Chronic Abdominal Ischemia Syndrome in Patients with Visceroptosis

The dissertation is devoted to the study of chronic abdominal ischemia syndrome in patients with visceroptosis, a pathological prolapse of the abdominal organs. The research addresses the etiology and pathogenesis of visceroptosis and examines the combination of visceroptosis with disturbances of visceral blood circulation. Particular attention is paid to the dynamics of blood flow in the mesenteric vessels, structural changes in the colonic wall, and the development of hypoganglionosis as a cause of chronic colonic stasis. Clinical, radiological, ultrasonographic, angiographic, endoscopic, and morphological research methods were used. On the basis of the data obtained, the algorithms of diagnostics and treatment of this category of patients were improved, and the effectiveness of conservative vascular therapy was evaluated.

Relevance of the problem. Chronic disturbance of visceral blood circulation is better known in the literature under the term "angina abdominalis" and was first proposed by Bacelli in 1903. In 1979, A.V. Pokrovsky proposed the term "chronic abdominal ischemia syndrome" (СХАИ). According to the authors, the mechanism of pain origin in this syndrome is identical to angina pectoris of effort and is associated with insufficient blood flow to actively functioning organs of the abdominal cavity as a result of impaired blood flow through altered visceral arteries. It should be noted that similar symptoms were described by researchers studying the problem of visceroptosis. The authors (Us V.G., 1987; Ivanov A.I., 2000; Tobokhov A.V., 2006) note that one of the leading symptoms in patients suffering from this pathology, after constipation, is the pain syndrome, varying in intensity and localization. The cause of the development of the pain syndrome in patients with visceroptosis has not been fully studied. It cannot be excluded that the pain syndrome in visceroptosis may also be caused by chronic intestinal ischemia. This is largely explained by the insufficient understanding of the diversity of the clinical picture of the disease and its pathogenesis. It should also be emphasized that in the clinic a comprehensive study of intestinal ischemic disease is extremely difficult, since it occurs less frequently than other types of abdominal pathology (Davydov Yu.A., 1997; Kuznetsov M.R., 1999). Because of the complexity of timely diagnosis, this disease is often recognized only at late stages, when, in fact, the opportunity to carry out targeted conservative treatment of the patient is missed (Pokrovsky A.V., 2001; Savelyev V.S., 1999). It should be noted that at present the pathogenesis of hypoganglionosis development has also been insufficiently studied (Vorobyov G.I., 2007; Osipenko M.F., 2005; Kirgizov I.V., 2005), which causes chronic colonic stasis, which may also be a consequence of chronic ischemia of the colonic wall.

All of the above testifies to the relevance of the problem and the need for an in-depth study of the problem of visceroptosis, including the architectonics of mesenteric vessels and their functional state in this pathology with the use of modern research methods.

Objective of the study:

To improve treatment outcomes on the basis of improvement of algorithms for the diagnostics and treatment of chronic abdominal ischemia syndrome in patients with visceroptosis.

Tasks of the study

1. To study the dynamics of blood flow velocity in mesenteric vessels in patients with visceroptosis.

2. To study the nature of structural changes in the wall of the colon in patients with visceroptosis.

3. To improve the algorithm of differential diagnostics in patients with visceroptosis.

4. To evaluate the effectiveness of the proposed algorithm of conservative treatment in patients with visceroptosis.

Scientific novelty:

During a comprehensive examination and treatment of patients with visceroptosis, we were the first to:

1 — study the functional state of the vascular system of the colon in patients with visceroptosis and reveal hemodynamic changes caused by deviations of the colon;

2 — prove that the cause of chronic colonic stasis in patients with visceroptosis in the subcompensated and decompensated degree is hypoganglionosis developing as a result of chronic abdominal ischemia;

3 — reveal that the administration of conservative vascular therapy improves the results of treatment of patients with visceroptosis, makes it possible to postpone surgery or to avoid it;

4 — improve the algorithms of diagnostics and treatment of patients with visceroptosis.

Practical significance

The introduction of ultrasonographic Dopplerography in patients with visceroptosis makes it possible to improve diagnostic results and to optimize further treatment tactics.

The use of conservative vascular therapy in patients with visceroptosis will improve the results of treatment of this pathology.

Statements submitted for defense

1. In patients with visceroptosis, according to Dopplerography data, there is a decrease in blood flow velocity in the superior mesenteric artery in the orthostatic position compared with the blood flow velocity in the clinostatic position, and peripheral resistance also increases, which is caused by pronounced kinks and deformations of the colon as a result of its deviations.

2. Chronic colonic stasis is a consequence of the development of hypoganglionosis caused by chronic disturbance of nutrition of the intestinal wall, which leads to destruction of the intermuscular ganglia.

3. Conservative therapy of patients with visceroptosis aimed at improving microcirculation of the colonic wall makes it possible to increase the effectiveness of treatment and to postpone radical surgery, and in some cases to avoid surgical treatment.

Approval of the dissertation

The results of the conducted research and the main provisions of the dissertation were reported and discussed at the scientific-practical conference "Postgraduate Readings of YaSU named after M.K. Ammosov", Yakutsk, 2007; the scientific-practical conference "Lavrentyev Readings", Yakutsk, 2007; the VI scientific-practical conference "Actual Problems of Emergency Medical Care", Yakutsk, 2008; the scientific-practical conference "Actual Questions of the Gastroenterological Service of the Republic of Sakha (Yakutia)", Yakutsk, 2009.

Publications

Thirteen scientific works have been published on the topic of the dissertation.

Implementation of the results of the work

The obtained results have been introduced into the work of surgeons of Surgical Department No. 2 of RB No. 1 of KC NCM and are used in the educational process at the Department of Hospital Surgery of the Medical Institute of Yakutsk State University named after M.K. Ammosov.

Volume and structure of the dissertation

The dissertation is presented on 117 pages of typewritten text and consists of an introduction, 5 chapters, a conclusion, conclusions, practical recommendations, and a bibliography. The work contains 21 tables, is illustrated with 19 figures and 3 diagrams. The bibliographic reference list contains 122 domestic and 39 foreign sources.