Predictors of occurrence, diagnosis and treatment of diversion colitis in stoma patients after gunshot abdominal trauma

Levchuk A.L., Grin N.A.

The treatment of colitis of the “switched-off” colon is becoming increasingly important, both medically and socially and economically, in patients with abdominal gunshot trauma, significantly delaying the possibility of performing reconstructive surgeries aimed at eliminating the stoma and restoring colonic continuity with fecal passage.

Materials and Methods: to determine the predictors of the development of diversion colitis and its severity in 42 patients with stomas following abdominal gunshot trauma, a retrospective and prospective comparative controlled study of the diagnostic and surgical treatment outcomes during the rehabilitation phase was conducted in a multidisciplinary hospital. Patients in the study (n = 20) and control (n = 22) groups underwent clinical and endoscopic examinations, computed tomography, and morphological examination of mucosal biopsies from the switched-off colonic areas, including bacterial analysis. Results: Clinical manifestations of diversion colitis were detected in 64.2% of patients. It was established that predictors of its occurrence were pathomorphological processes in the intestine and zones of gunshot injury alteration in the phase of purulent-septic complications of the course of traumatic disease in the wounded. Three degrees of colitis severity in stoma patients were distinguished: minimal (19.1%), moderate (38.2%), significant (42.7%), objectified by morphological and bacteriological results, which are the basis for the diagnostic algorithm of instrumental studies. Patients of the main group underwent preoperative preparation for 10-14 days to correct the disturbed microbiocenosis. The terms of reconstructive and restorative surgeries aimed at eliminating stomas and restoring gastrointestinal continuity ranged from 2 to 12 months. The total number of complications in the study group was 11.7%, in the control group 29.3%. The average hospital stay in the study group was up to 25 days, while in the control group it was over 90 days, taking into account the treatment of purulent-septic complications.

Conclusion: the pathogenesis of diversion colitis in patients with gunshot abdominal trauma is ischemic in nature and is associated with a disruption of the microflora in the dysfunctional colon. Its diagnosis should be based on the results of MSCT, FCS, morphological and bacteriological studies. Surgical rehabilitation of wounded patients with a functional stoma for more than 6 months requires specific preparation, including correction of the microbiome and intestinal motility.

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