The Experience of Using Ultrasound in Differential Diagnostics of Difficult Cases of Urgent Surgery (Mesenteric Thrombosis and Destructive Pancreatitis)

There has been presented the experience of using ultrasound in urgent abdominal surgery. There have been demonstrated the possibilities of US in difficult cases and urgent situations. Differential and diagnostic criteria in acute disorder of the mesenteric circulation and destructive pancreatitis have been given. Revealed ultrasonographic phenomena have been correlated with the data of clinical examination, infrared thermography (CEM ThermoDiagnostic), computer and magnetic resonance tomography, selective angiography, intraoperative review of abdominal cavity organs, as well as verified morphologically (fine needle and intraoperative biopsy) and assessed together with the results of surgical interference and conservative treatment. Clinical examples of using additional possibilities of the technique (performing diagnostic fine needle biopsy under US control) have been shown.

1. Bagnenko S.F., Gol'tsov V.R. et al. Tezisy dokladov 16-go Mezhdunarodnogo kongressa khirurgov-gepatologov [Abstracts of reports of 16th International congress of hepatological surgeons]. Ekaterinburg; 2009; p. 54.
2. Klinicheskoe rukovodstvo po ul’trazvukovoy diagnostike [Clinical guide on ultrasound diagnostics]. Pod red. V.V. Mit’kova [V.V. Mit’kov (editor)]. T. 1. Moscow: Vidar; 1996.
3. Debus E.S., Diener H., Larena-Avellaneda A. Acute intestinal ischemia. Chirurg 2009 Apr; 80(4): 375–385.
4. Ghisletta N., von Flue M., Eichlisberger E., Bruhwiler I., Ritz R., Harder F. Mesenteric venous thrombosis (MVT): a problem in diagnosis and management. Swiss Surg 1996; 2(5): 223–229.
5. Lui G.A., Poniachik T.J., Quera P.R., Bermudez E.C. Mesenteric vein thrombosis: clinical manifestations, treatment and outcome. Rev Med Chil 2005 Jan; 133(1): 17–22.
6. Kuntsevich G.I., Shilenok D.S. Hirurgia 1993; 7: 48–51.
7. Perko M.J. Duplex ultrasound for assessment of superior mesenteric artery blood flow. Eur J Vasc Endovasc Surg 2001 Feb; 21(2): 106–117.
8. Danse E.M., Kartheuser A., Paterson H.M., Laterre P.F. Color Doppler sonography of small bowel wall changes in 21 consecutive cases of acute mesenteric ischemia. JBR-BTR 2009 Jul-Aug; 92(4): 202–206.
9. Savel'ev V.S., Gel'fand B.R., Gologorskiy V.A. Anesteziologiya i reanimatologiya 1999; 6: 28–33.
10. Schneider L., Hartwig W., Flemming T., Hackert T., Fortunato F., Heck M., Gebhard M.M., Nawroth P.P., Bierhaus A., Bаchler M.W., Werner J. Protective effects and anti-inflammatory pathways of exogenous calcitonin gene-related peptide in severe necrotizing pancreatitis. Pancreatology 2009 Aug 14; 9(5): 662–669.
11. Vege S.S., Gardner T.B., Chari S.T., Munukuti P., Pearson R.K., Clain J.E., Petersen B.T., Baron T.H., Farnell M.B., Sarr M.G. Low mortality and high morbidity in severe acute pancreatitis without organ failure: a case for revising the Atlanta classification to include “moderately severe acute pancreatitis”. Am J Gastroenterol 2009 Mar; 104(3): 710–715.
12. Tolstoy A.D. Ostryy pankreatit. Trudnosti, vozmozhnosti, perspektivy. Klinicheskie lektsii [Acute pancreatitis. Difficulties, possibilities, prospects. Clinical lectures]. Saint Petersburg: Predpriyatie SPb Soyuza khudozhnikov. 1997; 140 p.
13. Butkevich A.Ts., Chadaev A.P., Lapin A.Yu., Sviridov S.V. Otkrytye dreniruyushchie operatsii v khirurgicheskom leche­nii rasprostranennogo infitsirovannogo pankreonekroza [Open drainage operations in surgical treatment of gene­ralized infected pancreatic necrosis]. Moscow: Granitsa; 390 p.
14. Bryukhovetskiy Yu.A. Znachenie kompleksnogo ul’tra­zvukovogo issledovaniya v diagnostike i diffe­rentsial’noy diagnostike form ostrogo pankreatita. Avtoref. dis. … kand. med. nauk [The importance of complex ultrasound in diag­nostics and differential diagnostics of acute pancreatitis. Abstract of Dissertation for the degree of Candidate of Medical Science]. Moscow; 1998.
15. Blagovestnov D.A., Khvatov V.B., Upyrev A.V., Grishin G.P., Novosel S.N. Hirurgia 2004; 5: 68–75.
16. Agaev B.A., Dzhafarli Z.E. Hirurgia 2010; 4: 63–66.
17. Kuznetsov N.A. et al. Hirurgia 2005; 11: 32–36.
18. Briskin B.S. et al. Vestn Hir im II Grekova 2008; 167(6): 105–109.
19. Peter A. Banks. Practice Guidelines in Acute Pancreatitis. Am J Gastroenterol 2006; 101: 2379–2400.

Firsova V.G., Parshikov V.V., Gradusov V.P., Artifexova А.А., Potekhina Y.P. The Experience of Using Ultrasound in Differential Diagnostics of Difficult Cases of Urgent Surgery (Mesenteric Thrombosis and Destructive Pancreatitis). Sovremennye tehnologii v medicine 2011; (4): 102