[Clinical problems of extended intestinal resections].

UNLABELLED

Extended intestinal resections constitute a primary surgical problem, and in numerous cases there is the necessity of programming an appropriate nutrition, including parenteral nutrition at patient's home. The aim of the work was to examine treatment problems: surgery indications, complications and the after-effects of extended intestinal resections as well as the procedure rules.

MATERIALS AND METHODS

The group of 51 patients with extended intestinal resections who were subjected to treatment in the years 1988-2002. The group was comprised of 25 female patients with the average age 64.2 years (34-86) and 26 male patients at the age of 56.3 (21-72).

RESULTS

Extended intestinal resections resulted from: cancer--30, ischemia (embolism, thrombosis)--12, injury--3, inflammatory bowel diseases--2, intestinal polyposis--2, diverticulosis with hemorrhages--1, toxic necrosis--1.9 deaths were recorded within the post-operative period: 7 (that is 7 of 12) due to ischemia, 1 due to cancer, 1 due to colon toxicum. The overall mortality rate was 17% (that is 9 deaths of all the 51 patients); the highest rate reached as much as 58.3% in the ischemia cases. The most frequent reason of the deaths following extended intestinal resections performed due to ischemia of intestine was: the impossibility of hemodynamic stabilization--3, the escalation of intestinal ischemia and septic shock--2, simultaneously both causes--2. The average length of time between admittance to hospital and surgical intervention was 5.1 days (0-31); the average length of stay in hospital amounted to 20.8 days (2-102).

CONCLUSIONS

Extended intestinal resections were the most frequently performed due to neoplastic or vascular reasons. Such surgical interventions are fraught with a high risk of complications and deaths. Furthermore, the foregoing surgeries demand a very expensive therapeutic procedure including the post-operative parenteral nutrition.