Обструктивная резекция кишки в лечении травматических повреждений кишечника в условиях перитонита

Abstract

Treating bowel injuries is challenging. Although the failure of anastomosis or suture of the intestine remains a dangerous complication and multiplies in conditions of peritonitis, multistage tactics before the tactics of maintaining intestinal continuity during the first operation is becoming an increasingly preferred strategy. The aim of the research. To evaluate the treatment results for delayed formation of the inter-intestinal anastomosis in patients with bowel injury complicated by peritonitis. Material and Methods. A total of 69 patients were enrolled in the study, among which 40 were included in the retrospective group and 29 were included into the prospective group. All included patients underwent surgery for bowel injuries at the NCHKH 29 and at the NCHKH 1 within the period from 2011 to 2019. The patients’ mean age amounted to 33.4±9.2 years. A total of 35 patients were admitted with blunt trauma and 34 had stab wounds. The retrospective group received treatment with bowel resection with application of anastomosis during the initial surgery while patients of the prospective group had their anastomosis formation delayed to the time after peritonitis management. The postoperative course was analysed in regard to the frequency and severity of postoperative complications and mortality. Results. Among the 69 patients, 78% had a small bowel injury and 47% had a colon injury. A total 39.1% of the lesions in the small intestine and 21.7% of the lesions in the colon were treated with wound closure or bowel resection with primary anastomosis, regardless of the site of injury (p = 0.381). Mortality was 33%, of which 47.5% in the control group and 13.8% in the comparison group. A severe course of the disease was noted in 32% and complications in the abdominal cavity occurred in 32% of patients. The risk factors for severe course of the disease were formed intestinal stomas (p = 0.036), massive blood loss (p = 0.005) and delayed seeking medical care (p = 0.023). The incidence of intestinal suture incompetence was 28.2%. All failures occurred in the early postoperative period. Conclusion. Multi-stage surgical tactics in treatment of patients with intestinal injury complicated by peritonitis should be the preferred option, regardless of the site of injury – small or large intestine. The imposition of an intestinal stoma is an important factor in the development of postoperative complications, which can be compared with the risk of an intestinal suture or anastomosis in peritonitis