spracticeХирургическая практикаSurgical practice (Russia)2223-2427АНО "Консорциум "Медицинская техника"10.38181/2223-2427-2023-4-3spractice-427Research ArticleХИРУРГИЯSURGERYОстрое неокклюзионное нарушение мезентериального кровообращения у пациентов с различными видами сопутствующей патологии и послеоперационных осложнений: клинические случай и наблюдениеAcute non-occlusive mesenteric ischemia in patients with various types of comorbidities and postoperative complications: clinical case and observationhttps://orcid.org/0000-0003-1327-6973РогальМ. М.RogalM. M.

Михаил Михайлович Рогаль, врач-хирург, старший научный сотрудник

129090, Москва, Большая Сухаревская пл., 3

Mikhail M. Rogal, Surgeon, Research associate

Sq. Sukharevskaya B., 3, Moscow, 129090

rogal.md@gmail.comhttps://orcid.org/0000-0003-4008-6462ЛебедевА. Г.LebedevA. G.

Александр Георгиевич Лебедев, доктор медицинских наук, врач-хирург, главный научный сотрудник

129090, Москва, Большая Сухаревская пл., 3

Alexander G. Lebedev, Surgeon, Chief Researcher

Sq. Sukharevskaya B., 3, Moscow, 129090

lebedev_ag@mail.ruhttps://orcid.org/0000-0003-1270-5414ЯрцевП. А.YartsevP. A.

Петр Андреевич Ярцев, доктор медицинских наук, профессор

129090, Москва, Большая Сухаревская пл., 3

Dr. Petr A. Yartsev, Professor, Head of Research Department

Sq. Sukharevskaya B., 3, Moscow, 129090

peter-yartsev@yandex.ruhttps://orcid.org/0000-0001-8319-7440СтинскаяН. А.StinskayaN. A.

Надежда Александровна Стинская, врач-хирург

129090, Москва, Большая Сухаревская пл., 3

Nadezhda A. Stinskaya, Surgeon

Sq. Sukharevskaya B., 3, Moscow, 129090

vasacorona@yandex.ruНаучно-исследовательский институт скорой помощи имени Н. В. СклифосовскогоРоссияSklifosovsky Research Institute for Emergency MedicineRussian Federation202326122023043041Copyright © Рогаль М.М., Лебедев А.Г., Ярцев П.А., Стинская Н.А., 20232023Рогаль М.М., Лебедев А.Г., Ярцев П.А., Стинская Н.А.Rogal M.M., Lebedev A.G., Yartsev P.A., Stinskaya N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.spractice.ru/jour/article/view/427Цель

Цель: улучшить результаты лечения пациентов с острым неокклюзионным (очаговым) нарушением мезентериального кровообращения, проанализировав исходное и послеоперационное состояние для снижения рисков возникновения осложнений.

Материалы и методы

Материалы и методы. Рассмотрен клинический случай лечения пациента с острым неокклюзионным нарушением мезентериального кровообращения в условиях абдоминального сепсиса и некрозом стомы на фоне воспалительного заболевания оболочек спинного мозга. Также приведено клиническое наблюдение пациентки, послеоперационный период которой осложнился коронавирусной инфекцией и двухсторонним гидротораксом.

Результаты

Результаты. У пациента на фоне тяжелой коронарной патологии и стертой клинической картины мезентериальной ишемии в отсроченном периоде была выполнена резекция участка кишки с выведением стомы, с последующим ее некрозом, что потребовало проведения реконструктивной операции. Исходное тяжелое состояние пациента в совокупности с выполнением повторного хирургического вмешательства привело к стремительному нарастанию полиорганной недостаточности и летальному исходу. У пациентки с выявленной в послеоперационном периоде коронавирусной инфекцией и двухсторонним гидротораксом на фоне проведенного лечения было отмечено улучшение состояния, что позволило ее выписать из стационара под наблюдение хирургом амбулаторно.

Заключение

Заключение. Ранняя диагностика и своевременное оперативное вмешательство в том или ином объеме способствуют улучшению прогноза лечения. Ранние послеоперационные осложнения и выполнение повторных хирургических вмешательств значительно ухудшают прогноз.

Aim

Aim. To enhance the outcomes of treating patients with acute non-occlusive mesenteric ischemia (focal) following colostomy, aiming to gain a better understanding of the prevalent risk factors for complications and exploring ways of their reduction.

Materials and methods

Materials and methods. A clinical case detailing the treatment of a patient with acute non-occlusive mesenteric ischemia amidst abdominal sepsis and stoma necrosis, compounded by inflammatory disease of the spinal cord membranes, is presented. Additionally, the clinical observation of a patient experiencing postoperative complications, including coronavirus infection and bilateral hydrothorax, is provided.

Results

Results. In a patient presenting severe coronary pathology alongside a nuanced clinical manifestation of mesenteric ischemia in the delayed phase, a surgical intervention involving intestinal tract resection and subsequent stoma removal was conducted. Regrettably, stoma necrosis ensued, necessitating reconstructive surgery. The patient’s initial critical state, compounded by the requirement for repeated surgical intervention, precipitated a swift progression of multiple organ failure, culminating in mortality. Conversely, another patient, postoperatively diagnosed with coronavirus infection and bilateral hydrothorax, exhibited amelioration in clinical status following administered treatment, ultimately warranting hospital discharge.

Conclusions

Conclusions. Early diagnosis and timely surgical intervention contribute to improving the prognosis of treatment. Early postoperative complications and repeated surgical interventions significantly worsen the prognosis.

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The authors declare that there are no conflicts of interest present.