Authors
Demko A.E.1, 2, Osipov A.V.3, Konyakin I.I.1, Batyrshin I.M.1, Taranov S.A.1, Pichugina G.A.1, Fomin D.V.1, Sakhno D.S.1
1 Dzhanelidze Research Institute for Emergency Care, St. Petersburg
2 S.M. Kirov Military Medical Academy, St. Petersburg
3 Federal center for disaster medicine of the N.I. Pirogov National Research Medical Center, Moscow
Abstract
The article presents the experience of the staged treatment of 31 patients with gunshot wounds to the abdomen, who were complicated by the formation of intestinal fistulas. A two-stage approach was used, including preparatory (conservative) and reconstructive-restorative stages. The severity of the injuries, the condition of the wounds, the number and volume of surgical interventions, and the treatment results are analyzed. The classified signs of “Open abdomen” were evaluated in detail, including the presence or absence of infectious and adhesive processes and entero-atmospheric fistulas according to Bjork M. (2016). Additionally, the severity of infectious processes, degree of malnutrition, and other factors were analyzed.. The article focuses on practical approaches to conservative treatment at the initial stage and the characteristics of reconstructive surgical interventions. It presents a differentiated, multidisciplinary algorithm for the perioperative management of patients with intestinal fistulas. Based on the data analyzed, recommendations for treating wounded patients with this condition have been formulated.
Keywords: intestinal fistula, staged approach, wounded patients, treatment algorithm, degree of injury, open abdomen, closed abdomen.
References
1. Demko AE, et al. Skin reconstructive plastic surgery in patients with unformed intestinal fistulas. Military Medical Journal. 2021; 342(4): 31-38. (In Russ.) doi: 10.17816/RMMJ82614.
2. Manukovskii VA, et al. Ten years of experience in the treatment of enteroatmospheric fistulas at the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine. 2025. (In Russ.) doi: 10.17816/mechnikov636058.
3. Demko AE, Batyrshin IM, Shlyapnikov SA, et al. Stage-by-stage approach in the treatment of patients with unformed intestinal fistulas. Surgery. Journal named after N. I. Pirogov. 2020; 11: 66-73 (In Russ.) doi: 10.17116/hirurgia202011166.
4. Savelyev VV, Vinokurov MM, Popov VV, Badagueva VV. Treatment tactics and results of surgical treatment of unformed high and medium intestinal fistulas in conditions of widespread purulent peritonitis. Far Eastern Medical Journal. 2022; 2: 10-14. (In Russ) doi: 10.35177/1994-5191-2022-2-2.
5. Lammers D, et al. Management Strategies for the Open Abdomen Following Damage Control Laparotomy. 2023; 9: 140-148. doi: 10.1007/s40719-023-00262-8.
6. Dubose J, Scalea T, et al. Open abdominal management after damage-control laparotomy for trauma: A prospective observational American Association for the Surgery of Trauma multicenter study. Journal of Trauma and Acute. 2013. doi: 10.1097/TA.0b013e31827891ce.
7. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8): 801-10.
8. Björck M, Kirkpatrick AW, Cheatham M, et al. Amended classification of the open abdomen. Scandinavian Journal of Surgery. 2016; 105(1): 5-10. doi: 10.1177/1457496916631853.
9. Demko AE, Batyrshin IM, Ostroumova YuS, Sklizkov DS, Fomin DV. The use of negative pressure in the treatment of patients with unformed intestinal fistulas. (In Russ.) doi: 10.34215/1609-1175-2020-3-90-92.
10. Vorobyov SA, Levchik EYu. Stage-by-stage treatment of patients with external small intestinal fistulas 2008. (In Russ.)
11. Björck M, Bruhin A, Cheatham M, et al. Classification – important step to improve management of patients with an open abdomen. World journal of surgery. 2009; 33(6): 1154-1157.
12. Berelavichus SV, Struchkov VYu, Akhtanin EA. Conservative stage of treatment for patients with small intestinal fistulas. Surgery. Journal named after N. I. Pirogov. 2020; 6: 98-103. doi: 10.17116/hirurgia202006198.
