Analysis of the results of treatment of small and large intestine damage in combat trauma of the abdomen
DOI:
https://doi.org/10.11603/2414-4533.2022.4.13619Keywords:
gunshot wounds, small intestine, colonAbstract
The aim of the work: to analyze the results of treatment of patients with intestinal damage in the case of abdominal combat trauma in order to improve and choose the appropriate diagnostic and therapeutic tactics to minimize postoperative complications.
Materials and Methods. The results of treatment of 69 wounded with complications of abdominal combat trauma in the form of intestinal damage for the year 2022 were studied. The causes of combat trauma of the abdomen were: explosive injury in 62 wounded and bullet wound in 7. An isolated abdominal injury was observed in 25 cases, and combined injuries were observed in 44 cases. Damage to the small intestine occurred in 16 patients, to the large intestine in 25, combined injury to the small and large intestine in 28 patients, and to the stomach and large intestine in 5 patients. All the wounded were subject to a full clinical and laboratory examination, FAST protocol, CT Scan of abdominal and thoracic organs, diagnostic laparoscopy according to indications, as well as in some cases gastroscopy and colonoscopy.
Results and Discussion. In the early postoperative period complications were observed: suppuration of the postoperative wound in 15 patients, seroma of the postoperative wound in 21 patients, failure of intestinal sutures with the development of postoperative peritonitis in 4 patients, and failure of the stoma in the form of its collapse in 2 patients, the formation of interloop abscesses in 4 patients, early adhesion postoperative intestinal obstruction – in 5 patients, incomplete external colonic fistula – in 1, eventerization – in 2 patients. Due to existing complications relaparotomy was performed: in 4 cases due to failure of intestinal sutures with resection of a segment of the intestine with the formation of an intestinal stoma, in 2 cases – elimination of failure of the stoma with the formation of double sigmoid stoma; in 4 – opening and drainage of interloop abscesses, in 5 – elimination of early adhesive intestinal obstruction, in 1 – suturing of eventerization, in 1 – formation of a laparostomy with the application of abdominal VAC bandage.
Thus, gunshot wounds of the intestine in combat trauma to the abdomen make up 35.6 % and remain at a high level, despite the use of improved means of protection and require active surgical tactics. The early using of the FAST protocol, spiral computer tomography and damage control surgery tactics allows to manage patients in severe and extremely severe conditions and to reduce postoperative mortality to a minimum. Postoperative complications are dominated by purulent-inflammatory ones associated with the failure of intestinal sutures, the formation of interloop abscesses, and early adhesion intestinal obstruction. The issues of volume and method of completion of surgical intervention for gunshot injuries of the colon require further research.
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