Abstract:

Aim: was to identify features of echographic imaging in patients with suspicion on nonocclusive mesenteric blood-flow disorders.

Materials and methods: we analyzed ultrasound data of 50 patients with dynamic ileus (DI). Patients with severe bulging of the transverse colon and the presence of free gas in the abdominal cavity were not included into the research.

All patients underwent ultrasound examination. We evaluated the functional and morphological state of small intestine and colon, celiac trunk and the superior mesenteric artery (SMA). We also examined intraorganic blood flow in walls of small intestine and colon with the determination of the resistance index (RI) and the linear velocity of blood flow.

The ultrasonic data was verified in 34 cases intraoperatively and morphologically, in 12 cases - only morphologically.

Colonoscopy was performed in 4 patients whose ultrasound differential diagnosis between nonocclusive blood-flow disorders in colon walls and pseudomembranous colitis.

Results: in 3 cases nonocclusive blood-flow disorder was not confirmed. Based on endoscopic and bacteriological data we revealed pseudomembranous colitis (PMC). In 1 patient with ultrasound signs of inflammatory changes in walls of the descending colon at colonoscopy revealed necrotizing ulcerative colitis and suspected circulatory problems in the intestinal wall.

It was morphologically identified that 24 patients had nonocclusive blood-flow disorders in walls of the small intestine,10 patients had nonocclusive segmental infarction of small intestine and colon, in 12 patients had nonocclusive segmental infarction of colon.

Conclusion: ultrasound study, conducted in dynamics, in patients with DI, reveals inflammatory and ischemic changes in walls of the small intestine and colon, which provides an abillity to choose the optimal method of treatment of these patients, in some cases predicted for the pathological process.

Absolute symptoms of nonocclusion ischemia of intestine during ultrasound mode in colour doppler imaging (CDI) are: violation of diameter, lack or absence of blood flow in intraorganic walls of the affected intestine while maintaining its mesentery tissue, in a number of patients - bubbles of gas in the intestinal wall.

An indirect sign of circulatory disorders of the small intestine is a complex of ultrasonic signs as an extension of its diameter with liquid contents, wall thickening by submucosal edema, mucosal folds flattening and lack of peristalsis.

An indirect sign of circulatory disorders of the colon during US is identification of a fragment of the colon with thick walls layered structure haustrum smoothness, lack of blood flow in the structure of the wall in the presence of it in the mesentery

When comparing ultrasound, endoscopic and morphological data, in some cases it is possible to make differential diagnosis between nonocclusive intestinal blood-flow disorder and pseudomembranous colitis.

Abstract:

Acute severe pancreatitis remains one of the actual issue in urgent surgery Forecast of the disease is dependant on spread of purulent necrotic process in pancreas and retroperitoneal tissues. Therefore diagnosis of purulent complications becomes extremely important.

The aim of the study was to demonstrate and evaluate features of ultrasonography in diagnosis and treatment strategy definition of purulent necrotic complications of acute severe pancreatitis.

Materials and methods. The study included 115 patients with acute destructive pancreatitis aged of 21-81 years The major part of them (50%) were persons at most able-bodied (working) aged 32-59 years. All patients underwent ultrasound diagnostics for determination the spread of pathology and detection of complications of the disease.

Ultrasound scanning was carried out as follows:

1. inspection of pancreatic parenchyma;

2. inspection of cellular tissues;

3. detection of free liquid in the abdominal cavity;

4. evaluation of the abdomen and kidneys;

5. inspection of the pleural cavity

Results. Examination of the parenchyma revealed that the pancreas was often inlarged, had a fuzzy, uneven contours and heterogeneous structure. However, it should be noted that in some cases, the pancreas was normal size and structure. Infected necrosis, acute liquid accumulation and/or free liquid in the abdominal cavity had occurred in 100% of cases in various combinations during examination of cellular tissues. Regarding the abdominal organs following complications were revealed: obstructive jaundice - in 5(4.3%) cases; portal vein thrombosis - in 1 (0.9%) case; splenic abscess - in 1 (0.9%) case. The presence of liquid in the pleural cavity was determined by leaves dissociation of the parietal and visceral pleura. The volume of the liquid was determined according standard classification.

Conclusion. Ultrasound scanning allows to determine the presence and extent of local complications arising at the stage of purulent necrotic complications of acute severe pancreatitis and general complications as a result of systemic pathological effect on the body of the disease.

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Abstract:

Aim: was to evaluate possibilities of using of ultrasound classification of subcutaneous rupture of the Achilles tendon (AT) for hospital clinical practice.

Materials and methods: we examined 11 patients (9 men and 2 women). Clinical and X-ray examinations were done. Ultrasound examination was done by the standard method; modern sonographic classification of the rupture of AT was done with functional probe

Results: clinical signs of subcutaneous rupture of AT were obtained in each patient. According to sonographic classification, complete AT rupture was found in 27,2% patients (3 of 11), incomplete rupture was found in 72,8% (8 of 11). Tendinosis signs were found in 37,5% patients (3 of 8) with incomplete rupture.

Conclusions: obtained data prove the effectiveness of ultrasound method of diagnosis of subcutaneous rupture of AT, in detection various variants of its trauma. It is important for optimization of treatment strategy. 

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