Introduction. Acute small intestinal obstruction with adhesions is one of the most widespread diseases in abdomen surgery. The frequency of acute small intestinal obstruction with adhesions varies from 54 to 90% among other types of intestinal obstructions. Its frequency increase is related to the growing number and volume of operative interventions on the abdomen organs. Nowadays this disease treatment results cannot be considered as satisfying, as acute intestinal obstruction shows high death rate (8-30%) comparing to other acute surgical diseases of abdomen organs. It is vitally important to pay attention to the necessity of the development of the unified and generally agreed diagnostic tactics as well as the programs of conservative and surgical treatments of these patients category. Aim of the research. To hold a retrospective analysis of the treatment of patients with acute small intestinal obstruction with adhesions and to find disadvantages of the standard diagnostic program. Materials and methods. The work held is based on the data of the retrospective analysis of the diagnostics and treatment results among 60 patients with acute small intestinal obstruction with adhesions who received medical treatment in the department of surgery in the Communal Health Protection Institution “Valky Central District Hospital” during the period from 2012 to 2016. The diagnostics of acute small intestinal obstruction with adhesions consisted of anamnesis data, physical, laboratory, roentgen and ultrasound examinations. Results. Discussion. As the result of the anamnesis data study it was found that in all 100% cases patients had had one or more operative measures in the past. The most frequent surgeries that had led to further appearance of acute small intestinal obstruction with adhesions were appendectomy, measures on the pelvic organs and open surgeries caused by acute cholecystitis or hernioplasty. 22 (36,7%) patients had the anamnesis with one operative measure, 38 (63,3%) ones had two or more of them. 3 (5%) people had surgeries caused by acute small intestinal obstruction with adhesions. The manifestation of acute small intestinal obstruction with adhesions using standard diagnostic program during first 12 hours was noticed in 47 (78,3%) cases, 13 (21,7%) patients with mild symptoms of acute small intestinal obstruction with adhesions were diagnosed only after 48 hours after the admission to hospital. In 36 (60%) cases Swartz reaction was used. 23 (43,3%) patients underwent ultrasound treatment, however, acute small intestinal obstruction with adhesions was found in only 21 (91,3%) cases. Significant difficulties were related to the diagnostics of high bowel obstruction that had 11 (18,3%) patients. All of them were diagnosed with it tardily, only after 12 hours starting from the moment of the admission. Conservative treatment worked positively in 19 (31,7%) cases, 41 (68,3%) had surgeries. In 32 (53,3%) cases intraoperative adhesion prophylaxis via peritoneal lavage with Dekasan liquid was implemented. Anus divulsion by Subbotin was also used. Electrical stimulation was applied during the postoperative period in 31 (75,6%) cases for additional stimulation of vermicular movement caused by low efficiency of conservative therapy. Intestinal tubes were removed on the 4-5th day after vermicular movement redressment. 2 (3,3%) patients had complications in the form of suture sinuses during the postoperative period. Fatal cases were absent. Conclusions. The usage of standard diagnostic program of acute small intestinal obstruction with adhesions with predominant involvement of clinical and radiographic research methods allows to make the diagnosis on time only in 78,3% cases. The limitations on timely and repeated ultrasound examinations do not allow to determine the diagnosis of acute small intestinal obstruction with adhesions in proper time and therefore conduct dynamic monitoring of the disease.

Introduction.We performed analysis of the liver in patients with local and diffuse peritonitis. In patients with diffuse peritonitis occurring phenomena liver failure. In the early postoperative period in patients with peritonitis occurring violations excretory, metabolic and liver barrier function that worsens the disease. The presented morphological changes in the liver under local or diffuse peritonitis received during autopsy. Results. When the local peritonitis in liver develop adaptive-compensatory changes in hepatocytes (preserve the structure of hepatic lobules, the radial location of liver plates, laminar swelling between spaces, focal polymorphonuclear cell infiltration with a predominance of white blood cells, increasing the number of Kupffer cells), while they are absent when patient has a spilled peritonitis. With diffuse peritonitis dominated dystrophic necrotic processes, almost never occur adaptive-compensatory changes from hepatocytes (vascular walls leakage plasma with perivascular edema, endothelial damage, the emergence of numerous Leukocyte extravasation, edema and inflammatory infiltration along the portal tracts, hydropic degeneration of hepatocytes), indicating that depletion of liver detoxification function and activation of destructive processes. Reduced liver parenchymal tissue density with diffuse peritonitis due of degenerative and necrotic changes hepatocytes,and increased blood flow and lymph organ swelling spaces Diss. In patients with local or diffuse peritonitis was observed decrease in functional cell mass, that there was an absolute reduction in the number of hepatocytes with preserved functional capacity per unit volume of liver tissue. Along regressed and nuclear mass index. Significant reduction of nuclear material in hepatic tissue (especially in diffuse peritonitis) should be regarded as an indicator of pronounced imbalance nuclear-cytoplasmic relationships, which are the physiological basis of adequate response to pathogenic influences cell. Conclusions. Taking into account the data and evaluating the dynamics of changes in hepatocytes dual mass index, which grew at a local peritonitis and significantly decreased when spilled, it is conceivable that in the first case, the regenerative capabilities of the liver intensified, and the second - depleted. This is indicated and functional cell nuclear index - an indicator of nuclear material per one hepatocytes. This morphometric parameters decreased in both study groups, but the diffuse peritonitis regression reached higher values. The treatment must include drugs for detoxification treatment and antihepatotoxicity prevention and treatment of liver failure should begin in the preoperative and postoperative continue without waiting for its clinical manifestations.