Novosti
Khirurgii

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Year 2019 Vol. 27 No 2

GENERAL & SPECIAL SURGERY

I.N. KLIMOVICH, S.S. MASKIN, P.V. ABRAMOV, A.V. PAVLOV

CLINICAL IMPORTANCE OF INTESTINAL INSUFFICIENCY SYNDROME IN ULCEROUS GASTRODUODENAL BLEEDINGS

Volgograd State Medical University, Volgograd,
The Russian Federation

Objective. To establish the frequency and predictors of intestinal insufficiency syndrome in patients with bleeding from gastroduodenal ulcers, to clarify its role in the pathogenesis of systemic dysfunctions.
Methods. The study involved 149 patients with bleeding from gastroduodenal ulcers. The severity of endotoxicosis in the intestinal insufficiency syndrome and without was investigated, the relationship of the syndrome with the formation of other systemic dysfunctions (for example, hepatic and renal failure) was traced.
Results. In the dynamics from the 1st to the 5th day of hospital stay, intestinal insufficiency syndrome was found in 72 (65%) patients out of 110 (110/149 – 74%) patients with only severe degrees of blood loss. In 90% of cases, the development of intestinal insufficiency syndrome was preceded by hypotension (systolic pressure <70 mmHg) of over 80 minutes duration. Ischemic-reperfusion injury of the small intestine wall led to the violation of its “barrier” function and a flood of blood with intraintestinal toxins, increasing systemic endotoxicosis reliably more significantly than in patients without the syndrome of intestinal insufficiency. In patients with the syndrome of intestinal insufficiency, systemic dysfunctions developed in 90% (65/72) of cases, and without it, only in 11% (4/38) of cases (p<0.05). This is explained by the fact that in the syndrome of intestinal insufficiency, an additional long-term toxic effect on the liver and kidneys leads to a breakdown in the adaptive capacities of their main functions, the violation of which extremely negatively affects homeostasis indicators. Mortality in the group with the intestinal insufficiency syndrome was 15% (11/72), and mortality in the group without the intestinal insufficiency syndrome was 5% (2/38).
Conclusions. 65% of patients with severe bleeding from gastroduodenal ulcers develop the intestinal insufficiency syndrome, which plays a significant negative role in the potentiation of systemic endotoxicosis, as a consequence in the formation of systemic dysfunctions and the outcome of the disease as a whole.

Keywords: syndrome of intestinal insufficiency, severe bleeding, ischemic-reperfusion injury, small intestine wall, «barrier» function, endotoxicosis
p. 161-167 of the original issue
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Address for correspondence:
400131, The Russian Federation,
Volgograd, Pavshih Boyzov Square, 1,
Volgograd State Medical University,
Department of Hospital Surgery.
Tel. office: 8(442) 71-87-62,
Tel. mobile: +7 905-336-23-69,
e-mail: klimovichigor1122@yandex.ru,
Igor N. Klimovich
Information about the authors:
Klimovich Igor N., MD, Professor of the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0002-7933-2635
Maskin Sergey S., MD, Professor, Head of the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0002-5275-4213
Abramov Pavel V., Post-Graduate Student, the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0002-8673-2581
Pavlov Alexandr V., PhD, Assistant of the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0002-1497-4231
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