Title:Pathogenetic Correction of the Enteric Insufficiency Syndrome in Patients with Advanced Peritonitis
Volume: 16
Issue: 3
Author(s): Fedor N. Ilchenko, Sergey G. Grivenko, Igor V. Kaminsky, Yuriy V. Artemov, Evelina R. Kondratiuk, Vitalii B. Kaliberdenko, Shanmugaraj Kulanthaivel*Keerthanaa Balasundaram
Affiliation:
- Department of Internal Medicine No. 2, V.I. Vernadsky Crimean Federal University, Simferopol,Russian Federation
Keywords:
Peritonitis, enteric insufficiency, antiendotoxin immunity, anti-endotoxin antibodies, lipopolysaccharide, dioctahedral
smectite.
Abstract:
Introduction: Common purulent peritonitis is one of the most formidable complications
in abdominal surgery. Evidence of this is the continuing high mortality rate, which according to
various authors, ranges from 11% to 83%. According to modern concepts, the leading role in the
development and progression of widespread purulent peritonitis is assigned to enteric insufficiency
syndrome (EIS), which occurs in 90-100% of cases.
Aim: The aim of the study was to improve the treatment outcomes of patients with peritonitis complicated
by the development of enteric insufficiency syndrome and also by developing and introducing
into clinical practice a complex of therapeutic measures, including the combined use of enterosorption
in combination with antioxidant and antihypoxant therapy.
Materials and Methods: The evaluation of the effectiveness of the proposed complex therapeutic
measures was carried out on the basis of a prospective examination of 83 patients (26 men and 57
women) aged 24 to 76 years with diffuse peritonitis with III-IV degree of operational risk for ASA.
The comparison group included 37 healthy people aged from 20 to 54 years.
All examined patients were divided into two clinical groups. The first clinical group consisted of
67 patients with EI of the first degree and second clinical group comprising 16 patients with II degree
EI. Before the operation, a suspension of enterosorbent was preliminarily prepared. Suspension
of DS was injected through the inserted probe using a Janet syringe, creating an exposure for
10-15 minutes; and then restored the free outflow of the contents of the probe. After completion of
the surgical intervention, in the conditions of the intensive care unit, enterosorption continued to
perform every 8 hours (3 times a day). The study was carried out before the operation and in the
terms of the 1-3rd and 10-14th days in the postoperative period. Anti-endotoxin antibodies of classes
A, M and G (respectively anti-LPS-IgA, anti-LPS-IgM, anti-LPS-IgG) were determined by
ELISA.
Results: When used in the postoperative period for the treatment of enteric insufficiency with detoxification
and antihypoxic therapy according to the developed method, a favorable effect is noted,
which is confirmed by an assessment of the state of antiendotoxin immunity associated with the
development of bacterial translocation and enterogenic toxemia.
Conclusion: The use of the proposed intestinal therapy in combination with antioxidant and antihypoxic
therapy helps to prevent the progression of endogenous intoxication, through inactivation
and effective clearance of toxic metabolites, reducing the effects of hypoxia, which leads to a significant
decrease in membrane-destabilizing effects from the intestinal cell structures and leads to a
significant decrease in the expressed specific antigen of the immune system and better clinical outcomes.
