Репозиторий Университета

© 2018 Vitebsk State Medical University. All rights reserved. The aim of this review is a detailed description of the alleged mechanisms of involving the adrenal glands, as a key element of the system of nonspecific protection of an organism and adaptation to stress, in the pathogenesis of clinical manifestations of acute small bowel obstruction and developing complications, including peritonitis, sepsis and multiple organ failure. In the discussion of the pathogenesis of clinical manifestations of acute small bowel obstruction and its complications, leading to the disappointing results of treatment of patients on a large sample of contemporary scientific publications, it is noted that many researchers see a close connection between the influence of various stress effects on humans and the functioning of internal organs and systems. It is demonstrated that in the literature there is growing evidence of the negative effects of stress and related affective disorders on the course of inflammatory bowel diseases and gastrointestinal tract, which is one of the targets of stress, and hormones of the hypothalamicpituitary- adrenal system, especially the adrenal glands take an active part in the mediation of these reactions. The conducted analysis of the current literature demonstrates a large number of unsolved issues in this direction, that proves the need for a comprehensive experimental and morphological studies to clarify and detail all pathogenetic links of dependent morpho-functional transformations in the dynamics of development of acute small bowel obstruction which may lead to adrenal insufficiency and disruption of adaptation mechanisms that maintain the stability of homeostasis.

AIM: To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction.MATERIAL AND METHODS: The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience.RESULTS: It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.