Acute Intestinal Obstruction of Nonneoplastic Origin: Current State of the Problem

Recent Russian and foreign publications on the problem of surgical management of acute intestinal obstruction of nonneoplastic origin were reviewed. Current views on the main pathogenetic aspects determining the severity of the disease and the high incidence of lethal complications were represented. The features of the pathology in elderly patients were shown. There was proved the necessity of a comprehensive examination of patients enabling to determine not only the obstruction nature, but also the degree of functional impairments of vital organs and systems due to the comorbidity; and emphasized the complexity of intraoperative assessment of the viability of the bowel area with impaired blood supply making surgeons to expand the volume of bowel resection. The features of the decompression nasogastrointestinal intubation of the digestive tract and its sanitation through a probe were represented. The feasibility of a multidisciplinary approach in preoperative preparation planning and choosing an anesthetic technique and treatment of patients after the surgery was demonstrated.

1. Dederer Yu.M. Patogenez i lechenie ostroy neprokhodimosti kishechnika [Pathogenesis and treatment of acute intestinal obstruction]. Moscow: Meditsina; 1971; 272 p.
2. Mayorov M.I. Klinicheskie aspekty ostroy kishechnoy neprokhodimosti. Avtoref. dis. … dokt. med. nauk [Clinical aspects of acute intestinal obstruction. Dissertation for the degree of Doctor of medical science]. Moscow; 2003.
3. Chupris V.G. Ostraya tonkokishechnaya neprokhodimost’ neopukholevogo geneza (patogenez, diagnostika, lechenie) (kliniko-eksperimental’noe issledovanie). Avtoref. dis. … kand. med. nauk [Acute small bowel obstruction of nonneoplastic origin (pathogenesis, diagnostics, treatment) (clinical and experimental study). Dissertation for the degree of Candidate of medical science]. Saint Petersburg; 2009.
4. Bass K.N., Jones B., Bulkley G.B. Current management of small-bowel obstraction. Adv Surg 1997; 31: 1–34.
5. Miyauchi Т., Kuroda T., Nisioka M., Hashimoto T., et al. Clinical study of strangulation obstraction of the small bowel. J Med Invest 2001; 48(2): 66–72.
6. Kurygin A.A., Stoyko Yu.M., Bognenko S.F. Neotlozhnaya khirurgicheskaya gastroenterologiya [Emergency surgical gastroenterology]. Saint Petersburg: Piter; 2001; 469 p.
7. Plechev V.V. Ostraya spaechnaya kishechnaya neprokhodimost’ (problemy, resheniya) [Acute adhesive intestinal obstruction (problems and solutions)]. Ufa; 2004; 279 p.
8. Külah B., Gülgez B., Özmen M.M., et al. Emergency bowel surgery in the elderly. Turkish J Gastroenter 2003; 14(3): 189–193.
9. Arenal J.J., Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 2003; 46: 111–116.
10. Gurleyik E. Small bowel volvulus: a common cause of mechanical intestinal obstruction in our region. Eur J Surg 2003; 1: 51–55.
11. Rukovodstvo po neotlozhnoy khirurgii organov bryushnoy polosti [Guidelines for emergency abdominal surgery]. Pod red. Savel’eva V.S. [Savel’ev V.S. (editor)]. Moscow: Triada-Kh; 2004; 640 p.
12. Dibirov M.D., Rodionov I.E., Kakubava M.R., Yuanov A.A., et al. Korrektsiya vnutribryushnoy gipertenzii i mikrotsirkulyatsii u bol’nykh ostroy kishechnoy neprokhodimost’yu starcheskogo vozrasta [Correction of intraabdominal hypertension and microcirculation in patients with acute intestinal obstruction in the elderly]. Moskovskiy khirurgicheskiy zhurnal — Moscow Surgical Journal 2012; 3(25): 9–14.
13. Guzeev A.I. Intubatsiya tonkoy kishki v neotlozhnoy abdominal’noy khirurgii [Small bowel intubation in emergency abdominal surgery]. Vestn Hir Im II Grekova — Surgery Reporter named after I.I. Grekov 2002; 161(2): 92–95.
14. Totikov V.Z., Kalitsova M.V., Amrillaeva V.M. Lechebno-diagnosticheskaya programma pri ostroy spaechnoy obturatsionnoy tonkokishechnoy neprokhodimosti [Diagnostic and treatment program in acute adhesive small bowel obstruction]. Khirurgiya — Surgery 2006; 2: 38–43.
15. Kalff J.C. Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus. Ann Surg 2007; 1: 228–232.
16. Rybachkov V.V., Mayorov M.I., Makanov O.A. Neyrogumoral’nye izmeneniya pri ostroy kishechnoy neprokhodimosti [Neurohumoral changes in acute intestinal obstruction]. Vestn Hir Im II Grekova — Surgery Reporter named after I.I. Grekov 2005; 164(1): 25–28.
17. Savel’ev V.S., Petukhov V.A., Karalkin A.V., et al. Sindrom kishechnoy nedostatochnosti v urgentnoy abdominal’noy khirurgii: novye metodicheskie podkhody k lecheniyu [Intestinal insufficiency syndrome in urgent abdominant surgery: new methodological approaches to treatment]. Trudnyy patsient — A Difficult Case 2005; 4.
18. Gel’fand B.R., Protsenko D.N., Podachin P.V., et al. Sindrom abdominal’noy gipertenzii: sostoyanie problemy [Abdominal hypertension syndrome: the state of the problem]. Meditsinskiy alfavit. Neotlozhnaya meditsina — Medical Alphabet. Emergency Medicine 2010; 3: 34–42.
19. Lukoyanychev E.E. Khirurgicheskaya korrektsiya intraabdominal’noy gipertenzii pri ostroy kishechnoy neprokhodimosti (eksperimental’no-klinicheskoe issledovanie). Avtoref. dis. … kand. med. nauk [Surgical correction of intraabdominal hypertension in acute intestinal obstruction (experimental and clinical study). Dissertation for the degree of Candidate of medical science]. Nizhny Novgorod; 2011.
20. Brush K.A. Abdominal compartment syndrome: the pressure is on. Nursing 2007; 31: 37–40.
21. Vidal M.G., Ruiz Weisser J., Gonzalez F., et al. Incidence and clinical effects of intra-abdominal hypertension in critically ill patients. Crit Care Med 2008; 36: 1823.
22. Petukhov V.A., Son D.A., Mironov A.V. Endotoksinovaya agressiya i disfunktsiya endoteliya pri sindrome kishechnoy nedostatochnosti v ekstrennoy khirurgii bryushnoy polosti: prichinno-sledstvennye vzaimosvyazi [Endotoxin invasion and endothelial dysfunction in intestinal insufficiency syndrome in emergency abdominal surgery: cause-effect relationship]. Annaly khirurgii — Surgery Annals 2006; 5: 27–33.
23. Rakhmatullin Yu.Ya. Rezul’taty lecheniya ostroy kishechnoy neprokhodimosti [Results of treatment of acute intestinal obstruction]. Vestnik KazNMU — Vestnik of KazNMU 2012; 1: 281–283.
24. Kahi C.J., Rex D.K. Bowel obstruction and pseudoobstruction. Gastroenterol Clin North Am 2003; 32: 1229–1247.
25. Miller G., Boman J., Shrier I., Gordon P.H. Etiology of small bowel obstraction. Am J Surg 2000; 180(7): 33–36.
26. Gavrilik B.L. Spaechnaya kishechnaya neprokhodimost’. V kn.: Aktual’nye voprosy neotlozhnoy khirurgii: neprokhodimost’ kishechnika: sbornik nauchnykh trudov [Adhesive intestinal obstruction. In: Relevant problems of urgent surgery: bowel obstruction: collection of scientific papers]. Otv. red. Smotrin S.M. [Smotrin S.M. (editor)]. Grodno: 2012. P. 10–14.
27. Grigor’ev P.Ya., Yakovenko A.V. Klinicheskaya gastro-enterologiya [Clinical gastroenterology]. Moscow: Meditsinskoe informatsionnoe agentstvo; 2001; 704 p.
28. Eryukhin I.A., Petrov V.P., Khanevich M.D. Kishechnaya neprokhodimost’ [Bowel obstruction]. Saint Petersburg: Piter; 1999; 448 p.
29. Milyukov V.E. Izmeneniya gemomikrotsirkulyatornogo rusla pri raznykh vidakh kishechnoy neprokhodimosti [Changes in hemomicrocirculatory bloodstream in different types of bowel obstruction]. Morfologiya — Morphology 2001; 120(5): 31–34.
30. Korymasov E.A., Gorbunov Yu.V. Printsipy differentsial’noy diagnostiki i taktiki pri ostroy kishechnoy neprokhodimosti [Principles of differential diagnosis and management in acute intestinal obstruction]. Khirurgiya — Surgery 2003; 3: 101–106.
31. Ignat’ev V.V. Algoritm khirurgicheskogo lecheniya bol’nykh s ostroy kishechnoy neprokhodimost’yu. Avtoref. dis. … kand. med. nauk [Algorithm of surgical management of patients with acute intestinal obstruction. Dissertation for the degree of Candidate of medical science]. Yakutsk; 2005.
32. Bogdanovich A.V., Shilenok V.N., Kirpichenok L.N. Ispol’zovanie ingibitorov proteoliza v lechenii bol’nykh ostroy spaechnoy kishechnoy neprokhodimost’yu [The use of proteolysis inhibitors in treatment of patients with acute adhesive intestinal obstruction]. Vesti Natsional’noy akademii nauk Belarusi — News of Belarusian National Academy of Sciences 2008; 1: 119–123.
33. Fevang B.T., Jensen D., Svanes K., et al. Early operation or conservative management of patients with small bowel obstruction? Eur J Surg 2002; 168: 475–481.
34. Williams S.B., Greenspon J., Young H.A., et al. Small bowel obstruction: conservative vs. surgical management. Dis Colon Rectum 2005; 48(6): 1140–1146.
35. Korymasov E.A., Gorbunov Yu.V. Kogda pokazana operatsiya pri spaechnoy kishechnoy neprokhodimosti [When surgery is indicated for in adhesive intestinal obstruction]. Skoraya meditsinskaya pomoshch’ — Emergency Medical Service 2004; 5(3): 91–92.
36. Chen S.C., Yen Z.S., Lee C.C., et al. Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial. CMAJ 2005; 173(10): 1165–1169.
37. Senlin P. Small Intestine obstruction. Physiopathology, etiology, diagnosis, treatment. Rev Prat 2005; 17: 1927–1932.
38. Biondo S., Pares D., Mora L., et al. Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstruction. Br J Surg 2003; 90: 542–546.
39. Jang T.B., Schindler D., Kaji A.H. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J 2011 Aug; 28(8): 676–678.
40. Wiarda B.M., Horsthuis K., Dobben A.C., et al. Magnetic resonance imaging of the small bowel with the true FISP sequence: intra- and interobserver agreement of enteroclysis and imaging without contrast material. Clin Imaging 2009; 33(4): 267–273.
41. Sheyanov S.D., Kharitonova E.A., Zukhraeva Z.I. Diagnostika ostroy spaechnoy kishechnoy neprokhodimosti metodom izmereniya vnutribryushnogo davleniya [Diagnostics of acute adhesive intestinal obstruction by intraabdominal pressure measurement]. Vestn Hir Im II Grekova — Surgery Reporter named after I.I. Grekov 2012; 171(5): 24–30.
42. Sobolev V.E. Laparoskopiya pri ostroy neprokhodimosti kishechnika [Laparoscopy in acute intestinal obstruction]. Endosk Hir — Endoscopic Surgery 2007; 2: 18–20.
43. Franklin M.E., Jr. Gonzalez J.J., Miter D.B., et al. Laparoscopic diagnosis and treatment of intestinal obstruction. Surg Endosc 2004; 18: 26–30.
44. Bailey I.S. Laparoscopic management of acute small bowel obstruction. Br J Surg 2008; 1: 84–87.
45. Hendrickson M., Naparst T.R. Abdominal surgical emergencies in the elderly. Emerg Med Clinic North Am 2003; 21: 937–969.
46. Hayanga A.J., Bass-Wilkins K., Bulkley G.B. Current management of small-bowel obstruction. Adv Surg 2005; 39: 1–33.
47. Khryachkov V.V., Sazanov V.V. Novye sposoby opredeleniya zhiznesposobnosti diskreditirovannykh uchastkov kishki v khirurgii [New methods for determination of viability of discredited bowel areas in surgery]. Khanty-Mansiysk: Poligrafist; 2000; 40 p.
48. Leont’ev S.N., Sovtsov S.A., Podshivalov V.Yu. Diagnosticheskaya tsennost’ dopplerografii pri mekhanicheskoy kishechnoy neprokhodimosti [Doppler sonography diagnostic value in mechanical intestinal obstruction]. Vestn Hir Im II Grekova — Surgery Reporter named after I.I. Grekov 2002; 26: 37–39.
49. Dadzhiev A.B. Sostoyanie mikrotsirkulyatsii v stenke kishki pri obturatsionnoy kishechnoy neprokhodimosti i ee vliyanie na vybor ob”ema i kharaktera operatsii. Avtoref. dis. … kand. med. nauk [Microcirculatory condition in bowel wall in obturation intestinal obstruction and its effect on the choice of the operation volume and character. Dissertation for the degree of Candidate of medical science]. Moscow; 2009.
50. Vorobey A.V., Shuleyko A.Ch., Lur’e V.N. Puti uluchsheniya rezul’tatov lecheniya bol’nykh s tonkokishechnoy neprokhodimost’yu [Methods of improvement of treatment results of patients with small bowel obstruction]. Khirurgiya — Surgery 2012; 10: 35–39.
51. Krums L.M., Sabel’nikova E.A. Sindrom korotkoy tonkoy kishki: aktual’nye voprosy patogeneza, kliniki i lecheniya [Short small bowel syndrome: relevant problems of pathogenesis, clinical picture and treatment]. Consilium medicum 2002; 2: 27–29.
52. Chupris V.G., Pelipas’ Yu.V., Boyarinov D.Yu. Morfologicheskie izmeneniya v stenke tonkoy kishki pri strangulyatsionnoy kishechnoy neprokhodimosti [Morphological changes in small bowel wall in strangulated intestinal obstruction]. Problemy biologii i meditsiny — Problems of Medicine and Biology 2004; 38(4): 119.
53. Akcakaya A., Alimoglu O., Sahin M., Abbasoglu S.D. Ischemia-reperfusion injury following superior mesenteric artery occlusion and strangulation obstruction. J Surg Res 2002; 108(l): 39–43.
54. Diaz J.J. Jr., Bokhari F., Mowery N.T., Acosta J.A., et al. Guidelines for management of small bowel obstruction. J Trauma 2008 Jun; 64(6): 1651–1664.
55. Tamazashvili T.Sh. K voprosu odnovremennoy dekompressii razlichnykh otdelov pishchevaritel'nogo trakta [The study of simultaneous decompression of different parts of the digestive tract]. Klinicheskaya khirurgiya — Clinical Surgery 1986; 8: 77–78.
56. Timerbulatov V.M., Khunafin S.N., Gattarov I.Kh., et al. Klinika i khirurgicheskoe lechenie spaechnoy kishechnoy neprokhodimosti [Clinical picture and surgical treatment of adhesive intestinal obstruction]. Vestn Hir Im II Grekova — Surgery Reporter named after I.I. Grekov 1999; 158(6): 36–39.
57. Shal’kov Yu.L., Vorozhko A.G. Intubatsiya zheludochno-kishechnogo trakta: retrospektivnaya otsenka pokazaniy i rezul’tatov [Ggastrointestinal tract intubation: retrospective assessment of indications and results]. Ukraїns'kiy zhurnal khіrurgії — Ukrainian Journal of Surgery 2011; 6(15): 85–89.
58. Abdulzhalilov M.K. Puti povysheniya effektivnosti nazointestinal’nogo drenirovaniya u bol’nykh s ostroy kishechnoy neprokhodimost’yu i peritonitom [The improvement of nasointestinal drainage efficiency in patients with acute intestinal obstruction and peritonitis]. Khirurgiya — Surgery 2003; 4: 39–41.
59. Fleshlier P.R., Siegman M.G., Slater G.I., et al. A prospective, randomized trial of short versus long tubes in adhesive small-bowel obstruction. Am J Surg 1995; 4: 366–370.
60. Babaev A.A., Shishikhin A.B., Zorin P.V. Intubatsiya tonkogo kishechnika i ego lavazh ozonirovannym rastvorom v kompleksnom lechenii ostroy tonkokishechnoy neprokhodimosti. V kn.: Materialy IX Vserossiyskogo s”ezda khirurgov [Small bowel intubation and its lavage by ozonized solution in complex treatment of acute small bowel obstruction. In: Proceedings of IX All-Russian congress of surgeons]. Volgograd; 2000. Р. 142.
61. Beyrout I., Gargouri F., Gharbi A., et al. Late post-operative adhesive small bowel occlusions. Tunis Med 2006; 84(1): 9–15.
62. Fazio V.W., Cohen Z., Fleshman J.W., et al. Reduction in adhesive small-bowel obstruction by Seraphim adhesion barrier after intestinal resection. Dis Colon Rectum 2006; 49(1): 1–11.
63. Fevang B.T., Fevang J., Lie S.A., Soreide O., et al. Long-term prognosis after operation for adhesive small bowel obstruction. Ann Surg 2004 Aug; 240(2): 193–201.
64. Yudin A.B., Demko A.E., Chupris V.G. Rannyaya enteral’naya terapiya u bol’nykh, operirovannykh po povodu ostroy spaechnoy tonkokishechnoy neprokhodimosti [Early enteric therapy in patients operated for acute adhesive small bowel obstruction]. Voenno-meditsinskiy zhurnal — Military Medical Journal 2008; 6: 60–61.
65. Gel’fand B.R., Gur’yanov V.A., Martynov A.N., et al. Profilaktika stress-povrezhdeniy zheludochno-kishechnogo trakta u bol’nykh v kriticheskikh sostoyaniyakh [Prevention of gastrointestinal stress-damages in patients in critical conditions]. Consilium medicum 2005; 7(6).

Menkov А.V., Gavrilov S.V. Acute Intestinal Obstruction of Nonneoplastic Origin: Current State of the Problem. Sovremennye tehnologii v medicine 2013; 5(3): 109