What complications can occur after the operation. Complications after surgery. Improving operational technology

4.9. INTOXICATION

We will not consider intoxication, which depends on the nature of the pathological process itself and already exists by the time of the operation, often aimed at eliminating it. Let us dwell on the intoxication that occurs as a result of surgical intervention, and on the tasks of an assistant in its prevention. At the same time, we will understand here under the very general term "intoxication" only a complex of various adverse consequences of the penetration of bacteria and their toxins into the blood and lymphatic channels, as well as tissue decay products arising precisely as a result of surgical procedures. We will not consider their pathogenetic mechanisms, which are often fundamentally different. We will also not touch on such types of intoxication, which are inevitably associated with the features of this surgical intervention (for example, after the imposition of a direct porto-caval shunt) or with the nature of the anesthesia.

Having thus defined intoxication, let us dwell on its immediate causes. These reasons can be divided into 2 groups - those associated with the presence of a localized source of intoxication and those associated with the formation of a new source of intoxication.

Intoxication in the presence of its localized source occurs when protective barriers are destroyed and conditions are created for the generalization of the process. These conditions are:

Open gaping lumens of vessels, especially venous plexuses, large and intraorgan veins;

Restoration of blood flow in intact vessels as a result of separation of blood clots or elimination of their mechanical compression (destruction of the protective barrier of localized abscesses; elimination of intestinal volvulus with compression of the mesenteric vessels);

The ingress of toxic contents onto a vast suction surface - the villous mesothelial cover of the visceral and diaphragmatic peritoneum.

Purely mechanical factors contributing to the implementation of the first two conditions are an increase in pressure in a localized focus of intoxication and the occurrence of a "pump effect".

Intoxication in the presence of its localized source is generalized under the listed conditions, most often in the following situations:

At the opening of intraperitoneal and extraperitoneal abscesses infected with hematomas, accumulations of tissue decay (parapancreatitis), which have a pronounced infiltrative or granulation barrier;

In case of contact with pus, tissue decay products, the contents of hollow organs (especially infected or with intestinal obstruction), cysts, etc. into the free abdominal cavity;

With detorsion of the volvulus of the intestine or node.

The task of the assistant in the prevention of intoxication in these cases is similar to his task in the prevention of surgical infection in case of the threat of diffuse peritonitis, bacterial shock, etc. The question of the expediency of detorsion of the volvulus or resection of the intestine is decided by the surgeon. Usually, before this, a puncture is performed and toxic contents are evacuated from the intestine.

The assistant should in every possible way avoid such manipulations with napkins inside the abscess, which can increase the pressure there and cause a "pump effect".

Intoxication associated with the formation of its new source as a result of surgery, has various causes. The most frequent of them are the following:

The ingress of toxic disinfectants into the abdominal cavity and into the wound (when using any liquids for washing the abdominal cavity, the assistant must personally verify their name and concentration by reading the label on the bottle; the same applies to the use of novocaine or alcohol for all kinds of intraoperative blockades and anesthesia) ;

Carrying out autoinfusion (reinfusion) of infected blood that has spilled into the abdominal cavity (to prevent this danger, the assistant evaluates, together with the surgeon, the possibility of reinfusion and provides the surgeon with the conditions for a thorough revision of the abdominal organs in order to timely identify organ damage that could serve as a source of infection of the spilled blood );

Tight tamponade of areas of tissue decay or bleeding areas of organs and tissues, creating conditions for delaying toxic discharge behind the tampons with insufficient outflow to the outside (when performing tamponade in the cases shown, the assistant positions the organs surrounding the tampon insertion site so that the tampons can be brought into the wound in the shortest way and that this channel should be as funnel-shaped as possible with a base facing the skin wound; when suturing the wound of the abdominal wall, it must provide conditions that exclude compression of the tampons, which leads to a violation of their drainage function and a delay in the discharge flowing past the tampons; for this, the tampons must be flattened over the entire width, should not twist in the form of a tourniquet, and a finger should pass freely between the edge of the tampon and the suture of the abdominal wall);

The use of excessively narrow drainage tubes that do not provide proper outflow of tissue discharge or the contents of hollow organs and their excretory ducts (the assistant should check the patency of the drainage tubes using a syringe with novocaine solution. After installing and fixing the drains in the lumen of the hollow organ, he should make sure that there is an outflow of the contents and in the absence of outflow obstructions - blockage with mucus clots, "sand", tube kinks, suction of side windows in the tube to the organ wall, etc.; only by ensuring proper decompression of the hollow organ can the development of intoxication in the postoperative period be prevented);

Wound intoxication due to the disintegration of tissues dissected and crushed during surgery (even with small incisions, careful hemostasis and reliable wound closure with sutures, slight wound intoxication in the postoperative period is inevitable; the larger the incision, the larger the area of ​​surgical tissue damage, especially muscles, the more areas of hemorrhage , unremoved hematomas, crushed with clamps, tied with ligatures and deprived of blood supply, doomed to tissue necrosis, the more pronounced wound intoxication in the postoperative period; it intensifies if the surgical wound for any reason is left unsewn or poorly drained; can be performed very carefully very a large operation, and wound intoxication will be barely pronounced; poor surgical technique, rough handling of tissues, blunt cutting instruments, poor hemostasis, grabbing excessively large areas of tissue into ligatures, crushing muscles with clamps, crushing burning and blunt separation of tissues instead of their dissection lead to severe wound intoxication even after small volume operations; the source of intoxication, as a rule, are histamine-like products of tissue decay; for the prevention of wound intoxication, an all-round reduction in the volume of surgical trauma and careful delicate surgical technique are necessary, which largely depends on the quality of the assistance).

A special and independent cause of intoxication is postoperative pneumonia. The causes of pneumonia after operations on the abdominal organs and the abdominal wall are different. These include defects in preoperative preparation and management of the postoperative period, errors in the conduct of anesthesia, especially artificial lung ventilation, the nature of the initial surgical and concomitant diseases, but the surgical intervention itself plays an important role in the development of pneumonia. Consider the main causes that contribute to the occurrence of pneumonia and are directly related to the technique of the operation.

The duration of the operation. The longer the abdominal cavity is open, the greater the likelihood of pneumonia. One of the reasons for its occurrence is cooling, so the assistant's task is to warm the eventrated organs, cover a wide surgical wound.

Area of ​​surgical intervention. The closer this area is to the diaphragm, the more likely it is to develop pneumonia. Restriction of respiratory excursions of the diaphragm by laying napkins and towels under it, pressing down on it with mirrors impairs lung ventilation and contributes to the development of pneumonia.

Hypoventilation due to compression of the chest. It was stated above that the assistant should not lean on the patient's chest and should not place surgical instruments on it.

Reflex effects from the abdominal organs, especially its upper floor. Rough pulling of the stomach, gallbladder, pancreatic injury, etc. lead to the development of subsegmental lobular (disc-like) atelectasis (collapse) in the lower lobes of the lungs and contribute to the onset of pneumonia.

Blood loss and traumatic (operational) shock. Measures to prevent these complications are described above.

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Today, 70% of people have pronounced or hidden hemorrhoids, which are characterized by the expansion of hemorrhoidal veins. In the advanced stages of the pathology, the patient is recommended surgical intervention. Surgery is the only way to eliminate the deviation when conservative methods are no longer effective. The rehabilitation period after surgery depends on the procedure itself and the individual characteristics of the patient. Complications can occur in the patient both in the absence of treatment and after surgery. It is important to follow all the doctor's recommendations to reduce the risk of worsening the condition.

In this article you will learn:

Causes of violations

Complications of hemorrhoids occur in the absence of treatment. The condition can worsen even after surgery. Pathology manifests itself in people regardless of gender and age. It is characterized by the expansion of the veins in the anus. The disorder often affects children as well.

Complications of hemorrhoids develop most often in patients with a latent form of the course. Due to the lack of obvious signs, the disease is diagnosed late, when the condition is already rapidly deteriorating. Deviation is usually discovered by chance.

Treatment of complications of hemorrhoids should take place under the close supervision of doctors. Additional violations may occur against the background of:

• non-compliance with nutritional recommendations;
• non-compliance with medical measures;
• the introduction of an inactive lifestyle;
• late visit to the doctor;
• refusal to change preferences in sexual life;
• self-treatment.

Most often, the occurrence of complications is due to the lack of treatment or the adoption of self-selected medicines. Therapy should be selected by the proctologist, taking into account all individual characteristics.

Complications after hemorrhoid surgery are rare, but the likelihood of their manifestation still exists. The root causes of deterioration in the background of surgical intervention include:

• improper procedure;
• non-compliance with the recommendations of the doctor;
• neglect of rehabilitation therapy.

Complications after removal of hemorrhoids usually have a pronounced intensity. In some cases, the patient may experience a recurrence of the disease.

Varieties of disorders that have arisen against the background of hemorrhoids

Complications of internal hemorrhoids occur against the background of non-compliance with the recommendations of the doctor. The patient may show:

• crack in the anus;
• necrosis;
• infringement of nodes inside the intestine;
• anemia;
• thrombosis.

Possible complications can be ruled out with recommended treatment, a strict diet, an active lifestyle, and good personal hygiene. If the first symptoms occur, you should immediately consult a doctor. The doctor will help reduce the risk of deterioration and eliminate the pathology.

In rare cases, complications may not manifest themselves for a long time. It is important that the patient carefully monitor their well-being.

anal fissure

A fissure in the anal sphincter area is the most common complication of pathology. It manifests itself against the background of constant constipation. When defecating, a person is very tense. For this reason, a deviation occurs.

Violation appears:

• the presence of blood in the stool;
• severe pain syndrome.

A rupture can lead to infection. An immediate consultation with a proctologist is required. The pain syndrome in the presence of a crack directly depends on the depth of its localization. If left untreated, the symptom may become chronic.

Necrosis and infringement of nodes

Such complications after hemorrhoids as necrosis and infringement of nodes are not uncommon. Occur at 3-4 degrees of pathology. Significantly worsen the patient's well-being.

Necrosis is a consequence of the prolapse of hemorrhoids, which are pinched in the anal canal.

Complication leads to:

• impaired blood flow;
• malnutrition of hemorrhoids.

With necrosis, the patient feels severe and sharp pain. Hemorrhoids become purple-blue. A strangulation occurs when knots fall out in a constipated patient. The anal passage narrows and the anus swells.

paraproctitis

Paraproctitis is accompanied by the formation of an abscess. Purulent neoplasms are observed. Violation can be diagnosed when:

• redness of the skin around the anus;
• pain syndrome;
• fistulas.

The patient in the presence of complications notices purulent discharge. Pathology can be chronic and acute. The disorder requires surgical intervention.

The operation consists in excision of the fistulous tract. The complication is established through differential diagnosis. Conservative methods are not effective.

Anemia

Anemia or anemia leads to a decrease in the amount of hemoglobin in the blood. Pathology provokes the appearance of:

• weaknesses;
• loss of strength;
• frequent mood swings;
• lack of appetite;
• dizziness;
• memory impairment;
• tachycardia;
• shortness of breath;
• pain in the region of the heart.

If left untreated, the pathology can become chronic. Gradually, oxygen starvation begins in the patient's body. The process of breathing becomes much more difficult. Accompanied with hemorrhoids, pathology causes great discomfort. The patient has difficulty even performing daily tasks.

Thrombosis

Thrombosis of hemorrhoids is a complication that not only increases the pain syndrome, but also poses a great danger to the patient's life. The reasons for such a violation in hemorrhoids include:

• spontaneous increase in intra-abdominal pressure;
• hypothermia;
• traumatization of the anus.

Thrombosis against the background of increased intra-abdominal pressure occurs due to excessive physical activity. A provoking factor may be lifting a heavy object or straining.

In the presence of hemorrhoids, it is important to avoid hypothermia. Otherwise, thrombosis of the hemorrhoid develops against the background of stagnant processes in it.

Hemorrhoids provoke complications in the form of thrombosis of the hemorrhoidal node only at stages 3 and 4 of the disease. At the initial stages, there is no violation.

Complication is accompanied by:

• pain syndrome;
• swelling of the hemorrhoid;
• bleeding;
• redness of the affected area.

The disorder needs to be consulted by a doctor. It cannot be removed on its own.

Complications after surgery

Complications after surgery to remove hemorrhoids occur in all patients. Their severity and quantity depends on the quality of the procedure. Therefore, it is important to contact only highly qualified and proven doctors.

Often patients do not even know if there are complications after hemorrhoid surgery. Surgery can cause:

• suppuration;
• narrowing of the anus;
• fistula formation;
• individual intolerance.

Complications usually occur on the 3rd-5th day of the rehabilitation period. When they appear, it is important to consult a doctor.

Suppuration can appear 1-3 days after manipulation. This indicates that an infection has entered the patient's body. Violation is accompanied by fever and fever.

If suppuration occurs after a week, the root cause is an insufficient level of personal hygiene. That is, the complication manifested itself through the fault of the patient himself. After surgery, the anal passage may narrow. However, only in 3 cases out of 10 the patient will need help in the form of surgery. The rest of the sick complication does not cause any discomfort.

Hundreds of thousands of surgical interventions are performed worldwide every year. Unfortunately, not all of them go smoothly. In some cases, doctors are faced with certain complications.

They can occur both during the operation itself and in the postoperative period. It should be noted that modern medicine has a very effective arsenal of tools to help deal with negative consequences.

What complications can surgeons face?

Collapse.

Coma.

A coma, or coma, is a deep disturbance of consciousness that occurs as a result of damage to brain cells and a violation of its blood circulation. The patient has no reflexes and reactions to external influences.

Sepsis.

It is one of the most severe complications. People call it "blood poisoning". The cause of sepsis is the ingestion of pyogenic organisms into the wound and blood. At the same time, the likelihood of developing sepsis is higher in patients whose body is depleted and whose immunity is low.

Bleeding.

Any surgical intervention can be complicated by bleeding. In this case, bleeding can be not only external, but also internal. Bleeding can be caused both by a violation of blood clotting, and slipping of the ligature from the ligated vessel, violation of the integrity of the dressing, and so on.

Peritonitis.

After intra-abdominal operations, such a severe complication as peritonitis is possible. This is an inflammation of the peritoneum, the cause of which is the divergence of the sutures placed on the intestines or stomach. If the patient is not provided with immediate medical assistance, he may die.

Pulmonary complications.

Insufficient ventilation of one or another part of the lungs can lead to development. This is facilitated by shallow breathing of the operated patient, accumulation of mucus in the bronchi due to poor coughing, stagnation of blood in the lungs due to prolonged lying on the back.

Paresis of the intestines and stomach.

It is manifested by stool retention, flatulence, belching, hiccups and vomiting. All these manifestations are due to the weakness of the muscles of the digestive tract after abdominal surgery.

Postoperative psychoses.

Excitable people after surgery may experience hallucinations, delusions, motor agitation, lack of orientation in space. The reason for this behavior may be intoxication after anesthesia.

thromboembolic complications.

They are the most common complications after surgery. A patient who does not move enough develops thrombosis and inflammation of the veins, blood clots form.

Thromboembolic complications are most common in people who are overweight, bleeding disorders. Women who have given birth several times and weakened people are also at risk.

Modern medicine pays great attention to the prevention and prevention of surgical complications. This is achieved through sanitary and hygienic measures in the hospital, ensuring sterility during surgery and postoperative care.

In addition, any patient entering a planned operation must undergo an examination, during which the degree of blood clotting, the state of the cardiovascular system, and so on are established. In case of detection of any pathologies, doctors take timely preventive measures to prevent negative consequences.