Duodenostaza, dyskinesia of the duodenum

Treatment. Suspected acute obstruction of the duodenum patients will be urgent hospitalization and close observation of the surgeon. Surgical treatment takes a significant place in therapy of chronic duodenostasis. However, it is quite agree with the opinion, according to which surgical treatment in every case, should be preceded by a purposeful attempt conservative therapy (A. P. Mirzaev, 1970). Only in the absence of the effect of the applied conservative treatment the patient may be recommended surgical intervention.
Conservative treatment should be strictly individual and complex. It aims to restore normal motor function of the duodenum and to eliminate the consequences of the violation of patients.
Patient with duodenostasis, you must give food 5-6 times a day in small portions. Diet largely depends on the presence and severity of the disease, which accompanies duodenostasis (ulcer, cholecystitis, pancreatitis). If clinical symptoms of impaired patency of the duodenum prevail (duodenostasis is the main disease), it is advisable to appoint a full qualitative composition and rich of vitamins, easily digestible food. Noteworthy is the supervision of K. I. Shirokova with co-authors (1969), according to which by increasing the weight of the patient improves permeability duodenal ulcers in patients with chronic arterio-mesenteric obstruction. This is due to the accumulation of fat in the small intestine mesentery. In this regard, in most of these cases, the authors recommend a high-calorie food (to improve appetite when required was administered insulin). When expressed duodenostaza shown in 10-15 days analnoe power - the introduction of liquid food in small portions every 20-30 minutes through a thin probe directly into the proximal Department of the jejunum.
One of the most effective means of conservative therapy of duodenostasis is washing the duodenum. It may or serial introductions and vvedeniye small amounts of liquid (300 to 350 ml), as it recommends Century X. Vasilenko, or continuous introduction and removal of fluid through the double probe (Centners, Masevich, 1964). One channel of such a probe fluid under low pressure enters the duodenum, and the other with a small vacuum (40-Ls RT. century), created a water vacuum pump is retrieved back. At the distal end of this dual probe opening for the entry of liquid to the duodenum is 8-12 cm proximal than the opening of the second channel probe sucking. In the first scenario, washing duodenum (sequential introduction and removal of fluid) per procedure is 1,0-1,5 liters, while the second number of the washing liquids with each procedure is increased from 2 to 10 liters For washing may be used mineral water (Essentuki # 4, Borjomi) or 0.25-0.5% solution of baking soda. The procedure is held the first two weeks in a day, then two times per week to achieve a stable clinical effect.
In parallel with the washing of the duodenum shows a 6% solution of thiamine 2 ml of a parenteral daily for 20 days. It is also shown antispasmodic (no-Spa, drugs atropine, spazmolitin). Their function is most useful when combined duodenostasis with severe dyskinesia duodenum (spasm). In these cases, these drugs often eliminates pain syndrome. When there is a neurotic state appropriate designation of belloid (instead of atropine). Frequent vomiting can lead to dehydration, significant weight loss, disorders of mineral metabolism. Such patients should parenteral administration of fluid, protein hydrolysates to restore the water and protein deficiency.
Often specified in the complex therapy is sufficient to achieve remission or recovery. In some cases, conservative treatment is ineffective, or the result of his short-lived. In such cases, it may be an issue of surgical intervention. Last pursues objectives: addressing the causes impaired patency of the duodenum, the creation of optimal conditions for the passage of food masses through it or the release of the duodenum from transit and, finally, creation of conditions for normal activity of pathologically changed the digestive system, which can be linked with the development of duodenostasis (stomach, biliary tract, pancreas). Proposed different ways of duodenojejunostomy, stomach resection by Billroth II with a minimum of getting food masses into the duodenum, inter-intestinal anastomosis.