PECULIARITIES OF DIAGNOSIS AND SURGICAL TACTICS IN ILEUS CAUSED BY ADHESIONS

The work analyses the results of examination and treatment of 273 patients, aged from 18 to 74 years, with ileus caused by adhesions (AI). There were 159 males and 113 females. The diagnosis of AI was based on the findings of clinico-radiological, ultrasonic, and endoscopic examination. Early AI was recognized in 61 and delayed Al in 212 patients. Nonoperative therapy was effective in 53 patients. Operation was performed on 220 patients. Twenty-one patients underwent emergency.operations due to peritonitis, urgent surgery was performed in 163 patients with unsuccessful complex nonoperative treatment and growth of clinical manifestations of AI, 36 patients were managed by planned operations after adequate examination and preoperative treatment. Obstruction of the small intestine was found in all patients: dynamic in 60, strangulation in 111, obturation in 66, and recurrent in 36 patients. Cutting of the adhesions was the operation of choice, it was performed in 178 patients. Nobles' intestinoplication was conducted in 24 and resection of the small intestine in 15 patients. A bypass anastomosis was formed in 3 patients. Postoperative complications occurred in 18 patients, 10 had to be reoperated on. Twenty-one (9.5 %) patients died after surgery: 8 after emergency operations and 13 patients after urgent operations. Death was caused by intoxication (7), peritonitis consequent upon failure of the anastomosis sutures (5) hepatic failure (3), acute cardiovascular failure (3), thromboembolism of the pulmonary artery (2), and stroke (1).