Surgical tactics for external small intestinal fistulas after gunshot wounds to the abdomen

Levchuk A.L., Ignatev T.I., Terentev N.A., Vinogradov A.V.

The aim of the study: to analyze the treatment results of patients with small intestinal fistulas after gunshot wounds to the abdomen and to choose the optimal surgical tactics for these complications.

Materials and methods. The analysis of diagnostics and treatment results was carried out for 58 patients who were operated on at the stage of qualified medical care for gunshot wounds to the abdomen with damage to the small intestine. In the late period of the course of traumatic disease at the stage of specialized care, they were diagnosed with unformed (n = 31) and formed (n = 27) fistulas of the small intestine. According to the type of atmospheric-intestinal anastomoses, the wounded were classified into 5 groups.

Results. Diagnostics was carried out using clinical, radiological, endoscopic methods with mandatory fistulograms and computed tomography. Local treatment included: dressing purulent wounds, protecting surrounding tissues from the effects of aggressive intestinal secretions, reducing chyme loss by installing obturator plugs. General treatment was aimed at normalizing homeostasis, replenishing water-electrolyte and protein losses. Patients with multiple organ failure (n = 30) underwent extracorporeal detoxification. All patients were operated on at different times. Surgical tactics were determined by the localization of the small intestinal fistula, its complications, the size of the defect, the time of its occurrence and the type of atmospheric-intestinal anastomosis. The scope of operations was aimed at eliminating the fistula and restoring the passage of food through the intestine.

Conclusion. Diagnostics and treatment of this severe category of wounded should be carried out at the stages of specialized medical care by a multidisciplinary team of specialists with a personalized approach in each specific case of atmospheric-intestinal anastomosis after gunshot injuries of the abdominal organs.

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