Early inflammatory bowel obstruction after abdominal surgery is a common postoperative complication. 2005 – 05 – 2008 – 10, the author treated 21 cases of early inflammatory bowel obstruction after abdominal surgery using a combination of Chinese and Western medicine, and the results are as follows.
1. Data and methods 1 . 1.1 Diagnostic criteria: The disease occurred after abdominal surgery, there was anal venting and defecation, and began to eat, but the symptoms of obstruction appeared again. The diagnosis was made based on symptoms, signs and laboratory tests. Laboratory examination: abdominal X-ray standing radiographs were dilated intestinal canal, or with air-fluid planes of different sizes, of which the more severe 12 cases did whole abdominal CT examination showed dilated intestinal canal, thickening of the intestinal wall, fluid accumulation in the abdomen. Blood tests: white blood cell count and neutrophils were all elevated to varying degrees Shanghai Public Health Clinical Center, Department of Imaging Shi Yu Xin Chinese medicine identified as intestinal dampness and heat, internal Qi blockage.
1 . 2 General data: The 21 cases were all general surgery patients in our hospital, 14 males and 7 females; age 20-68 years old, average 48.5 years old; appendectomy. 7 cases of appendectomy, 4 cases of gastroduodenal perforation repair, 4 cases of cholecystectomy, 4 cases of radical gastric cancer, 1 case of splenectomy, 1 case of cesarean section; 17 cases of mild abdominal distension, 4 cases of severe; 15 cases of abdominal pain, 18 cases of limited abdominal pressure, 15 cases of nausea and vomiting, 19 cases of cessation of exhaustion and defecation, 7 cases of diminished bowel sounds, 4 cases of disappearance of bowel sounds, 4 cases of hyperinflation of bowel sounds or with gas over water sound 10 cases. All patients’ symptoms occurred 4-8 d after surgery, with an average of 6 d. 1 . 3 Treatment method 1 . 3 . 1 Conventional conservative treatment: food, gastrointestinal decompression, anti-infection, maintenance of water-electrolyte balance, total gastrointestinal nutrition. In severe cases, injectable growth inhibitor (Shenzhen Squire Pharmaceutical Co., Ltd., approval number: H20044101) was added, dissolved in 0 . Ltd. (approved No.: Guoji Zunzi H35020163), dissolved in 0.9% sodium chloride injection, and then infused by infusion pump at 250 μg/h for 5-7 days until the obstruction is lifted; dexamethasone sodium phosphate injection (Fujian Sanai Pharmaceutical Co. If the symptoms are not relieved, the drug can be discontinued gradually after 5-7 days.
1 . 3 . 2 Chinese medicine therapy: the treatment should be to clear the intestines and internal organs, drain heat and detoxify. Drug composition: 30 g of raw rhubarb (later), 10 g of each of Citrus aurantium, Houpu, Peach kernel and Peony bark, 15 g of each of Herba Red Vine and Fructus septicum. 1 dose daily, decoct 300 mL of juice, retain the enema, twice daily.
1 . 4 efficacy criteria (self-designed): cure: abdominal distension, abdominal pain disappeared, the anus resumed defecation, abdominal softness, normal bowel sounds, abdominal pain, constipation and other symptoms no longer appear after resuming diet.
The shortest cure time was 5 d, and the longest cure time was 11 d, with an average of 8 d. The other case was treated for 13 d and then transferred to surgery due to combined small intestinal anastomotic stenosis.
3. Discussion Inflammatory bowel obstruction is a mechanical and dynamic simultaneous adhesive bowel obstruction due to intestinal wall edema and extensive adhesions caused by inflammation in the abdominal cavity early after abdominal surgery. The disease occurs in the early postoperative period, intestinal peristalsis was once restored, some patients have resumed eating and drinking, the symptoms are mainly abdominal distension, abdominal pain is relatively mild or no abdominal pain. Because intestinal adhesions and inflammation are at a more serious stage, surgery is difficult and easy to damage the intestinal canal, causing intra-abdominal bleeding, infection, intestinal fistula, endangering the lives of patients, so conservative treatment is generally used. Inflammatory bowel obstruction belongs to the category of intestinal node and guanger disease in Chinese medicine. Its occurrence is due to surgical injury, the intestinal tube function is weakened, the lack of intestinal internal organs, the accumulation of dampness in the intestinal tract, the accumulation of heat. Chinese herbal medicine has better advantages in the treatment of this disease, which can promote early recovery and shorten the hospitalization time. The main medicine for the treatment of acute abdominal disease is raw rhubarb, which is bitter-cold in nature and has the effect of removing blood stasis and fire, together with Citrus aurantium and Houpu to eliminate distension and move Qi, Peach kernel and Peony bark to invigorate blood and cool blood, and Herba Hongteng and Fructus septicae to clear heat and detoxify toxins, activate blood stasis and eliminate carbuncles and pus. Modern medical research has shown that rhubarb, thick park and citrus aurantium can promote intestinal contraction, enhance intestinal peristaltic function, significantly increase intestinal wall blood flow, improve hypoperfusion and ischemia and hypoxia, and can effectively inhibit intestinal bacterial translocation in the tissue, reduce intra-abdominal inflammation, eliminate intestinal edema, restore the function of intestinal passage. Expose the intestinal canal, reduce the presence of ischemic tissue, remove the accumulation of blood and fluid in the abdominal cavity, and prevent intra-abdominal contamination.