Lupine Publishers | Journal of Surgery & Case Studies
The author watched 83 patients with postoperative peritonitis
bilious, of whom 27 (32.5%) the reason for its development was
inspired by the ongoing peritonitis, 38 (45.9%) is non-suite Lodge of
the gall bladder, 3 (3.6%)-damage to abnormally developed
bile ducts, 8 (9.6%)-migration tubes exegesis, 7 (8.4%)-wound exegesis.
Died 8 (9.6%) patients. The author notes the difficulty of
diagnosis of this complication due to the paucity of symptoms.
Keywords:Operation; complication; bile peritonitis; diagnosis; treatment
Lately there has been a significant increase in patients with
acute cholecystitis, if this fatality rate when it is 3-7% [1]. Analysis
of literature data suggests that even now, despite great technical
capabilities of modern surgery, surgeries for cholecystitis are
accompanied by various tactical and technical medical errors.
So, if damage reaches exegesis cholecystectomy 5.6% and
zhelcheistechenie from gallbladder bed is 8.3% [2]. In 68%-
81.1% of cases the reason for the development of postoperative
biliary peritonitis are tactical and technical medical errors [3,4,5].
Prominent negative role for prediction of treatment provides
and the presence of patients expressed disorders of immunity
and slowing the regeneration process [5]. The most frequent
complications arise during surgery in patients with destructive
form of this disease, the syndrome of Mirizzi, sclerosis of the
gallbladder and biliary tract abnormalities. Postoperative mortality
in persons aged patients reaches 80% [2.5]. Prognosis worsens or if
there already or developing in the patient of acute pancreatitis. Such
observations lethality reaches 30-35% [1]. These data demonstrate
the feasibility of evaluating the treatment of patients with acute
cholecystitis in the various hospitals to develop a diagnostic and
treatment algorithm specified complications.
The OCG in surgical units were MUNICIPAL treatment
5412 patients with acute cholecystitis. Men (33.7%), 1828 and
women-3584 (66.3%). the age of the patients was from 21 until
95 years. Operations are performed at 4106 (75.8%) patients,
among them a laparoscopic way-from 1728 (42.1%), conversion
option-250 (6.1%) Postoperative lethality was 2.18%. All patients,
including those under the age of 50 years, revealed on 2 or more
For Co morbidities. Emergency operations were performed at
2464 (60%) patients. Destructive form of inflammation identified
at 3116 (75.9%) patients and it has always been associated with
the more or less pronounced inflammatory infiltrate around
the gallbladder with involvement in the pathological process of
adjacent liver tissue and liver the duodenum bundles, with 507
(14.8%) He was a development density. Out of the total number of
cholecystectomy (4106) postoperative biliary peritonitis, varying
degrees of prevalence was observed in 83 (2.02%) patients. At 8
(0.19%) of them he was the cause of death.
A complication they had revealed before relaparotomy and confirmed during the repeated surgical intervention. For the diagnosis of this complication conducted clinical and laboratory, biochemical and instrumental examinations, including ultrasound, CT scan, x-ray and laparoscopy, abdominal and thoracic cavities. From 83 patients were carried out at relaparotomy 22 (26.5%) of them have 18 with symptoms of widespread peritonitis and 4 after random enforced pulling the drain tube from the patient when turning-exegesis nabob (among these patients during relaparotomy discovered a clump of bile under the liver). At 41 (49.4%) same patient relaparotomy was replaced by venting bile accumulation zones (in the right podreberie, right side canal and pelvic cavity) under ultrasound control. Reasons for the development of postoperative bile peritonitis were: continuing peritonitis-27 (32.5%), non-suite lodge gallbladder-38 (45.9%), corruption of abnormally developed bile ducts-3 (3.6%), the migration of the drainage tube from exeresis-8 (9.6%), wound choledochitis-7 (8.4%) On clinical flow disease from 83 patients, only 12 (14.4%) There were symptoms of peritonitis, and 71 (85.6%)-they were erased.
On the prevalence of abdominal lesion bed (limited and unlimited) peritonitis diagnosed at 65 (78.3%), and common-u 18 (21.7%) should indicate if local peritonitis symptoms of peritoneal sepsis was observed then when they were distributed in all patients, and 5 (6%) He even accompanied the infectious-toxic shock (these patients died). Marked by a certain relationship between severity of endogenous intoxication and volume zhelcheistechenija. So, if you lose your 300-500 ml of bile develops local peritonitis with mild degree of intoxication, 500-1000 ml-diffusive-spilled with average and more than 1000 ml-General severe peritonitis. From 83 patients with Leukocytosis, with a shift of Leukocyte formula left, there were only 31 (37.3%). Thus, in the majority of patients leading diagnostic test was abundant expiration of bile from the abdominal cavity, or drainage, or past them.
5412 of patients with acute cholecystitis (1.66%) and 90
died people from postoperative bile peritonitis 8 (0.16%). The
remaining 82 patients died from other causes. From 83 patients
with postoperative peritonitis bilious died 8 (9.6%) of the 27
patients with peritonitis was before surgery and he continued
after she died 4 (15%), conditionally from 38 patients with nonushitym
gallbladder bed-1 (2.6%) From 3 patients where the
damage occurred an abnormally developed bile ducts, there have
been no deaths. Of the 8 patients who died of the drainage tube
migration, died 1 (12.5%), conditionally of 7 patients with wound
choledochitis died 2 (28.5%) of probation. We believe it necessary
to point out that damage to abnormally developed bile ducts and
was immediately identified exeresis wound during the execution of
the primary operation and steps were taken to restore the tightness
of biliary tract, bile peritonitis but evolved, Despite the timely
diagnosis of this complication. All 10 patients were performed
relaparotomy during which only 8 have external drainage of biliary
tract, and the 2-x stitches on holedoh, but after 1 day they prorezalis,
accompanied by a progression of his fatal peritonitis exodus.
Thus, the development of postoperative bile peritonitis was due
to tactical and technical medical mistakes made as when choosing
how to gall bladder removal and manipulation on this body and
its surrounding tissues, and also when draining the abdominal
cavity. A negative role played and the older patient’s violations of
immunity. If you get the drain tube from the exegesis, diagnose
the development of this complication did not pose any difficulty,
when his other reasons it was difficult-because of wear of clinical
symptoms. This can be attributed to the conduct of postoperative
corrective medical therapy, use of antibiotics and pain medication.
However, the patients symptoms of intoxication (tachycardia and
dehydration) and euphoria, but the main thing-the expiration
of bile by drainage tubes, allowed or suspect the complications,
or conclude the progression of peritonitis if he had before the
surgery. Severity of the pathological process is largely dependent
on zhelcheistechenija. So the lowest mortality was observed in
patients with defects in the closing of the lodge of the gall bladder.
It is possible to explain the cover bed great seal and other soft tissues, limiting the speed of zhelcheistechenija. Rate and amount of bile in the free abdomen mostly depend on the diameter and the nature of the damage to the bile duct, as well as on the availability of occlusion is below the level of his trauma. The greater was hypertension, the faster evolved intoxication, with 8 (9.6%) patient’s zhelcheistechenie to drain the tubes should not exceed 50 ml, and took place by them. Effaced symptomatology was the main reason the diagnosis on complications lag 1-2 days. With the increase in the number of zhelcheistechenija is progressing not only peritonitis, but endogenous toxemia. In such cases, the expectant surgical treatment becomes dangerous to the life of the patient. However, the mere relaparatomy or drainage of abdominal cavity under ultrasound control does not ensure success in the treatment of this complication. To do this, you must use complex medication therapy, which helps secure the correction vodno-elektrolitnogo balance, renal and hepatic failure to conduct the fight against toxemias and microbial aggression.
Postoperative biliary peritonitis usually driven by technical
and tactical mistakes when performing cholecystectomy. Most
frequently surgeons admit negligence when closing a lodge of
the gall bladder. Rough pricking the surrounding liver tissue
accompanied by damage to needle close located vnutripechenerngo
bile duct that is accompanied by the expiration of bile into the
abdominal cavity-free. In such cases rarely imposed the seams do
not provide impermeability Lodge. Risk of bile peritonitis increases
dramatically when injury anomalous biliar no traumatic ducts.
For this reason, when determining the patient’s development
anomalies Brigade must immediately be turned surgeon, has
extensive experience in biliary tract surgery. Particular nuisance
calls cause gall development of peritonitis such as migration of
the tube, which the surgeon introduced clearance exegeses. Most
often this occurs when the patient is rotated on its side. However,
it tube prolapsed may occur and when the surgeon does not take
into account its length from exegeses and up to the abdominal wall.
If it is short, when awakening the patient strains, inflates, twitches, and as a result dramatically increases the distance from exegesis and to the anterior abdominal wall and tube vydjorgivaetsja of duct, that is to create a vnutribrjushinnyj supply of its length. Wound choledochitis usually occurs when a patient has a dense inflammatory infiltrate. Of particular concern is the incidence of severe biliary peritonitis while destructive-nekroticheskom lesions of gallbladder and pancreas. These patients require not only adequate drainage of the abdominal cavity, but also sound therapy and antifermentnuju is pathogenetically local hypothermia pancreas.
Annotation
Keywords:Operation; complication; bile peritonitis; diagnosis; treatment
Introduction
Material and Methods
A complication they had revealed before relaparotomy and confirmed during the repeated surgical intervention. For the diagnosis of this complication conducted clinical and laboratory, biochemical and instrumental examinations, including ultrasound, CT scan, x-ray and laparoscopy, abdominal and thoracic cavities. From 83 patients were carried out at relaparotomy 22 (26.5%) of them have 18 with symptoms of widespread peritonitis and 4 after random enforced pulling the drain tube from the patient when turning-exegesis nabob (among these patients during relaparotomy discovered a clump of bile under the liver). At 41 (49.4%) same patient relaparotomy was replaced by venting bile accumulation zones (in the right podreberie, right side canal and pelvic cavity) under ultrasound control. Reasons for the development of postoperative bile peritonitis were: continuing peritonitis-27 (32.5%), non-suite lodge gallbladder-38 (45.9%), corruption of abnormally developed bile ducts-3 (3.6%), the migration of the drainage tube from exeresis-8 (9.6%), wound choledochitis-7 (8.4%) On clinical flow disease from 83 patients, only 12 (14.4%) There were symptoms of peritonitis, and 71 (85.6%)-they were erased.
On the prevalence of abdominal lesion bed (limited and unlimited) peritonitis diagnosed at 65 (78.3%), and common-u 18 (21.7%) should indicate if local peritonitis symptoms of peritoneal sepsis was observed then when they were distributed in all patients, and 5 (6%) He even accompanied the infectious-toxic shock (these patients died). Marked by a certain relationship between severity of endogenous intoxication and volume zhelcheistechenija. So, if you lose your 300-500 ml of bile develops local peritonitis with mild degree of intoxication, 500-1000 ml-diffusive-spilled with average and more than 1000 ml-General severe peritonitis. From 83 patients with Leukocytosis, with a shift of Leukocyte formula left, there were only 31 (37.3%). Thus, in the majority of patients leading diagnostic test was abundant expiration of bile from the abdominal cavity, or drainage, or past them.
Results
Discusión
It is possible to explain the cover bed great seal and other soft tissues, limiting the speed of zhelcheistechenija. Rate and amount of bile in the free abdomen mostly depend on the diameter and the nature of the damage to the bile duct, as well as on the availability of occlusion is below the level of his trauma. The greater was hypertension, the faster evolved intoxication, with 8 (9.6%) patient’s zhelcheistechenie to drain the tubes should not exceed 50 ml, and took place by them. Effaced symptomatology was the main reason the diagnosis on complications lag 1-2 days. With the increase in the number of zhelcheistechenija is progressing not only peritonitis, but endogenous toxemia. In such cases, the expectant surgical treatment becomes dangerous to the life of the patient. However, the mere relaparatomy or drainage of abdominal cavity under ultrasound control does not ensure success in the treatment of this complication. To do this, you must use complex medication therapy, which helps secure the correction vodno-elektrolitnogo balance, renal and hepatic failure to conduct the fight against toxemias and microbial aggression.
Conclusion
If it is short, when awakening the patient strains, inflates, twitches, and as a result dramatically increases the distance from exegesis and to the anterior abdominal wall and tube vydjorgivaetsja of duct, that is to create a vnutribrjushinnyj supply of its length. Wound choledochitis usually occurs when a patient has a dense inflammatory infiltrate. Of particular concern is the incidence of severe biliary peritonitis while destructive-nekroticheskom lesions of gallbladder and pancreas. These patients require not only adequate drainage of the abdominal cavity, but also sound therapy and antifermentnuju is pathogenetically local hypothermia pancreas.
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