EUROMEDICA  Hanover 23-24  Mai 2011	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover

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Despite the introduction of new diagnostic tools, the expansion of the possibilities of the operational techniques and drug therapy of acute intestinal obstruction remains one of the most terrible diseases, takes 3-4 place in urgent surgery of abdominal organs. In recent decades, maintained a steady tendency to increase the number of patients with acute intestinal obstruction and among patients with emergency surgical pathology, it is up to 14,5%

Purpose: prove the high diagnostic capability of the ultrasonic method at all stages of development of acute intestinal obstruction in children.

Materials and Methods: the ultrasound examination was performed in 36 patients (ratio of boys to girls 1:1) with acute small bowel obstruction before surgery and at 1-2, 3-4, 5-6, 7-9 postoperative days on devices Sonoline «SL -1 company «Siemens», Combisone 530 D, Sono Ase 8,800 MT with a gray scale in real time using a linear, convex and sector transducers with a frequency of 3500 MHz.

The results of the studies: ultrasound symptoms of early stages of development of high acute intestinal obstruction syndrome (intestinal hypertension) in children were intraintestinal syndrome of deposit of the liquid and expansion of the loops of the small intestine leading to ≤ 3,06 ± 0,1 mm defined, respectively, via 2,3 ± 0,02 and 2,7 ± 0,02 (P<0,05) hours after acute obstruction (according as anamnestic data). Further development of the pathological process with the formation of intestinal insufficiency syndrome (local stage) shifts the emphasis sonographic signs in the direction of those who testify to the functional disorders of the small intestine. These include the syndrome of deposit intraintestinal fluid, expanding the diameter of the small intestine to 3,96 ± 0,01 cm (P<0,05), thickening of the wall up to 4,52 ± 0,1 mm (P<0,05) and the emergence of 15, 3 ± 0,08 hours (P<0,05) from the time of obturation symptoms of congestive stomach. Ultrasound examination of patients with an low acute intestinal obstruction revealed a higher frequency of occurrence and severity of sonographic signs of obstruction than in the high-level obturation. Syndrome of intraintestinal deposit of fluid through 5,0 ± 0,01 hours (P<0.01) after acute obstruction of the small intestine was determined in nearly all patients (97.2%). Signs are indicative of the degree of expansion of the small intestine to 3,84 ± 0,14 mm and a thickening of its walls to 4,05 ± 0,02 mm, 20,7 2% (P<0.05) and 4.44% ( P<0.05) than under the same terms of high acute intestinal obstruction. Development of a local stage intestinal failure syndrome is characterized by a pronounced wall thickening of the small intestine to 4,56 ± 0,04 mm (P<0.05) and increase its diameter up to 4,39 ± 0,2 cm (P<0.05). With the development of universal stages of intestinal insufficiency syndrome noted thickening of the intestinal wall to 4,61 ± 0,04 mm and the appearance of effusion in the abdominal cavity through a 25,1 ± 0,7 hours from the onset.

Conclusions: The sensitivity of the ultrasonic method in the early phase (intestinal syndrome of hypertension), high development of acute intestinal obstruction was 68.3%, at an early stage of development of low obstruction of 87.5%. Development of high acute intestinal obstruction is accompanied by smaller structural-functional disorders than low acute intestinal obstruction. Late stages of development (a syndrome of intestinal insufficiency), both high and low acute intestinal obstruction, accompanied by an increased frequency of ultrasonic signs of small bowel obstruction. Syndrome of intestinal insufficiency in the universal stage is a risk of the development festering-septic complications and revealled ultrasonic under-signs are identified as a poor prognostic signs for the postoperative period.