Preface

A group of pathological conditions characterized by the impaired passage of contents from the stomach to the rectum as well as the intestinal obstruction is associated with a very severe course, difficulty in diagnosis, and an unfavorable outcome. Mechanical intestinal obstruction is a current problem of emergency abdominal surgery. The frequency of intestinal obstruction is about 5 cases per 100,000, accounting for 3% to 5% of admissions to emergency surgical hospitals. Among all types of obstruction, small bowel obstruction predominates, which is distinguished by complex clinical manifestations and a poor prognosis. As a rule, it occurs due to adhesions after previous operations. However, there are also rarer causes, for example, gallstones, bezoars, and others. Large bowel obstruction, being one of the most common and dangerous complications of colon cancer, is observed in 15% to 75% of cases. Intestinal strangulation, caused by volvulus or incarceration, is the most insidious due to the rapid onset of ischemia and necrosis of the intestine and always requires urgent surgical intervention. Intestinal intussusception usually occurs in young children and, with timely diagnosis, can be successfully eliminated by conservative or endoscopic methods. Written by an international team of highly qualified specialists, this book will be of interest to anyone engaged in emergency abdominal surgery.

> **Dmitry Victorovich Garbuzenko** Professor, Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russia

**1**

**Chapter 1**

Introductory Chapter: Nuances

Adhesive small bowel obstruction is one of the most formidable urgent surgical diseases of the abdominal organs [1]. Surgeons that encounter this disease are well aware of how insidious it is and how difficult it is to treat this pathology. Adhesive small bowel obstruction may often be successfully resolved conservatively. However, if conservative treatment is not effective within 72 h, and if there are signs of peritonitis, strangulation, or bowel ischemia, surgery is necessary [2]. Very often, a surgeon on call decides on the necessity of surgery. This surgeon might not have a lot of experience, but has to deal with the disease face-to-face. However, even experienced specialists may run into significant difficulties during such surgical interventions [3]. The only way to disengage from such a situation with honor is to strictly follow tactics and techniques developed by doctors involved in emergency abdominal surgery. In this chapter, I would like to share the nuances of performing surgery in patients with acute adhesive small bowel obstruction, based on more

of Surgical Technique for the

Treatment of Adhesive Small

than 35-year experience of night shifts in an urgent surgical clinic.

Despite the achievements of laparoscopic surgery, in most cases of adhesive small bowel obstruction, surgery is performed via a wide incision of the anterior abdominal wall. The optimal surgical approach is midline laparotomy, which, if necessary, is extended up to the umbilicus or down to the pubic symphysis. If the patient has previously undergone midline laparotomy, it is expedient to start surgery with an incision upper or lower the scar. In any case, the scar, encapsulated non-absorbable sutures, and granulation tissue are excised, and the incision is

The parietal peritoneum in the area of the postoperative scar of the anterior abdominal wall always has gross adhesions with aponeurosis forming the *linea alba*. Moreover, as a rule, internal organs are fixed to the *linea alba* by adhesions. Therefore, the peritoneum should be lifted with tweezers and opened very carefully, since the dilated bowel loops may be easily damaged. It is better to keep the surgical site dry for a better view but achieve it without electrocauterization. When a small penetration into the abdominal cavity is achieved, the available area of the peritoneal cavity is carefully examined with a finger. Next, the abdominal wall is lifted with

Bowel Obstruction

*Dmitry Garbuzenko*

**1. Introduction**

**2. Surgical access**

treated with an antiseptic solution.

#### **Chapter 1**
