Clinical Evaluation of the Method of Active Abdominal Drainage in General Peritonitis Rancid

Acute general putrid peritonitis refers to the severe inflammation of the peritoneum. He is constantly accompanied by jendotoksicheskim shock and progressive multiple organ failure. Macro and micro blood circulation in tissues and organs of the abdominal cavity Portal vein system is blocked from the first minutes the development of pathological process and toxins and nedookislennye metabolic products accumulate in them. For their removal requires efferent methods of treatment, one of which suggests the author of this article. Technical and physical techniques against a backdrop of complex drug therapy perpetrated as cleansing and forcible blood vessels promotion portal system. In this way manage to restore homeostasis. For developing this method, he was extradited to USSR patent (No. 1787036, dated March 7, 1991). To confirm the effectiveness of the proposed method of treatment, the author describes the clinical observations.


Introduction
Almost every sixth patient with acute surgical abdomen disease enters the hospital with symptoms of peritonitis, lethality which averages 20-39%, and severe forms, such as gnilostnoe (calves) inflammation of the peritoneum. It already reaches 80-90% [4.6]. The leading value in an unfavorable outcome of the treatment of the pathological process is given the progressive increase intra-abdominal pressure (LD) [1.4, 8]. It is established that primary remediation does not result in abdominal cavity odnomomentnomu eliminate inflammation of the peritoneum, and inadequate treatment tactics contributes to the progression of LD. Eventually develops intra-abdominal hypertension syndrome (SIAG)-abdominal compartment syndrome (ACS) [9.10]. The term was proposed in 1980 year Kron [2,7,11]. It occurs when the pressure in the abdominal cavity is closed already exceeds the level that ensures the normal blood flow to organs and tissues contained therein. The threshold of this pressure depends on the voltage of the abdomen with stretching of the abdomen, as well as the degree of hypovolemia. Typical clinical signs improve LD include: stressful and inflated abdomen, increased peak high pressure, increased CVP, reducing cardiac output, hypoxia, giperkapniju and Liguria [1,3,8]. Enhancement LD leads to the development of multiple organ failure. Understanding of all the reasons for the rise of the severity of the disease is extremely important in the question of how to develop appropriate treatment [1.4, 5]. At the present stage of development of medicine General peritonitis treatment remains one of the most difficult problems in emergency abdominal surgery. Due to the severity of the violations occurring homeostasis is always difficult to implement its correction. Typically, the algorithm of treatment includes drainage of the abdominal cavity. Bigger than the inflammatory process of peritoneum, the larger you want this drainage cavity ( fig. 1). This is required to ensure that does not remain enclosed cavities.  (1, 2.4) are used to imposing solutions, while the lower (3.5) for removing dializata from the abdominal cavity. However, all these methods are effective only when the LD does not block the micro and macro circulation of blood in the abdominal cavity. If this occurred, or passive outflow of pus, or active (via washing), change the situation. Intoxication quickly amplified and patients die. Such an outcome is usually observed when General putrid peritonitis. Improving the outcome of treatment of acute peritonitis, the authors relate or programmed relaparotomiej, or peritonealnym dialysis [1.3, 6]. However, these techniques do not adjust the portal circulation and multiple organ dysfunctions. With this in mind, we have developed a method of active drainage of the abdominal cavity which can be quickly complemented lavage-dialysis. It turned out to be the same as the known practices in vitro plasma purification on the effectiveness of the blood of toxins and nedookislennyh products. But they only clean inner Wednesday the body of toxins, and the proposed method restores blood flow to the portal system that significantly improves the prognosis.

The purpose of the study
On the basis of 4 clinical observations show therapeutic significance of the method of active drainage of the abdominal cavity.

Material and methods
Before applying in clinic treatment method described below General purulent peritonitis, we have conducted experiments on 3 Mongrel dogs. It was found that swelling rubber tank, located in the abdomen, does not cause cancer, and does not cause the development of adhesions in it and abscesses. It can be used for peritoneal dialysis as fluid dializirujushhej immerses in all departments of this cavity. Active drainage of the abdominal cavity is carried out as follows ( fig. 2). After eliminating the source of peritonitis, sanation of abdominal cavity and intestinal intubation, as by the stomach and rectum, impose 4 kontrapertury (both iliac and podrebernyh areas). Through these incisions into the abdominal cavity perforated plastic tubular misleading drainages, and next to them 2-e LaTeX containers of variable capacity. The most convenient containers made of latex surgical gloves, skylight which is tightly fixed frame ducts. Above the surface of the skin remains only perchatochnoe ring seal and air duct. If you intend to conduct peritoneal lavage-dialysis, then drains and gloves on the sides to seal tissue wounds. This prevents seepage of washing fluid from the abdominal cavity outwards during the procedure. Median wound sutured closed. In the House drains are connected to the measuring lines and ducts connected to HEPA objomnomu. Set parameters for the operation of the respirator: volume one capacity 300 cube. see discharge pressure-280 mm of water, and the reset is 0. The multiplicity of cycles varies from 22 to 28 in 1minutu. Preferred synchronization cycles at a frequency of respiratory excursion. In the case of surgery, this is accomplished by synchronizing two volumetric respirators. If you cannot sync with breathing, the multiplicity of standartiziruetsja cycles-cycle 22 per minute. The duration of the procedure using a volumetric respirator depends on strong recovery of intestinal peristalsis. Capacity of complex configuration, which is the glove to ensure both inflow and squeezing peritoneal exudate through drains, and produce a kind of internal massage of the entire abdominal cavity with passive transfer and the squeezing of the entire gastrointestinal tract. It promotes it gas and fluid that helps restore his Peristaltic activity. The most important positive property of this method is also restoring circulation in all tissues and organs of the abdominal cavity. Synchronize "intra-abdominal" massage with breathing; breathing creates a positive total pressure that dramatically increases the outflow of exudates on drainage. All these positive developments ensuring restoration of resistant peristalsis of the bowel during the 1-3 days. Optionally lavage continues until 5 days or more. This technique has been applied from 4 patients suffering from common gnilostnym (fecal) peritonitis. Age they had from 27 to 47 years. Of these 3 men and women -1. Everyone was open or closed injury of a division of the colon,: first-internal pneumatic rupture of the sigmoid colon, second-shot rektosigmovidnogo her third Division-stabbed downward guts, the fourth closed the gap the cecum. The wounds were from 3 cm long and up to 12 cm and circumference ranging from ¼ and up to ¾ diameter. The most extensive was the gap that Sigma occurred during the "comic" gas injection through the anus.
All patients received via 18-22 hours after the accident in predagonalnom condition. Consciousness was sputannoe. Skin cianotichnye and cold to the touch. HELL was 40-20/20-0 mm Hg. pillar, the pulse is thready, belly swollen dramatically, tongue dry and covered with Brown fur, urine was absent from patients assumed putrid smell. What they did not cause peritonitis, no doubt. Attested and history data. Figure. 2 Active abdominal drainage Scheme, where: 1-frame tube. introduced in the opening rubber container, 2-ring-seal glove, 3-drainage tube held beside the glove in the left side of the abdomen, Channel 4-drainage tube held beside the glove over the liver, 5-the same pipe carried out under liver, 6-the same tube held to the spleen, 7-intraperitoneal end tube held in the left side channel 8-same tube introduced into the cavity of the lesser pelvis, 9-frame tube introduced into the gloves, 10-11-tee, connecting both frame tubes with hose breathing respirator.
. After relative stabilization of blood pressure, run relaparatomy. From free Affected immediately directed to the operating room. Created teams of 2-3 surgeons, anesthesiologist and transfuziologa of abdominal cavity washed over the malodorous muddy effusion. Bowel loops were covered with brownish-grey fibrin and brazed among you in one conglomerate. After his separation, discovered the source of the peritonitis. He was eliminated after the first readjustment this cavity. Surgical tactics depended on the nature of the damage to the wall of the colon, but all 4 patients was excision of necrotic tissue bowel wall with transverse primary anastomosis. Precision joints were used, and after clearance carried out wide anastomosis vapor tube. After performing secondary sanitation of the abdominal cavity with up to 20 liters of solution furazilina (1:5000), was conducted by the excretion of anastomosis of abdominal cavity in the coming predbrjushinnye fabric. To do this, focus jazykoobraznyj ventral incision. The flap turned away. The wound surface was formed by anastomosis, which by abdominal flap of peritoneum educated fled. To anastomozu from the skin using pass-through puncture, summarized control rubber Strip. This is done in case suddenly comes failure-to intestinal contents of izlivalos outward, rather than in the free abdomen. Then carried out drainage of abdominal cavity using drainage tubes, as well as the introduction of rubber containers, whose forefathers also the methodology described above. Operating the victim walked into the intensive care unit and organized internal massage of the abdomen. Simultaneously to all patients during the 2-3 days held by the following procedure peritoneal dialysis. The abdominal cavity joined 100-200 ml of fat emulsion is recommended for injecting. Then, begin instillation of dializirujushhih solutions. Crucial is the alternation of every 4:00 Jet and a drip of different fluids with meticulous monitoring of their balance. The lower two levels fall below the drainage bed in measuring container, and the three top align system for intravenous fluids. Lavage-dialysis begins with Jet into the abdominal cavity through the three upper drainage 200-300 ml 0.25% solution novokaina, while controlled by Jet discharge of liquid from the lower drainages. Then also Jet instiliruetsja mixture furazilina with hydrogen peroxide (300-350 ml furazilina + 100-150 ml 3% solution of hydrogen peroxide), and then 300-500 ml 5% glucose solution or 500-1000 ml kristalloidnogo complex solution. Upon termination of the Jet dializata income from the abdominal cavity, i.e. the completion of the first cycle of the lavage, drip begins the introduction into the abdominal cavity 1.5% solution of sodium chloride, or more complex salt solution that lasts 4:00. At this time is cleansed of toxins and nedookislennyh homeostasis of metabolic products, i.e. committed dialysis. Then everything repeats itself. During the second cycle of this process, 2-3 times daily dializata composition included antibiotics-based antibiograms, as well as 300-500 ml 5% glucose solution and 100-150 ml of fat emulsion. They increases the sorption of toxins from the abdomen (due to increased osmotic perforate capacity) and monitors the progression of the process in the abdominal cavity.

The results
All these patients safely recovering from an operation. Postoperative period 3 have leaked without complications and recovery. 4 have the patient (male 27 years), whose gap cecum occurred simultaneously with multiple fracture of oskolchatym pelvic bones, 5 day, when active abdominal drainage was finished because the bowel motility, restored all of a sudden death. The autopsy showed that a major breakthrough hematoma in his brain ventricles. Abdomen was free from adhesions. However, still continued swelling and hyperemia of the peritoneum. Failure of sutures anastomosis has not been identified.

Discussion
Clinical analysis described how active drainage of abdominal cavity allows restoring homeostasis with the most severe form of putrefactive peritonitis. Internal massage of the abdomen organs and tissues, promotes blood into the portal system, which is not observed in all other efferent methods of treatment of this disease. The use of peritoneal lavage-dialysis enhances its detoxification effect. This is clearly evident in the treatment of patients with fecal peritonitis.

Conclusion
The developed method of active drainage of the abdominal cavity is an alternative to all other methods of treatment of the most severe forms of General peritonitis. Using it you can implement passive promotion of blood into the portal system, which is extremely important in the prognosis of the disease. Combined application of lavagedialysis can significantly improve the results of treatment of General purulent peritonitis due to: (a) strengthening the peritoneum perfusion), b) strengthening abdominal drainage in) quick recovery of motor-evacuation bowel function, g) significant purification from toxins and nedookislennyh homeostasis of metabolic products.

Cover Letter
Hereby guarantee that the placement of the scientific article "Clinical evaluation of the method active abdominal drainage in General peritonitis rancid» Shaposhnikov Veniamin Ivanovic in the magazine «American International Journal of Multidisciplinary Scientific Research '" does not violate the anyone's copyright. The author indefinitely to the founder of the magazine a non-exclusive right to use scientific articles through the publication of a printed magazine, as well as posting full-text versions of network numbers at the Web site of the magazine. The author is responsible for the misuse of scientific article of intellectual property objects, objects of copyright in full in accordance with the current legislation of the Russian Federation. The article bears no classified information and can be published in the press. The author confirms that sent the article never was published, has not been and will not be sent for publication in other scientific publications. The author agrees to the processing according to art. 6 of the Federal law "on personal data" from 27.07.2006 no. 152-FZ, of their personal data, namely Shaposhnikov Veniamin Ivanovich, doctor of medical sciences, Professor, academician of RAE. Oncology Department with course Radiology and radiotherapy non-profit educational private institutions of higher education "Kuban Medical Institute. Contact information for the workplace-350020, Krasnodar str. Budennogo 198, Tel. +7 (861) 255-46-07, the official website of the NIGHT in "KMI", Email info@kubmi.ru. To publish submitted articles in scientific journal Also certify that the author agrees with the rules for the preparation of manuscripts for publication, approved by, hosted on the official website of the magazine. Academician of RAE, MD, Prof. V.I. Shaposhnikov (official seal) Аннотация. Острый общий гнилостный перитонит относится к самой тяжелой форме воспаления брюшины. Он постоянно сопровождается эндотоксическим шоком и прогрессирующей полиорганной недостаточностью. Макро и микро кровообращение в тканях и органах брюшной полости по системе воротной вены блокируется с первых же минут развития этого патологического процесса и токсины и недоокисленные продукты обмена скапливаются в них. Для их удаления требуются эфферентные методы лечения, один из которых предлагает автор этой статьи. Техническими и физическими приѐмами на фоне комплексной медикаментозной терапии совершается, как очищение, так и насильственное продвижение крови по сосудам портальной системы. Таким способом удается восстановить гомеостаз. За разработку этого метода, ему был выдан патент СССР (№ 1787036 от 7 марта 1991 г.). Для подтверждения эффективности, предлагаемого способа лечения, автор описывает клинические наблюдения.