Surgical treatment of combined pelvioabdominal gunshot wounds and their complications in a multidisciplinary hospital

Levchuk A.L., Jojua A.V., Ignatiev. T.I., Grin N.A., Terentiev N.A., Vorobyova A.A.

In the structure of modern combat gunshot injuries, combined pelvioabdominal mine-explosive wounds that occur when heterogeneous damaging factors of an explosive device are simultaneously exposed to the body are particularly severe and extensive. The anatomical proximity of the vital organs of the abdominal cavity, pelvis, retroperitoneal space and bone structures contribute to the wounding agents to inflict massive crushing and damage in various variations.

Objective. To improve the results of diagnosis and treatment of gunshot pelvioabdominal wounds and related complications at the stage of specialized medical care in a multidisciplinary hospital.

Materials and methods. A retrospective analysis and a single-center study of the treatment of 136 male wounded with combined gunshot wounds of the abdominal cavity and pelvis were conducted. The immediate and long-term results of providing qualified and specialized medical care, treating complications using the tactics of stage-by-stage surgical interventions of general surgical, traumatological and urological profiles are analyzed.

Results. Damage to the bladder (17.4%), pelvic bones (25.9%), small (26.8%) and colon (14.7%) intestines, major vessels and other organs (13.3%) was most often noted in combination with wounds to the intra-abdominal rectum. With extraperitoneal localization of rectal wounds, injuries to the bladder and ureters (51.3%), pelvic bones (35.5%), main vessels (1.7%) and small intestine (9.7%) were most often diagnosed. The volume of qualified medical care is represented by surgical interventions aimed at: stopping bleeding, sealing hollow organs, removing intestinal contents from the passage through the damaged rectum, applying epicystostomy, stabilizing fractures of the pelvis and hip with rod devices. The nature of surgical interventions at the stage of providing specialized medical care to this contingent of wounded was characterized by the use of high-tech, minimally invasive and reconstructive techniques. The total number of complications was 86.6%, of which 52.4% were purulent-septic. The widespread use of modern diagnostic and treatment techniques has made it possible to quickly identify and eliminate complications of urological, traumatological and general surgical profiles. Compliance with step-by-step surgical and reconstructive rehabilitation treatment of pelvioabdominal gunshot wounds led to a significant reduction in the number of purulent-septic complications (up to 12.8%) with the achievement of satisfactory results of physical and emotional rehabilitation of patients, minimizing the level of disability (9.6%).

Conclusion. Further improvement of the diagnosis and stage treatment of pelviobdominal gunshot wounds remains relevant and requires high-quality practical and theoretical training of a multidisciplinary team of military field surgery specialists, with a personalized approach to the timing, volume, and nature of surgical interventions for this severe group of wounded patients.

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