagnostika, lechenie). Rekomendatsii dlia vrachei. [adrenal insufficiency (clinical features, diagnosis, treatment)]. Moscow, Medpraktika-M, 2008; 44 p. - (in Russian).35. Chernov V.N., Belik B.M. Ostraia neprokhodimost' kishechnika (patogenez, klinicheskaia kartina, diagnostika i lechenie). [Acute intestinal obstruction (pathogenesis, clinical presentation, diagnosis, and treatment)]. Moscow, Meditsina, 2008; 512 p. - (in Russian).36. Schein M. "Schein's" zdravyj smysl v neotlozhnoj abdominal'noj hirurgii. [Schein's Common Sense Emergency Abdominal Surgery]. Springer, 2005, 469 p. Russ. ed.: Savchuka B.D. Zdravyi smysl v neotlozhnoi abdominal'noi khirurgii. Moscow, gEoTaR-MED, 2003, 272 p. - (in Russian).37. Burry l.D., Wax R.S. Rol' kortikosteroidov pri septicheskom shoke [Role of corticosteroids in septic shoch.] Ann-Pharmacother, 2004; 38(3): 464-472.38. Cooper M.S., Stewart P.M. Kortikosteroidnaya nedostatochnost' u tyazhelobol'nyh pacientov. [Corticosteroid insufficiency in acutely ill patients]. The new England journal of medicine, 2003; 348: 727-734.39. Dellinger R.P., Levy M.M., Carlet J.M. et al. Vyzhivshie kampanii sepsisa: mezhdunarodnye rekomendacii po vedeniyu tyazhelogo sepsisa i septicheskogo shoka. [Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock]. Crit. Care. Med., 2008; 36(1): 296-327.40. Franklin M.E., Gonzales J.J., Miter D.B. et al. Laparoskopicheskaya diagnostika i lechenie kishechnoj neprohodimosti. [Laparoscopic diagnosis and treatment of intestinal obstruction]. Surg. Endosc., 2004; 1: 26-30.41. Gomes J.A., Stevens R.D., Lewin J.J., et al. Glyukokortikoidnaya terapiya v nevrologicheskoj reanimacii. [Glucocorticoid therapy in neurologic critical care]. Crit. Care. Med., 2005; 33(6): 1214-1224.42. Guillamondegui O.D., Gunter O.l., Patel S. et al. Ostraya nadpochechnikovaya nedostatochnost' mozhet povliyat' na iskhod v travmatologiyu. [Acute adrenal insufficiency may affect outcome in the trauma patient]. Jr. Am. Surg., 2009; 75(4): 287-290.43. Kwon Y.S., Kang E, Suh G.Y. et al. Prospektivnoe issledovanie na chastotu i prognosticheskie faktory otnositel'noj nadpochechnikovoj nedostatochnosti tyazhelobol'nyh korejskih pacientov. [A prospective study on the incidence and predictive factors of relative adrenal insufficiency in korean critically-ill patients]. J. Korean Med. Sci., 2009; 24(4): 668-673.44. Levard H., Boudet M.J., Msika S. et al. Laparoskopicheskoe lechenie ostroj tonkokishechnoj neprohodimosti: mul'ticentrovoe retrospektivnoe issledovanie. [Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study]. ANZJ Surg., 2001; 71: 641-646.45. Maqbool M., Shah Z.A. et al. Pacientnaya rasprostranennost' skrytoj nadpochechnikovoj nedostatochnosti i prognosticheskoe znachenie korotkogo kortikotropinovogo testa stimulyacii s septicheskim shokom.[Prevalence of occult adrenal insufficiency and the prognostic value of a short corticotropin stimulation test in patients with septic shock]. Indian J. Crit. Care Med., 2009; 13(2): 85-91.46. Nilsson C., Jennische E., Ho h.p., et al. Poslerodovoj rezul'tat vozdejstviya ehndotoksina povyshenie chuvstvitel'nosti k insulinu i izmeneniya aktivnosti nejroehndokrinnoj osi v issledovaniya samok krys. [Postnatal endotoxin exposure result in increased insulin sensitivity and altered activity of neuroendocrine axes in aduit female rats]. Eur. J. Endocrinol., 2002; 146(2): 251-260.47. Rai R., Cohen J., Venkatesh B. Ocenka funkcii kory nadpochechnikov v kriticheskom sostoyanii. [Assessment of adrenocortical Function in the Critically ill]. Crit. Care and Resuscitation, 2004; 6: 123–129.48. Tourrel F., Gouin P., Dureuil B. et al. Sindrom "Waterhouse-Friderichsen", svyazannogo s "Morganella morganii" i "Enterococcus faecium" peritonitom. [Waterhouse-Friderichsen syndrome associated to a Morganella morganii and Enterococcus faecium peritonitis]. Ann. Fr. Anesth. Reanim., 2007; 26(10): 869-872. Recieved 11.11.2012