Diagnosis of diseases of the small intestine. Diseases of the ileum: symptoms and signs of the disease, treatment

Small intestine - an important part digestive system, it is the last to digest food into particles that are absorbed into it. The intestines absorb salts and vitamins that are needed for normal functioning body. Despite the variety of diseases small intestine, they manifest themselves in a fairly uniform manner, which makes it possible to give a general name to disturbances in its functioning - malabsorption syndrome, which automatically implies a deviation in the functioning of the digestive, motor and excretory functions.

General signs of small intestinal diseases

General symptoms:

• bloating (especially after lunch);
• gases;
• problems with stool (up to 6 times in large quantities, with remnants of food particles, without blood and mucus);
• rumbling in abdominal cavity;
• intestinal dispersion;
• painful sensations in the navel area, epigastric region or on the right in the abdominal cavity of a pulling, dull nature, which subside after the swelling has decreased, spasm (intestinal colic).

Symptoms can manifest as disturbances in the functioning of other organs and systems, since foods are not digested and absorbed properly, causing a deficiency of salts, vitamins and microelements.

Disorder is one of the symptoms of the disease small intestine.

Possible symptoms:

• decrease in BMI, the patient finds it difficult to gain weight back;
• inflammatory processes in the oral cavity and tongue;
• drop in hemoglobin level;
• blindness in the dark or dryness of the mucous membrane of the eye may develop;
• bruises appear for no reason;
• weakening of bones and teeth;
• the menstrual cycle is disrupted;
• impotence;
• dry skin;
• hair is coming out.

Methods for diagnosing diseases of the small intestine

To conduct research and determine what kind of disease is in the intestines, the doctor prescribes certain procedures. Diagnosis for diseases associated with the small intestine:

• Capsule endoscopy is expensive, but effective procedure. This type of endoscopy involves swallowing a video capsule that travels the entire gastrointestinal tract, which makes it possible to examine the entire mucous membrane;
• An x-ray will show that the intestinal walls are of unequal thickness, liquid or gases accumulate in the organ;
• Colonoscopy: First, the patient takes a laxative for cleansing; during the colonoscopy, discomfort and slight pain may be felt. Through anus the instrument is introduced; During colonoscopy, it is possible to collect material for histology;
• enteroscopy is a method similar to endoscopy, but with enteroscopy it is possible to do a biopsy, cytological and endoscopic examination;
• fiberoscopy;
• irrigoscopy;
• laboratory testing of blood and feces (the main component of interest is ESR);
• thyroid gland check.

Acute and chronic enteritis

The disease appears suddenly. The first symptom by which acute enteritis is diagnosed:

• loose stools up to 7 times a day (small intestine) - first in the form of a pulp, then more liquid, foam and an acidic smell may be present, up to 15 times - (thick) - accompanied by spasms, mucus in the stool, possible blood;
• stomach ache;
• gagging;
• exhaustion;
• temperature;
• I don't feel like eating.

With severe enteritis, dehydration may develop, cardiac activity may slow, the temperature may drop, and convulsions may occur. Adequate therapy will help in 3-5 days.

Chronic enteritis occurs from pathogens of intestinal diseases (rotavirus, salmonella), as a consequence of infection. With chronic enteritis, symptoms appear:

• rumbling;
• flatulence;
• periumbilical pain;
• diarrhea;
• decrease in BMI;
• dry skin;
• brittle nails;
• problems with sexual function in men;
• cycle disruption in women.

Lactose intolerance

Lactose intolerance occurs after the patient has eaten milk product. Symptoms:

• diarrhea;
• bloating;
• rumbling.

Problems disappear if you stop drinking milk. Therapy for the disease consists only of diet or consumption of dairy products from which lactose has been removed. Sometimes patients do not respond to small amounts of lactose, which means that they can drink a little milk or eat cottage cheese, in which low level substances.

There are preparations that contain a special enzyme (lactase) that helps digest dairy products. They are drunk in parallel with such food.

Vascular diseases of the small intestine

3 large arteries approach the small intestine: the celiac trunk; inferior mesenteric and superior mesenteric. Due to their illness or blockage, the amount of blood supplied decreases, causing atrophy. It shapes vascular disease small intestine (enteric toad). Symptoms:

• painful sensations after eating that begin in the epigastric region;
• refusal to eat, resulting in weight loss.

Often there is no pain. The disease creates a risk of blockage of the vessel, which leads to intestinal infarction.

Therapy consists of surgery to replace the diseased vessel. In another case, the patient is prescribed a diet and vasodilator medications. long acting and enzymes.

Allergic diseases

There are many manifestations allergic reaction in the human body. Sometimes only the small intestines are affected. Most often, this reaction occurs to food, medications, vaccinations or pollen. Allergies manifest themselves as intestinal disorders. Symptoms:

• rumbling;
• gases;
• diarrhea with undigested food debris;
• temperature;
• vomit.

Often, in parallel, such body reactions as rashes, swelling, etc. occur. Therapy begins by looking for the cause of the allergy and eliminating the allergen from the diet. Sometimes it is impossible to find the pest, in this case the most allergenic substances are excluded from the food: citrus fruits, milk, eggs, etc. Prescribe the use antihistamines.

Celiac disease

Celiac disease or celiac enteropathy is an autoimmune genetic disease, in which the intestines do not contain peptidase (an enzyme that releases gluten). This disease occurs quite often. Substances that are formed from the breakdown of protein promote cell exfoliation, which harms the small intestine. Because of this, the mucous membrane becomes thinner, which impairs digestion and absorption in the organ. Symptoms:

• loose stools;
• weight loss, etc.

As a result of celiac disease, the body is depleted and metabolic processes, anemia appears, reproductive function is disrupted in women and men, bone aches and a host of other unpleasant and dangerous consequences. Diagnostics is complex process, since there are no specific symptoms and they manifest themselves differently in everyone. The disease is disguised as other intestinal disorders.

The only treatment is to adhere to special diet with the complete exclusion of foods, medications and other substances that contain gluten. Even flour dust that gets onto a dish can cause severe reaction. It should be borne in mind that store-bought sausages, frankfurters, and sauces contain this dangerous component.

Whipple's disease

The small intestine is rare disease susceptible to the influence of a pathogenic microorganism - carinobacteria. Inflammation begins in the organ, and the tissues are filled with macrophages, causing lymphatic vessels overlap. This causes malabsorption. Signs:

• abdominal pain, like contractions;
• heat;
• loose stools;
• weight loss;
• joints become swollen and red;
• all lymph nodes are enlarged.

Antibiotics and antimicrobials are used for therapy. Therapy takes from 12 to 24 months. Sometimes hormonal treatment is used.

Nonspecific ulcers of the small intestine are extremely rare. Only isolated descriptions of this disease can be found in the literature. These are nonspecific ulcers, in contrast to ulcerations of an established nature, which can be tuberculous, syphilitic and cancerous. It is believed that this disease is approximately 3 times more common in men than in women, and is found mainly in middle-aged and elderly people.

The causes and pathogenesis of the disease are unknown. Since the pathomorphological picture is more often dominated by the phenomena of acute necrosis than by changes characteristic of a chronic (peptic) gastroduodenal ulcer, it can be assumed that local vascular factors(embolism, thrombosis), local mechanical damage mucous membrane or focal inflammatory process may be the cause of these diseases.

Symptoms, course and complications. Small intestinal ulcers can be acute or chronic, asymptomatic or with atypical pain in the paraumbilical area. However, most often for the first time they manifest themselves suddenly with symptoms of intestinal perforation and clinical acute abdomen. Thus, after analyzing 130 reports described in the literature about primary nonspecific ulcers of the small intestine, it was found that in 81 cases it was perforation of the ulcer.

In more rare cases, ulcers of the small intestine are complicated by intestinal bleeding.

Clinical diagnosis is difficult. Only in rare cases in the presence of ulcer-like pain and signs of repeated intestinal bleeding by exclusion peptic ulcer and other diseases of the gastroduodenal zone, as well as lesions of the colon, the doctor can come to the conclusion about a possible disease of the small intestine and direct the radiologist to a targeted examination of this part of the intestine. However, due to known difficulties due to the structural features of the mucous membrane of the small intestine, as well as the location of the intestine, it is difficult to detect an ulcer of the small intestine using radiographs. If the ulcer perforated or a massive intestinal bleeding, during laparotomy and resection gastrointestinal tract ulcers of the small intestine can often be detected.

Signs of perforation of a small intestinal ulcer do not differ from those of perforation of a peptic gastroduodenal ulcer.

At chronic course ulcers, a rare complication is stenosis of the intestinal lumen.

Treatment of small intestinal ulcers is therapeutic and poorly developed in uncomplicated cases. Since it is never certain that an ulcer represents ulceration of a tumor, surgical treatment is more appropriate. In complicated and diagnostically questionable cases, treatment is surgical.

Diseases are among the most common pathologies digestive tract. The appearance of disturbances in the functioning of an organ can be due to many reasons. Often the disease is caused by inflammatory processes; autoimmune and allergic factors play a certain role in the development of pathology. Despite the diversity clinical symptoms, diseases of the small intestine have similar symptoms, which are caused by a specific reaction of the organ to damage.

All clinical manifestations characteristic of small intestinal disorders can be divided into two main groups - local and general.

Local symptoms

Local symptoms are directly related to organ damage. IN this group includes:

General symptoms

Many have severe course, at which pathological changes extend not only to the digestive system, but also to other organs. Therefore, diseases of the small intestine are characterized by a number of common symptoms which can often be found in patients. These include:

• General weakness. Fast fatiguability patient, decrease physical activity- This is one of the manifestations of intoxication syndrome. It occurs with severe inflammation, which accompanies most diseases of the small intestine.
• Increased irritability. Emotional reactions (nervousness, tearfulness, irritability of the patient) may be the first symptoms of dysfunction nervous system, which are also caused by severe intoxication of the body.
• Manifestations from the outside of cardio-vascular system. General decompensation of the patient's condition can lead to disruption of the heart and associated vascular reactions. These include arrhythmias (disturbances in the rhythmic contractions of the heart muscle), high or low blood pressure.

The severity of general symptoms directly depends on the course of the underlying disease - intestinal pathology. In mild forms, they are manifested by mild weakness of the patient and decreased mood. More severe forms pathologies are accompanied by clear somatic manifestations, including those of the cardiovascular system.

Possible causes of pathologies

Experts identify many factors that can cause the appearance of pathologies of the small intestine. These include:

A common cause of diseases of the small intestine can be perverted immune reactions. This group includes allergic and autoimmune responses of the body, which lead to damage to the body's own intestinal cells.

Diagnostics

A gastroenterologist diagnoses diseases of the small intestine. At the first appointment, the specialist clarifies the patient’s complaints in detail and carries out general examination. This allows one to suspect the presence of pathologies of the small intestine and prescribe a number of specialized studies.

IN diagnostic complex includes both laboratory and instrumental methods for examining the patient. TO instrumental studies relate:

The most common pathologies of the small intestine

Inflammatory diseases

Enteritis is a pathology characterized by the development inflammatory process in the wall of the small intestine. The disease can be combined - accompanied by damage to the stomach (gastroenteritis) or large intestine (enterocolitis).

Enteritis is characterized by the appearance of symptoms of intestinal damage. The most common symptoms of this disease are diarrhea, changes in stool characteristics (color, consistency), cramping abdominal pain and flatulence. Often to local symptoms join communication - elevated temperature, general weakness, lethargy.

Crohn's disease

is a disease of autoimmune origin that occurs due to damage to the mucous membrane of the small intestine by one’s own immune complexes body.

The disease has a severe course, characterized by the following symptoms:

• constant nausea, vomiting;
• severe pain in the lower abdomen on the right;
• flatulence and bloating;
• diarrhea.

When analyzing stool, the appearance of blood in the stool is noted.

Irritable bowel syndrome

- This functional impairment, which occurs due to increased motility of the small intestine. The main clinical manifestation of the disease is diarrhea, which occurs in daytime. Other symptoms of the pathology are severe pain during an attack and flatulence.

Lactose intolerance

- This hereditary disorder, appearing due to a lack of enzymes in the patient’s body. As a result, the patient cannot break down milk sugar normally, which leads to the appearance of characteristic symptoms: diarrhea, flatulence, nagging pain in a stomach.

Allergic reactions

Allergic enteropathies are hypersensitivity reactions to an allergen that enters the patient’s body through the digestive system. For of this disease characterized by diarrhea, cramping pain, and nausea. On the background food allergies Intoxication may develop, which is manifested by general weakness and fever.

Other diseases

Prevention and therapy of diseases of the small intestine

Treatment of diseases of the small intestine depends on the cause that caused the development of the pathology. However, a number of common factors can be identified that are characteristic of most intestinal pathologies.

Of great importance in the treatment of the disease is therapeutic diet. For all patients, it is forbidden to eat salty, fatty and fried foods, drink alcoholic drinks. Other features depend on the specific disease (for example, if you are lactose intolerant, you should not consume dairy products).

To compensate for insufficient digestion, the patient may be prescribed replacement therapy. It involves the introduction digestive enzymes while eating. These substances ensure normal absorption nutrients in the intestines.

In case of severe damage to the digestive system, the patient is prescribed substances that have a beneficial effect on the mucous membrane. These may be the following medications:

1. Omperazole or Omez;
2. Ranitidine;
3. Maalox;
4. Gaviscon.

Precise selection of therapy is carried out based on the characteristics of the disease in a particular patient.

Prevention of intestinal diseases includes a number of recommendations. Nutrition should be correct and varied, contain sufficient amounts of nutrients and vitamins. It is important to take care of your intestinal microflora. To do this, the diet includes dairy products or a course of prophylactic intake of probiotics is carried out.

To avoid the development of drug-induced intestinal damage, it is necessary to control the intake of drugs from the risk group (antibiotics, cytostatics, salicylates). Medicines should be used only as prescribed by a doctor. Uncontrolled use of these funds can lead to serious complications, therefore it is necessary to strictly follow the instructions for use.

The small intestine plays a very important role in digestive system human body. It is responsible for the digestion of food, absorption useful substances, which are needed for the construction of cells and tissues. When the symptoms and signs of the disease occur are quite monotonous. Almost all diseases of the small intestine are covered by the concept of “malabsorption”. They are also known as malabsorption syndrome.

To enlarge the picture, click on it.

Description of the disease

The small intestine is located between the stomach and large intestine. It is in this area that the most important digestive processes take place. The small intestine includes the following sections:

• duodenum. It is the initial part of the small intestine. It begins immediately after the stomach. It is associated with the following digestive glands: liver, pancreas, gall bladder;
• jejunum. It is represented by the middle part of the small intestine. This area is located between the duodenum and ileum. The loops of this intestine occupy a place in the left upper abdomen;
• ileum. It is the lower part of the small intestine. This section begins after the jejunum and ends in front of the cecum. This area has thick walls, a large diameter, and many vessels. It is located on the right lower abdomen.

Pain in the small intestine occurs with the following pathologies:

• maldigestion syndrome;
• Crohn's disease;
• intestinal dysbiosis;
• enteritis;
• celiac disease;
• intestinal obstruction;
• malabsorption syndrome;
• intestinal dyskinesia;
• ulcer duodenum;
• tumor of the small intestine;
• intestinal diverticula, volvulus;
• ischemia, intestinal infarction.

Symptoms

If the small intestine is affected by any disease, the following symptoms appear:

• pain localized in the navel area;
• transfusion in the abdomen, which the patient can feel or hear;
• loose stools (the color is light, it is mushy, foamy, there may be inclusions of undigested foods, the smell is sour, unpleasant);
• abdominal distension;
• increase in temperature (noted when inflammatory diseases intestines. The height of the thermometer readings depends on the number of microbes, their toxicity, and the body’s resistance);
• imperative urge to defecate;
• feeling of heaviness;
• bloating.

Let us consider in more detail the symptoms that arise with specific pathologies of the small intestine.

Enteritis

Enteritis is represented by inflammation of the small intestine. Depending on where the inflammation is localized, duodenitis (duodenum), ileitis (ileum), and jejunitis (jejunum) are distinguished.

At acute enteritis appear:

• vomit;
• diarrhea;
• acute pain (sudden);
• heat;
• pain in the epigastric region;
• dehydration;
• cardiovascular disorders;
• intoxication.

If it develops chronic enteritis, appear:

• diarrhea;
• vomit;
• weakness;
• nausea;
• constant epigastric pain (mild);
• decreased appetite;
• pain on palpation, manifested deep in the area above the womb;
• feeling of fullness;
• rumbling inside the intestines.

Crohn's disease

This chronic inflammation The gastrointestinal tract can affect all layers of the digestive tube. The disease can cause inflammation lymph nodes peritoneum, the appearance of ulcers, scars on the intestinal walls. When the disease occurs, the following symptoms appear:

• nausea, vomiting;
• abdominal pain;
• bloating;
• diarrhea;
• loss of appetite, weight;
• weakness;
• increased fatigue;
• temperature increase.

Duodenal ulcer

The main symptom is pain. It can be insignificant, stabbing, sucking, cramping. This pathology is characterized by “hunger pains.”

Intestinal obstruction

This pathology is represented by a complete/partial disruption of the movement of food along the digestive tract. A constant symptom of the disease is pain, which appears suddenly and does not depend on food intake.

In addition to pain, you may experience:

• bloating;
• abdominal asymmetry;
• vomit.

Intestinal dyskinesia

This disorder of the motor functions of the small intestine manifests itself in:

• abdominal pain;
• increased mucus production;
• feeling of pressure, heaviness in the lower abdomen;
• colic;
• constipation;
• diarrhea.

Diverticulum

With this pouch-like protrusion of the submucosal mucosa of the intestine, the following appear:

• heat;
• sharp abdominal pain;
• nausea;
• bloating;
• tension of the peritoneal wall;
• stool disorder.

Dysbacteriosis

This pathology manifests itself in a violation of quantity, quality normal microflora intestines. The patient develops:

• weakness;
• a sharp decrease in appetite;
• malaise;
• headache;
• decreased performance;
• pallor of the dermis.

Malabsorption syndrome

This pathology manifests itself in insufficient absorption of nutrients into the small intestine. The main symptom of the disease is loose, mushy stool. It is foamy and contains virtually no mucus. The patient is also concerned about:

• bloating;
• heaviness in the stomach;
• flatulence;
• muscle pain;
• weakness;
• nausea;
• decreased blood pressure;
• anemia;
• weight loss;
• numbness of fingers, lips;
• unpleasant taste in the mouth;
• belching.

Maldigestion syndrome

This clinical symptom complex is caused by impaired digestion of nutrients. It manifests itself with a lack of digestive enzymes and pathology of the small intestine.

With this disease the following are observed:

• pains of a pulling, bursting nature (they are provoked high blood pressure inside the intestine);
• stool disorder (diarrhea predominates);
• flatulence;
• rumbling, bloating;
• unpleasant taste in the mouth;
• belching.

Celiac disease

This pathology is hereditary. It manifests itself in intolerance to foods that contain gluten (rye, barley, wheat, oats).

When consuming complementary foods containing flour products, children exhibit:

• lethargy;
• weight loss;
• loss of appetite;
• pallor;
• mucous membranes become bright;
• the size of the abdomen increases.

You may also see:

• swelling of the lower extremities;
• dry dermis;
• stomatitis;
• Iron-deficiency anemia;
• pain in the intestines that has an aching, pulling character;
• diarrhea (stool is foamy, has Strong smell. Its color is light, grayish, its consistency is characterized by increased fat content).

Ischemia, heart attack

These pathologies manifest themselves in chronic disruption of the blood supply to the intestinal walls. The main symptom is severe abdominal pain. In addition to pain in the navel area, the patient experiences:

• loss of appetite;
• nausea, vomiting;
• bloating, rumbling stomach;
• diarrhea, constipation;
• pain when palpating the abdomen;
• the presence of blood in the stool.

Colon cancer, tumors

The pain with this pathology is mild. It is difficult to indicate their exact location. Main symptoms of the pathology:

• loss of appetite;
• weakness;
• increased fatigue;
• severe exhaustion of the body.

The following diagnostic methods will help a specialist find the cause of the disease:

1. Ultrasound of the abdominal cavity.
2. CT scan.
3. X-ray of the peritoneal organs.
4. Bacteriological examination of stool.
5. Endoscopic examinations (FEGDS, colonoscopy).
6. Histological studies. They are needed to clarify the nature of the pathology (benign, malignant tumor).

Treatment

If any disease has affected the small intestine, symptoms will appear that will be very difficult for the patient not to notice. If abnormal bowel movements, characteristic abdominal pain, nausea, vomiting, headaches, flatulence, or belching occur, you should seek specialized help.

Treatment of diseases arising in the small intestine is considered a rather complex process. The main thing is to strictly follow the doctor’s instructions during the treatment process and follow the prescribed diet.

An important point in the treatment of diseases of the small intestine is the effect on dysbiosis. Therapy is aimed at normalizing intestinal function. The patient must take antimicrobial drugs.

Vitamin therapy and a course of enzymes are also very important. This is necessary to restore the body's strength. Enzymes are needed for normal absorption of nutrients.

The doctor also needs to reduce inflammation and reduce intoxication of the body. The following medications are used in the treatment of infections and inflammations:

• antibacterial drugs;
• corticosteroids;
• immunomodulatory medications.

If drug therapy does not give desired results, the doctor decides on the use surgical intervention. During surgery, specialists remove the affected areas of the intestine.

Approximate price tags for treatment in major centers

Prevention

You can avoid the occurrence of many diseases of the small intestine. To do this, just follow these basic steps:

1. Eat properly.
2. Avoid stress and nervous breakdowns.
3. Eat high-quality, fresh food.
4. Do not abuse alcohol or tobacco.
5. Do not neglect diseases of the pelvic area (women).
6. Monitor the cleanliness of the food you eat (vegetables, fruits).
7. News active image life.
8. It is advisable to detect the disease in a timely manner. This contributes to a speedy cure of the pathology.
9. Drug therapy will be effective if you follow a diet and rest the body from emotional and physical stress.
10. For recovery you need a balanced, divided diet.
11. Recommended to take vitamin preparations with calcium, iron.
12. It is important to comply drinking regime. The patient should drink at least 2 liters of water per day.
13. You need to give up foods that contain a lot of fiber, foods that have a high glycemic index. Fried and fatty foods should be avoided and lactose intake should be limited.

The literature remains poor in reports of nonspecific ulcers of the small intestine. The first detailed work in Russian literature devoted to this issue belongs to S. M. Rubashev (1928). By 1961, we were able to find descriptions of 47 cases of nonspecific ulcers of the small intestine. P. 3. By 1965, Kletskin and B.A. Berlinskikh had collected 130 cases in the domestic literature and added their own 9 (139 in total). Subsequently, a description of 29 more observations appeared: D. V. Fedotkin, E. L. Kenng (1967) - 9, A. G. Kutepov (1968) - 19, P. A. Sazhenin, V. S. Kurko (1974) - 1. We must assume that this is not exhaustive, but close to the truth data - about 200 ulcers of the small intestine are described in the domestic literature. This disease is also rare in other countries. Watson, by 1963, found a description of only 170 cases of nonspecific ulcers of the small intestine in the world literature (Anderson, Drake, Beal, 1966).

Small intestinal ulcer has many synonyms: idiopathic, nonspecific, peptic, tryptic, simple, round - there are more names than the number of patients encountered by each surgeon. In our opinion, for simplicity and convenience, this disease should be called “ulcer of the small intestine” without explanatory words, by analogy with peptic ulcer of another localization (for example, stomach). This also makes sense because peptic ulcer of the small intestine has much in common with gastric ulcer (K. D. Toskin, 1955). Small intestinal ulcers are more common in men aged 30 to 60 years. The causes of small intestinal ulcers are not clear. In many patients, the disease can be associated with long-term poor diet, frequent consumption of strong alcoholic beverages and other negative effects on functional state gastrointestinal tract and protective reactions of the body. Some authors (Dyck, 1963) associate the severe progressive course of a penetrating ulcer of the small intestine with sharp increase content of hydrochloric acid in gastric juice. Importance is given to heterotopia of the gastric mucosa. Sometimes acute ulcers small intestine occur after operations on the stomach (Alnor, Ehlers, 1962), after appendectomy (P. 3. Kletskin, B.A. Berdinskikh, 1968), with relapse of stomach cancer (V.I. Rusakov, 1961), after abdominal bruises . Apparently, powerful neuroreflex influences are important, since ulcers and necrosis of the intestine associated with brain damage have been described (N. N. Burdenko, V. N. Mogilnitsky, L. O. Korst, etc.) and with brain disorders caused by violation cardiovascular activity(P. 3. Kletskin, B.A. Berdinskikh; Anderson, Drake, Beal. 1966). P. 3. Kletskin and B.A. Berdinskikh described a case of perforation of two ulcers of the small intestine in a patient with a wound to the lung and heart. The data presented are similar to those for stress gastric ulcers.

Localization of small intestinal ulcers

Pathogenesis peptic ulcer of the small intestine is unique and differs significantly from the pathogenesis of gastric and duodenal ulcers. A feature of the pathogenesis of small intestinal ulcers is their tendency to rapidly destroy the organ wall, which causes very frequent perforation and complications with massive bleeding. Ulcers of the small intestine are not prone to penetration. Described only isolated cases penetration of ulcers into upper sections intestines. The rapid course of the process, frequent perforations, sometimes accompanied by hemorrhages in the mesentery and intestinal wall, force us to think about the participation of allergic factors in the etiology and pathogenesis of small intestinal ulcers. Chronic ulcers with scarring and development of peri-process can be the cause of obstructive or strangulating intestinal obstruction.

Let us present one of our observations relating to the period of work in Novosibirsk.

Patient P., 44 years old (case history 671) was taken to the surgical department of the 1st clinical hospital by ambulance 05/08/52 at 13:00. 20 minutes. V drunkenness with complaints of cramping abdominal pain and vomiting. The patient is of average height, somewhat undernourished, groans, and stands at times intensifying to the point of screaming, which coincides with motor restlessness, expressed in taking bizarre poses in search of a position that alleviates suffering. There is vomiting of cloudy liquid with greenish tint. Answers questions vaguely. I only managed to find out that I drank a lot of vodka the night before. I woke up in the morning with stomach pains. I had never had abdominal pain before.

General condition of the patient moderate severity. The pulse is rhythmic, satisfactory filling, 78 beats per minute. The boundaries of the heart are within normal limits, the tones are somewhat muffled, but clear. Lungs unchanged.

The tongue is thickly coated with a grayish-brown coating and is dry. Many teeth are missing. The abdomen is flat, the upper half is slightly involved in the act of breathing. On palpation, sharp pain is noted in the lower half of the abdomen. The Shchetkin-Blumberg symptom is vague. Percussion revealed a shortening of the sound in the left iliac region. Liver dullness saved. It is impossible to palpate the abdominal organs due to the sharp tension of the anterior muscles abdominal wall. Auscultation - silence. The rectal ampulla is empty; a painful elastic formation resembling an intestine in shape is palpated on the left.

With a diagnosis of intestinal obstruction, peritonitis, the patient was taken to the operating table.

Operation. Under ether anesthesia, the abdominal cavity was opened layer by layer using a lower midline incision, from which the a large number of cloudy hemorrhagic fluid foul odor. The adjacent loops of the intestine are sharply hyperemic with fibrinous-purulent plaque. A round hole with a diameter of up to 2.5 cm was found on one of the loops of the ileum. The edges of the perforation hole are uneven, bordered by protruding mucosa, the serous membrane is thickened and compacted. Loose blood clots are visible in the intestinal lumen. In the pelvis there is a large amount of purulent mucous fluid mixed with intestinal contents and the remains of undigested food (pieces of tomatoes, eggshells). There are many small hemorrhages throughout the intestine and mesentery. At the root of the ileal mesentery, near the perforation, there is a large hemorrhage, protruding in the form of a sausage-shaped formation up to 10 cm long. After toileting the abdominal cavity, a resection of the intestine was performed for 8 cm, followed by the application of a suspended enterostomy to a slightly changed area of ​​the ileum. 400,000 units of penicillin were injected into the abdominal cavity. Two rubber strips are placed to the lateral abdominal folds and one to the pelvis. Suturing the wound. Postoperative period proceeded without complications. 06/23/52 patient was discharged from the clinic in good condition.

Microscopic examination of the preparation - at the edges of the ulcer there is tissue necrosis and impregnation with leukocytes. No specific changes found.

Ulcers are most often localized in the ileum, but are also found in other parts of it (Fig. 59). According to K. D. Toskin (1955), in half of patients the ulcers are localized in the terminal ileum and in 1/3 - in primary department skinny. As a rule, the ulcers are solitary. A. G. Kutepov (1968) of 19 patients found a single ulcer in 15, two ulcers in 2, and three (all perforated) in 3. The size of the ulcers is from 0.5 to 1.5-2.5 cm.

The clinical picture of uncomplicated ulcers of the small intestine is inexpressive: periodic abdominal pain, sometimes worsening after eating, sometimes diarrhea, bloating, “sensation of peristalsis” and other symptoms that can occur with many other diseases,

The main manifestation of a small intestinal ulcer is perforation into the abdominal cavity. Provoking factors can include rich food, alcoholic drinks, and physical activity. In about half of patients, the disease begins suddenly in the midst of full health.

All authors write about the impossibility of preoperative diagnosis of a perforated ulcer of the small intestine, which is most likely explained by the exceptional rarity of the disease and the limited familiarity of doctors with this disease. Of course, it is impossible to differentiate between perforation of a nonspecific ulcer and, for example, perforation benign tumor small intestine. But in some cases the localization of the perforation can be determined.

The disease begins sudden pain in the stomach, which patients compare to a knife blow. Pain most often occurs in the lower half of the abdomen, but often in the epigastrium. Patients take a forced position, groaning from pain, which, unlike a perforated stomach ulcer, is accompanied by repeated painful vomiting. The abdomen becomes board-shaped, the tongue quickly dries out, the initially slow pulse increases sharply, intoxication increases - diffuse peritonitis develops, with which the patient is taken to the hospital.

In patients with perforated ulcers of the small intestine, intoxication increases very quickly. In a short period of time, large changes in the white blood formula develop. With a slight increase or normal number of leukocytes, a sharp shift to the left occurs, eosinophils disappear, and the number of lymphocytes and monocytes decreases significantly, which indicates inhibition of the body's defense reactions. Hence, characteristic symptoms for a perforated ulcer of the small intestine there are sudden dagger pains (this also happens when the stomach wall is perforated) and vomiting (which happens very rarely with a perforated gastric ulcer).

In a minority of patients, the first manifestation of a small intestinal ulcer is massive bleeding. The clinical picture depends on the intensity of bleeding and the characteristics of the patient's reactions. Feszler (1964) believes that in 4.5% of patients, massive gastrointestinal bleeding is associated with ulcers of the jejunum. The clinical picture in some patients consists of two complications: perforation and massive bleeding.

Cicatricial narrowing of the intestinal lumen and deformations cause symptoms of a gradually increasing clinical picture intestinal obstruction. Ulcers accompanied by penetration and periprocess can give a picture of acute intestinal obstruction, which is especially severe when the ulcer is localized in the upper parts of the small intestine.

Diagnosis of chronic ulcers of the small intestine is almost impossible. Ulcers complicated by perforation, bleeding or intestinal obstruction are also poorly recognized. Patients, as a rule, are operated on with a diagnosis of “perforated gastric ulcer”, “ acute appendicitis", "intestinal obstruction", and with massive bleeding, people most often think about a duodenal ulcer or a disintegrating tumor.

The starting point in the diagnosis of perforated ulcers of the small intestine can be dagger pain in the lower abdomen, repeated vomiting, symptoms of peritonitis and gas in the abdominal cavity. Air in the abdominal cavity is detected in approximately 40% of patients (D.V. Fedotkin, E.A. Koenig, 1967).

The diagnosis should use the entire range of studies of a patient with acute pathology belly. The most important condition The basic rule of emergency surgery must be followed: if there are symptoms of peritonitis - immediate surgery. The diagnosis in such cases is clarified on the operating table. A diagnostic error by a surgeon who does not recognize the cause of peritonitis will not bring any harm to the patient. Tactical mistakes and delays in operations are dangerous. In patients with perforated ulcers of the small intestine, delay in surgery is especially dangerous, since peritonitis develops quickly, violently and has a very high mortality rate even after operations in the first hours after perforation.

A special group consists of patients with perforated ulcers of the small intestine that developed after operations on the stomach or other abdominal organs (stress ulcers). Alnor, Ehlers (1962) operated on 40 patients with such ulcers and noticed in a number of patients a tendency to relapse of the ulcerative process.

Treatment depends on the shape of the ulcer. Chronic ulcers are not recognized, and therefore targeted treatment cannot be provided. Perforated ulcers should be treated immediately surgical treatment. Once again we draw attention to the severity and speed of development of peritonitis in patients with perforated ulcers of the small intestine. This is an insufficiently deciphered aspect of pathogenesis.

The operation consists of suturing the perforation hole. The ulcer should be excised before suturing, as re-perforation is possible. Bowel resection should not be performed; this significantly complicates the operation and worsens the outcome. Indications for resection are large changes in the intestinal wall, kinks, cicatricial narrowings, infiltrates, suspicion of a cancerous or specific process. After excision of the ulcer, the intestinal wound is sutured in the transverse direction with a two-story suture. It is necessary to perform a thorough toilet of the abdominal cavity, in case of severe peritonitis, rinse it with antibiotic solutions with a 0.8% solution of methyluracil, drain it with rubber strips and synthetic tubes, and in case of diffuse peritonitis with purulent exudate and fibrinous deposits, ensure constant or periodic lavage of the abdominal cavity. It is advisable to prescribe proteinase inhibitors and desensitizing agents.

The operation can present great difficulties when the ulcer penetrates into neighboring organs, the presence of infiltrates and interintestinal fistulas. In this regard, the observation of Dyck (1963) is of great interest. A 40-year-old patient underwent bowel resection with side-to-side anastomosis due to a perforated jejunal ulcer 16 cm from the ligament of Treitz. Due to the dense edges, it was impossible to suture the ulcer. After 7 months, a repeat operation was performed for a callous ulcer penetrating into the transverse colon and its mesentery - resection of the transverse and small intestines. After 7 and a half months, the patient died from progressive anemia and exhaustion. The section revealed a bleeding ulcer of the anastomosis of the small intestine and a connection (fistula) with the large intestine.

Bleeding ulcers require partial or circular resection of the intestine. Narrowed sections of the intestine are subject to resection with end-to-end anastomosis.

The results of treatment of perforated ulcers of the small intestine are unsatisfactory. Mortality reaches 50% (K. D. Toskin; D. V. Fedotkin, E. A. Koenig, 1967; C, 3. Kletskin, B. A. Berdinskikh, 1968). Apparently this explains serious condition patients and neglected peritonitis. In D.V. Fedotkin and E.A. Koenig, out of 9 operated patients, two died, admitted by the end of the day after perforation. In A.G. Kutepov, out of 19 patients, 4 died. The mortality rate is very high and not entirely clear. A.V. Gabay explains this by late surgical intervention due to uncertainty clinical picture, but it is difficult to agree with this, since acute peritonitis of any etiology is an indication for immediate laparotomy.