Refers to strangulation intestinal obstruction. Treatment methods and prognosis for strangulation intestinal obstruction. Symptoms of SCI of the sigmoid colon

According to surveys, 35-50% of residents of our country have encountered such a thing as intestinal obstruction. This phenomenon most often occurs in elderly people and is a life-threatening disease, the main characteristic feature of which can be considered a complete or partial disruption of the passage of food through the gastrointestinal tract. This disease can not only cause severe complications in the patient’s body, but also lead to death. There can be many reasons for the occurrence: this is the development of intestinal motility, and the consequences of surgical and medicinal intervention in the normal rhythm of the human body.

What is Strangulated Intestinal Obstruction?

Strangulating intestinal obstruction, in turn, is an extremely aggravated form of a previously described disease, in which passage through the intestinal tract is disrupted. This process is caused by complete infringement of the mesentery of the colon around its own axis. For example, under normal conditions of functioning of the patient’s organs, all intestinal loops carry out movements that are normal in terms of their pathological signs, making turns of up to 120 degrees. If the rotation of the intestine is 180 degrees or more, in this case there is a sharp closure of its lumens, due to which the vessels of the mesentery are compressed and are not able to function normally. In the most advanced cases, such a volvulus may involve several intestinal loops or the entire organ.

Types of strangulation intestinal obstruction

It is customary to distinguish three types of disease:

volvulus;
pinching;
nodulation.

Volvulus most often occurs in the ileum, less commonly in the area of the cecum and transverse colon. The appearance of the disease is facilitated by a large number of scars and adhesions, as well as prolonged fasting or strong peristalsis of organs. During the initial stage of volvulus, the patient feels sharp pain in the abdomen and navel, constipation, excessive gas formation, and a decrease in blood pressure. Pinching and coal formation can form at any level of the intestine. At the beginning of these types of disease, the patient may experience the symptoms of Val, Kivul and Mathieu-Sklyarov. The disease can be diagnosed using X-rays only with the patient in a supine position.

Causes of the disease

The causes of the occurrence and development of strangulation intestinal obstruction can be divided into two main groups:

Predisposing reasons. These include an intestinal mesentery that is too long in size, the presence of large or thick scar cords, splices, adhesions, incomplete rotation of the small intestine, as well as a sharp decrease in the patient’s weight or the presence of various congenital anomalies.
Producing causes: constant increase in abdominal pressure and sudden movement of intestinal loops, provoked by an incorrect or irregular diet or fasting.

Symptoms of the disease

Symptoms of strangulation intestinal obstruction include:

sharp and constantly increasing pain;
discomfort in the navel area;
constipation, diarrhea;
colaptoid state;
incessant vomiting;
increased body temperature;
dizziness;
general deterioration of a person's condition.

Strangulating intestinal obstruction in children

Strangulation obstruction is a fairly common and regularly occurring disease in children. In terms of frequency of occurrence, it ranks second after antusgination. As the disease develops in a child, mechanical ileus appears, a decrease in the lumen of the intestinal area, compression of adhesions and pinching of mesenteric vessels.

Signs of obstruction in children begin abruptly and acutely. The child feels constant pain, reminiscent of strong contractions, not only in the intestines, but also in the lumbar region. In addition, the baby’s pulse quickens, the temperature rises and the blood pressure level decreases. If you notice these signs in your child, do not place your hopes on a self-made diagnosis, but urgently contact the nearest medical center. The sooner a qualified specialist can diagnose the disease, the sooner you will begin the correct and effective course of treatment.

Treatment of the disease

Any manifestation of strangulation intestinal obstruction is subject to emergency surgical intervention. If you find any signs of this disease, consult a doctor immediately. Conservative types of therapy (all kinds of enemas, rehydration and taking antispasmodics) help only in the first few hours.

The operation is an open laparotomy, the first stage of which involves disinvagination and excision and removal of excess adhesions or scars. Next, surgeons reduce the mobility of the intestinal area and, in order to prevent recurrence of signs of the disease, perform cecopexy. Cecopexy is the process of fixing the terminal segment of the intestine with special interrupted sutures. If there is an advanced case of the disease and the intussusception cannot be corrected, then resection of the loops of the large and small intestine is performed. Most often, surgery is performed under general anesthesia with novocaine.

The result of the operation and the prognosis of the condition of a patient suffering from intestinal obstruction, first of all, depends on a correct and timely diagnosis. Assessing the capacity of the intestine should be carried out by doctors carefully and carefully, especially considering the fact that any necrotic changes initially appear in the mucous membrane, and only after that in the serous integument. During the operation, it is mandatory to empty the adductor intestine of gases and other contents located in it. Unfortunately, statistics show that the number of deaths in this case is 20% of all cases of surgical intervention. This is due to the fact that most patients turn to specialized medical institutions too late. Take care of yourself and be healthy!

Intestinal obstruction is an acute situation. It requires clear surgeon tactics. This is due to the fact that strangulation intestinal obstruction is accompanied not only by obstruction of the organ lumen, but also by pinching and compression of the arterial and venous vessels of the mesentery. Not only the flow of blood is disrupted, but also the outflow through the veins, as well as through the lymphatic vessels.

Compression of the vessels of the venous and lymphatic beds leads to stagnation. They increase the degree of edema of the intestinal wall and increase ischemia. Following ischemic processes, necrosis of a section of the intestine occurs.

The etiological factors of strangulation are numerous. These include not only anatomical features (intestine with a long mesentery or incomplete rotation, mobile cecum), but also acquired diseases. These include abdominal adhesions. Their appearance is caused by surgical interventions for various diseases of the abdominal or pelvic organs. However, in the postoperative period the patient did not receive prophylaxis for adhesive disease.

The next important factor is hernias. Most often, this surgical pathology is detected in elderly people. This is due to the loss of elasticity of the skin, muscle and connective tissue structures of the body. The development of intestinal strangulation during hernia is associated with infringement of its wall or loops.

The above factors are considered predisposing. A group of producing causes is also distinguished. These include:

Loss of body weight;
Changing the diet with a predominance of carbohydrates and fats with a lack of fiber and other ballast substances;
Prolonged cough and other conditions leading to a sharp increase in pressure inside the abdominal cavity;
Impaired intestinal motility;
Tendency to constipation;
Adynamia or physical inactivity.

In the presence of a background predisposing factor and a producing situation, the risk of developing intestinal obstruction increases many times over.

Volvulus

Surgeons distinguish three variants of the disease. They differ from each other in clinical features and treatment approaches.

Volvulus of intestinal loops.
Nodulation.
The appearance of intussusception.

Volvulus is typical for areas where there is a pronounced mesentery. Most often it appears in the sigmoid colon. Volvulus of the cecum and small intestine is less commonly detected.

Intestinal obstruction due to volvulus of the small intestine

This part of the intestine takes part not only in fecal formation, but also in the processes of absorption of electrolytes, nutrients, and water. Therefore, the development of obstruction in this area occurs very clearly and pronouncedly.

Pain primarily appears in the epigastric or mesogastric region. Most often, the pain syndrome is localized near the navel. Then nausea and vomiting occurs. They don't bring relief. Over time, vomit changes in character: first it is eaten food, and then - right up to feces.

The next sign is stool retention. In this case, there may be flatulence, but the gases do not escape. A single emptying of the lower intestines does not bring a feeling of relief.

Violations of electrolyte and water metabolism lead to headaches and confusion. Hyperthermia develops. With a positive Shchetkin-Blumberg symptom, peritonitis occurs - a dangerous situation that requires emergency measures.

Diagnosis uses plain radiography. In case of small intestinal strangulation obstruction, the image shows Kloiber cups with fluid levels.

Treatment of the disease is surgical. First, the doctor assesses how viable the intestine is. If there is no necrosis, then the loops are washed, and the volvulus is eliminated by detorsion. If there are areas of wall necrosis, the surgeon removes it within healthy tissue by 20 cm in the distal direction and 30 cm in the proximal direction.

Volvulus of the sigmoid colon

This type of intestinal obstruction is typical in older patients. The pain syndrome does not develop as clearly. It is localized in the left iliac region. During the examination, the doctor draws attention to the fact that the abdomen is “distorted” due to muscle tension of the abdominal wall and asymmetrical bloating.

Vomiting does not bother patients at first. With increasing intoxication, vomiting appears, which has a fecal character and smell. Retention of gases and stool is characteristic from the very beginning, since the sigmoid colon is the distal part of the digestive tract.

General symptoms are similar to manifestations of small intestinal obstruction due to volvulus of the loops of the jejunum and ileum. But they arise much later, with the addition of peritonitis. Diagnostic and treatment measures are the same.

Intussusception

This pathological process is often caused by tumors. Therefore, intussusception is preceded by a chronic stool disorder such as constipation and the appearance of pathological impurities.

But when a section of the intestine sinks into another section of the intestine, thereby obstructing its lumen, symptoms of acute intestinal obstruction develop. In this case, the pathological process develops in the submerged loop (ischemia of the walls), as well as in the intestinal area where the intussusception has submerged.

The pain syndrome has its own characteristics. It is localized in the right hypochondrium or periumbilical region. With peristaltic movements, the pain intensifies. At the height of pain there may be vomiting.

An important sign is stool upset. Bowel movements occur, but the stool contains blood or mucus. Sometimes the stool resembles raspberry jelly. To verify the diagnosis, a survey image of the abdominal organs and irrigography are used. The X-ray shows Kloiber's cups with fluid levels, and a contrast study shows the "divide" syndrome.

Treatment includes disinvagination. It is performed under anesthesia. If the intestine is viable, then resection is not performed. Otherwise, within the healthy tissue, the intestine is resected along with the intussusception.

Knot formation

For this type of strangulation intestinal obstruction, lumen closure at 2 or more levels is typical. The loops of the intestine become entangled relative to each other so that one is wrapped relative to the other along the axis of the mesentery.

Symptoms appear quickly. Pain may appear in various parts of the abdomen. Localization depends on which loops are involved in the process. Vomiting and stool retention are also typical. General intoxication syndromes arise very early. Treatment is carried out according to the same principles as intussusception therapy.

Strangulated intestinal obstruction is an acute surgical pathology that requires urgent treatment. It is dangerous because of its consequences. Therefore, the doctor requires experience and attentive attitude towards the patient. The patient is required to be careful and contact a doctor immediately if pain, stool retention and vomiting occur.

Strangulation OKN, which occurs in 15-40% of cases, differs from obstructive OKN primarily in that in addition to compression of the intestine (from the outside), the mesentery is also compressed, which leads to impaired circulation in the intestinal segment. With this form of obstruction, destructive changes in the strangulated loop increase faster, endotoxemia and peritonitis develop faster. The strangulation type of intestinal obstruction includes volvulus, nodulation and strangulation of the intestine in the external and internal hernial orifice.

Volvulus is a twisting of the intestine with its mesentery around the longitudinal axis.

There are 1) volvulus of the small intestine, 2) sigmoid colon and cecum.

Causes of bloat intestines secrete

Predisposing: a) excessively long intestinal mesentery, incomplete intestinal rotation; b) scar cords, adhesions, adhesions between intestinal loops, both congenital and acquired; c) sudden weight loss.
Producing factors: a) a sudden increase in intra-abdominal pressure, leading to a sudden movement of intestinal loops; b) nutritional factors: irregular nutrition, prolonged fasting with subsequent overload of the intestine with a large amount of roughage.

Volvulus of the small intestine.

Under normal conditions, the hinges rotate up to 90°. When the intestine is rotated more than 180°, its lumen is blocked and the mesenteric vessels are compressed. Volvulus is promoted by intestinal overflow, increased peristalsis, and adhesions. Volvulus may involve several loops, and sometimes the entire intestine.

Acute onset.
With severe general and local clinical symptoms characteristic of acute high strangulation obstruction.

- - Against the background of constant pain, cramping pain periodically occurs, the intensity of which increases synchronously with peristalsis, reaching the character of unbearable.
  - Restless, screaming in pain, taking a forced position with legs brought to the stomach.
  - From the onset of the disease, repeated vomiting occurs, which does not bring relief, initially with unchanged gastric contents and bile, and then it becomes fecaloid.
  - Retention of stool and gases is an unstable symptom of the disease: often at first there is a single stool due to emptying of the lower intestines, which does not bring relief.

— The patient’s general condition is serious.

— Disorders of water-salt, protein and carbohydrate metabolism, microcirculatory and hemodynamic disorders, intoxication, and decreased diuresis quickly appear and increase.

- The abdomen is moderately swollen, sometimes the swelling is manifested only by smoothness of the subcostal areas.

- Valya's positive symptom - a balloon-shaped loop of jejunum stretched and fixed in the abdomen, above which a high tympanitis and splashing noise are detected.

Diagnostics.

During a survey fluoroscopy of the abdomen, Kloiber's cups are detected, which appear 1-2 hours after the onset of the disease and are localized in the left half of the epigastric region and in the mesogastric region.

Treatment is surgical.

Detorsion or “untying” of knot formation, removal of intestinal contents through a long naso-intestinal tube. If the viability of the intestines is beyond doubt, detorsion is limited. In case of intestinal necrosis, the non-viable loop is resected with end-to-end anastomosis. The line of intersection of the intestine should be 40-60 cm above the obstacle and 10-15 below it.

Cecal volvulus

possible in cases where it has its own mesentery or a common mesentery with the small intestine.

— With cecal volvulus, the symptoms are as acute as with small intestinal volvulus. Pain (both constant and cramping) is localized in the right half of the abdomen and in the umbilical region. Vomiting is usually observed. Most patients have stool and gas retention.

— Upon examination, asymmetry of the abdomen is revealed due to swelling in the umbilical region. At the same time, retraction of the right iliac region occurs. Palpation of the abdomen often reveals a positive Schimans-Dans sign (a feeling of “emptiness” on palpation in the right iliac region) and rigidity of the abdominal wall muscles.

— When auscultating the abdomen, characteristic ringing peristaltic noises with a metallic tint are noted. Subsequently, as peritonitis develops, peristaltic sounds weaken.

Diagnostics.

A plain X-ray of the abdomen reveals a spherically swollen cecum, which is localized in the right half of the abdomen or is displaced inward and upward. In the intestinal projection area, a large (up to 20 cm long) horizontal fluid level is visible.

Volvulus of the sigmoid colon

occurs more often in older people who have suffered from constipation for a long time. In addition to the significant length of the mesentery, volvulus is facilitated by cicatricial wrinkling of the mesentery of the sigmoid colon in mesosigmoiditis. The consequence of this is the convergence of the adducting and efferent sections of the intestine, which are located almost parallel (like a “double-barreled shotgun”). When peristaltic contractions increase or overflow with dense and gaseous contents, the intestine easily twists around its axis, which leads to obstruction.

Clinic.

The pain occurs suddenly, is intense, is usually localized in the lower abdomen and in the sacral area, and is accompanied by single or double vomiting. Fecaloid vomiting, as a rule, occurs only with the development of peritonitis and paralytic obstruction.
The leading symptom of sigmoid colon volvulus is stool and gas retention. The abdomen is sharply swollen. Its asymmetry is noted - bulging of the upper parts of the right half due to movement of the sigmoid colon up and to the right. In this case, the stomach takes on a characteristic “skewed” appearance.
Due to severe swelling of the colon, all internal organs and the diaphragm are pushed upward. This leads to difficulty breathing and cardiac dysfunction.

Diagnostics.

Fluoroscopy reveals a colon (ascending, transverse, descending) sharply swollen with gases, which occupies almost the entire abdominal cavity (a characteristic symptom of a “light” abdomen), against which 1-2 Kloiber cups with long fluid levels are visible.

Treatment

For sigmoid colon volvulus, surgical and conservative treatment methods are used.

Surgical treatment consists of straightening the twisted loops of intestine (detorsion) and emptying the intestine of its contents (decompression). In case of intestinal necrosis, its resection is indicated according to the general rules adopted in the surgical treatment of acute intestinal obstruction. In order to prevent relapse of the disease in cases of sigmoid colon volvulus, mesosigmoplication is performed according to Hagen-Thorn. 3-4 parallel collecting sutures are placed on the anterior and posterior layers of the elongated mesentery from its root to the intestine. When they are tightened, the mesentery is shortened. This reduces the risk of recurrent bloat. Some surgeons prefer to fix the sigmoid colon with several sutures to the anterior or posterior abdominal wall.

Bowel nodulation

(nodulus intestini) occurs with severe circulatory disorders in the vessels of the mesentery and early necrosis of large areas of the small and large intestine.

Etiology and pathogenesis.

At least two intestinal loops take part in nodulation. One of them, folded in the form of a “double-barreled shotgun” together with its mesentery, forms an axis around which the second loop of the intestine, also together with its mesentery, twists one or more turns, compresses the first loop and itself undergoes strangulation. As a result of the formation of a node, the intestinal lumen is blocked at at least two levels.

The small intestine and mobile parts of the large intestine, which have their own mesentery, usually take part in nodule formation. The most common types of interintestinal nodes are those between the small intestine and the sigmoid colon or small intestine and the mobile cecum, which has its own mesentery. Nodulation between the loops of the small intestine (jejunum and ileum) is rarely observed.

The blood supply in the vessels of the mesenteries of the strangulated and strangulated intestine in the initial stages of the disease is disrupted to varying degrees (usually the blood supply in the strangulated loop suffers more). Then the blood supply to both loops is quickly disrupted, in which necrosis develops.

Clinical picture and diagnosis.

It is necessary to assume intestinal nodulation in cases where clinical and radiological signs of strangulation of the small intestine are combined with signs of obstruction of the large intestine (“balloon-shaped” rectal ampulla on rectal examination, horizontal fluid levels in the left parts of the colon along with fluid levels in the small intestine).

Treatment.

Only surgical treatment is used. In the early stage of the disease, the knot is “untied”. If it is impossible to straighten the knot, which is often observed in the later stages, resection of the large and small intestine is resorted to.

Forecast often unfavorable. Mortality is about 25%.

Intussusception

occurs as a result of the penetration of one of the intestinal sections into another. As a result, a cylinder (intussusception) is formed, consisting of three intestinal tubes passing into one another. The outer tube of the cylinder is called the receptacle or vagina. The middle and inner tubes of the cylinder are called generators. The area where the middle cylinder passes into the inner one is called the head of the intussusception, the place where the outer cylinder passes into the middle one is called the neck. In rare cases, intussusception consists of 5 - 7 layers. The penetration of one intestine into another occurs at different depths. Closure of the intestinal lumen with intussusception leads to obstructive obstruction. Together with the intestine, its mesentery is also introduced, which leads to compression of blood vessels (strangulation), circulatory disorders and necrosis of the internal and middle cylinder of the intestine. The outer cylinder of the intussusception, as a rule, does not undergo necrosis.

The most common is intussusception of the ileum into the cecum (ileocecal intussusception) or (in 80% of patients) the ileum and cecum into the ascending colon.

Etiology.

The main cause of intussusception is tumors on the “pedicle”, hematoma, inflammatory infiltrate, etc., which, as a result of peristaltic contractions, move in the distal direction, dragging the intestinal wall with them.
The cause of intussusception can be a persistent spasm of the intestinal wall, as a result of which the spasmed section of the intestine is introduced by peristaltic contractions into another section of the intestine, which is in a state of paresis.

Clinical picture and diagnosis. Children often have acute forms of the disease; in adults, subacute and chronic forms predominate.

In the acute form, the disease begins suddenly, sometimes against the background of enteritis or after taking a laxative.
The leading symptom is sharp, cramping pain, which increases in intensity until unbearable during peristaltic contractions of the intestine and then gradually subsides. Over time, the intervals between contractions become shorter, the pain becomes constant, and is accompanied by repeated vomiting.
At the same time, the discharge of intestinal contents from the underlying sections is preserved.
An admixture of blood and mucus is found in the stool. A number of patients experience bloody stools and tenesmus. Bloody discharge often looks like “raspberry jelly.”

- When examining the abdomen, peristalsis visible to the eye is revealed. The abdomen is soft on palpation. With deep palpation, it is usually possible to identify a painful, inactive, cylindrical formation located with ileocecal intussusception in the right iliac region, right hypochondrium or transversely above the navel (with deep intussusception).

During a rectal examination, an enlarged empty ampulla of the rectum is found, and with deep intussusception in children, sometimes the head of the intussusception that has descended into the rectum. As a rule, bloody discharge is found in the lumen of the rectum.

Diagnostics is based on a characteristic triad of symptoms - cramping abdominal pain, palpable cylindrical formation

Treatment. Emergency surgery. Conservative measures (siphon enemas, injection of gas into the colon, prescription of antispasmodics) are rarely effective even in the first hours of the disease.

During an operation performed in the early stages, by careful and gentle squeezing it is possible to perform disinvagination. After this, to reduce excessive intestinal mobility and prevent relapse of the disease, cecopexy is performed (the terminal segment of the ileum and the cecum are fixed to the posterior parietal peritoneum with separate interrupted sutures). If it is not possible to straighten the intussusception or the disinvaginated intestine turns out to be non-viable, resection of the intestinal loops is performed in compliance with all the rules for intestinal resection in conditions of acute obstruction.

This is a form of intestinal obstruction in which, along with disruption of the movement of contents through the intestinal tube, compression of the vessels of the intestinal mesentery occurs, which leads to ischemia and gangrene of the intestine. Typically, there are three types of strangulated intestinal obstruction: strangulation, volvulus, and nodulation.

With this form of obstruction, the same disorders of water-electrolyte metabolism occur as with obstructive obstruction.

However, with strangulation obstruction, these disorders are also accompanied by a toxic factor associated with ischemia of the intestinal loop excluded from the circulation - protein breakdown products - peptides, microbial enzymes and toxins. Necrosis, starting from the mucous membrane, quickly progresses and spreads to the entire thickness of the intestinal wall. This leads to a significant increase in the permeability of the intestinal wall to bacteria and toxic products. Water-electrolyte disturbances and intoxication very quickly lead to severe metabolic disorders of the entire body.

Most often, strangulation obstruction develops when infringements intestines in the hernial orifice - inguinal, femoral, umbilical, postoperative. Less often - other localizations, including internal hernias. When a hernia of any location is strangulated, sharp pain occurs, irreducibility of the hernia, tension in the hernial protrusion, and lack of transmission of the cough impulse. The pain is very strong, constant, and radiates along the hernial protrusion to the center of the abdomen and epigastric region. Patients usually scream in pain, behave restlessly, the skin turns pale, and pain shock with tachycardia and decreased blood pressure often develops. Usually the pain remains severe for several hours until the moment when necrosis of the strangulated organ occurs with the death of intramural nerve elements. Sometimes the pain can become cramping in nature. A strangulated hernia is often accompanied by vomiting, which at first is a reflex. Clinical manifestations depend on the level of intestinal strangulation. With high strangulation of the small intestine, the pain syndrome is pronounced, early repeated vomiting occurs, which does not bring relief.

Another cause of strangulating intestinal obstruction is volvulus intestines. The small intestine and colon can wrap up, including the sigmoid, cecum, and less commonly, the transverse colon. Gastric volvulus is very rare. Volvulus of the small intestine can develop with increased peristalsis, overflow of the intestine with contents, especially in the presence of an excessively long mesentery, as well as its congenital straight or vertical position, the presence of adhesions, adhesions, sudden weight loss, etc. The mobility of the small intestine under normal conditions is significant and under normal conditions the rotation of the intestine around its axis can reach 90 degrees. When the angle increases by more than 180 - 270 degrees or more, inversion occurs. The disease is usually acute in nature, manifested by severe constant pain, accompanied by vomiting from the very beginning. Abdominal bloating may not be noticeable at first. Visible peristalsis is observed only in the first hours; later it fades away. Palpation of the abdomen reveals a positive symptom Thevener(pain on palpation 6-8 cm below the navel - projection of the mesentery of the small intestine). The abdomen is soft, there is a splashing sound. By percussion, tympanitis is determined over the swollen loops of intestine; upon auscultation, peristalsis is first heard, which then disappears. X-rays reveal swollen, gas-filled loops of the small intestine, sometimes with the presence of cups located predominantly in the center of the abdominal cavity. The colon usually does not contain gas.

Cecal volvulus. In the occurrence of cecal volvulus, its mobility, due to the presence of its own mesentery, is of great importance. The disease is often acute, with a sudden onset. Characteristic is retention of stool and gases, and vomiting. Sometimes there is a clear asymmetry of the abdomen with a protrusion located in the upper left, and an “empty” iliac fossa is determined by palpation ( Danse's sign).

Transverse colon volvulus is a rare form of intestinal obstruction. The predisposing reasons for its volvulus are a large length of the intestine, a long mesentery, the presence of scars, adhesions and adhesions. The clinical picture of volvulus of the transverse colon develops as a type of colonic obstruction. The disease begins suddenly, with abdominal pain, vomiting, stool and gas retention. The abdomen is usually sharply swollen and asymmetrical. By percussion, tympanitis is determined over the swollen intestine.

Volvulus of the sigmoid colon- occurs most often. In its occurrence, the anatomical and physiological characteristics of the intestine itself and its mesentery are of great importance. The large length of the intestine and the width of its mesentery in the presence of a narrow root of the mesentery contribute to its volvulus. Predisposing factors are: size, shape and position of the intestine, increased peristalsis, chronic intestinal stasis, etc. The degree of volvulus of the sigmoid colon varies from 180 to 720 degrees. The most commonly observed twists are 180-360 degrees. The larger the volvulus, the more severe the disease. In acute cases, patients complain of sharp paroxysmal abdominal pain, nausea, vomiting, retention of stool and gas. When examining the abdomen, attention is drawn to its uneven swelling ( "oblique belly" symptom) asymmetry and protrusion of the left half. On digital examination, the rectal ampulla is empty, the sphincter is gaping ( Obukhovskaya's symptom hospitals). The symptom is also positive Tsege-Manteuffel. X-ray reveals a sharply swollen sigmoid colon filling the entire abdominal cavity ( symptom of a "lightened" abdomen).

Knot formation- refers to the most severe form of strangulation intestinal obstruction. When nodulation occurs, at least two sections of the intestine are involved in the process. The most common form is the formation of a node consisting of the sigmoid and small intestines. In the mechanism of nodulation, there are predisposing (high mobility of the intestines on the long mesentery, common mesentery of the cecum and ileum, the presence of adhesions) factors and producing (increased peristalsis, uneven filling of intestinal loops with contents, etc.) Usually, during nodulation, one loop (compressive) twists around the other (axial), pinching it. As a result, circulatory disturbance occurs in both loops, i.e. over a large area of the intestine and its mesentery. The clinical picture of the disease always develops very rapidly. Characterized by the presence of severe, sudden abdominal pain, signs of shock and intoxication in the early stages. Abdominal symptoms are poor. The abdomen is almost not swollen, peristalsis is not audible. Early free effusion appears in the abdominal cavity. X-rays reveal signs characteristic of mechanical obstruction of the small and large intestines.

The frequency of strangulation types of intestinal obstruction is 40-50% of all observations of acute obstruction.

Volvulus is a twisting of the intestine with its mesentery around the longitudinal axis. They make up 4-5% of all types of intestinal obstruction. There are volvulus of the small, sigmoid colon and cecum.

Among the causes of intestinal volvulus, predisposing and producing factors are distinguished.

Predisposing reasons include:

a) excessively long intestinal mesentery, incomplete intestinal rotation;
b) scar cords, adhesions, adhesions between intestinal loops, both congenital and acquired;
c) sudden weight loss.

Producing causes include:

a) a sudden increase in intra-abdominal pressure, leading to a sudden movement of intestinal loops;
b) nutritional factors: irregular nutrition, prolonged fasting with subsequent overload of the intestine with a large amount of roughage.

Volvulus of the small intestine

Under normal conditions, the intestinal loops make significant movements and often make turns of up to 90° without causing any pathological disorders. When the intestine is rotated more than 180°, its lumen is blocked and the mesenteric vessels are compressed. Volvulus is promoted by intestinal overflow, increased peristalsis, and adhesions. Volvulus may involve several loops, and sometimes the entire intestine.

Clinical picture and diagnosis. Volvulus of the small intestine begins acutely. The disease occurs with severe general and local clinical symptoms characteristic of acute high strangulation obstruction.

In the first hours of the disease, against the background of constant pain, cramping pain periodically occurs, the intensity of which increases synchronously with peristalsis, reaching the character of unbearable. Often patients become restless, scream in pain, and take a forced position with their legs brought to their stomach. From the very beginning of the disease, repeated vomiting occurs, which does not bring relief, initially with unchanged gastric contents and bile, and then it becomes fecaloid. Retention of stool and gases is an unstable symptom of the disease: often at first there is a single stool due to emptying of the lower intestines, which does not bring relief.

The general condition of the patient is serious. Disorders of water-salt, protein and carbohydrate metabolism, microcirculatory and hemodynamic disorders, intoxication, and decreased diuresis quickly appear and increase. The abdomen is moderately swollen, sometimes the swelling is manifested only by smoothness of the subcostal areas.

A positive sign of Will is often detected - a balloon-shaped loop of jejunum stretched and fixed in the abdomen, above which a high tympanitis and splashing noise are detected.

Treatment surgical. It consists of detorsion or “untying” the nodule, removing the intestinal contents through a long nasointestinal tube. If the viability of the intestines is beyond doubt, detorsion is limited. In case of intestinal necrosis, the non-viable loop is resected with end-to-end anastomosis. The line of intersection of the intestine should be 40-60 cm above the obstacle and 10-15 cm below it.

Cecal volvulus

Cecal volvulus possible in cases where it has its own mesentery or a common mesentery with the small intestine. With cecal volvulus, the symptoms are as acute as with small intestinal volvulus. Pain (both constant and cramping) is localized in the right half of the abdomen and in the umbilical region. Vomiting is usually observed. Most patients have stool and gas retention.

Upon examination, asymmetry of the abdomen is revealed due to swelling in the umbilical region. At the same time, retraction of the right iliac region occurs. Palpation of the abdomen often reveals a positive Schimans-Dans sign (a feeling of “emptiness” on palpation in the right iliac region) and rigidity of the abdominal wall muscles.

When auscultating the abdomen, characteristic ringing peristaltic noises with a metallic tint are noted. Subsequently, as peritonitis develops, peristaltic sounds weaken.

Volvulus of the sigmoid colon

Volvulus of the sigmoid colon occurs more often in older people who have suffered from constipation for a long time. In addition to the significant length of the mesentery, volvulus is facilitated by cicatricial wrinkling of the mesentery of the sigmoid colon in mesosigmoiditis. The consequence of this is the convergence of the adducting and efferent sections of the intestine, which are located almost parallel (like a “double-barreled shotgun”). When peristaltic contractions increase or overflow with dense and gaseous contents, the intestine easily twists around its axis, which leads to obstruction.

Clinical picture. The pain occurs suddenly, is intense, is usually localized in the lower abdomen and in the sacral area, and is accompanied by single or double vomiting. Fecaloid vomiting, as a rule, occurs only with the development of peritonitis and paralytic obstruction. The leading symptom of sigmoid colon volvulus is stool and gas retention. The abdomen is sharply swollen. Its asymmetry is noted - bulging of the upper parts of the right half due to movement of the sigmoid colon up and to the right. In this case, the stomach takes on a characteristic “skewed” appearance.

Due to severe swelling of the colon, all internal organs and the diaphragm are pushed upward. This leads to difficulty breathing and cardiac dysfunction.

Treatment. For sigmoid colon volvulus, surgical and conservative treatment methods are used.

Bowel nodulation

Bowel nodulation(nodulus intestini) occurs with severe circulatory disorders in the vessels of the mesentery and early necrosis of large areas of the small and large intestine. It is observed in 3-4% of all patients with acute intestinal obstruction.