FOREIGN BODIES OF THE PANCREAS OF GUNSHOT ORIGIN

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Summary. The goal is to demonstrate the peculiarities of diagnosis, removal of foreign bodies, and the structure of foreign bodies of the pancreas of gunshot origin. Materials and methods. 77 cases of penetrating gunshot wounds to the abdomen with damage to the pancreas were investigated during the specified period on the basis of the surgical clinic of the military medical clinical center of the Northern region of the Medical Forces Command. The average age of patients was (37.4±3.6) years (range 21-60 years). All patients were examined, laboratory tests were performed: general clinical blood tests, urine, biochemical blood analysis, blood coagulogram, blood group and Rh factor, thromboelastography, blood electrolytes, ultrasound examination of the chest and abdominal organs according to the FAST protocol, multispiral spiral computed tomography of the head, thoracic and abdominal organs, pelvis, radiographic studies of the head, thoracic and abdominal organs, electrocardiography. Foreign bodies (metal fragments) were removed using a general surgical instrument and a magnetic surgical instrument during operative interventions through a laparotomy approach. The results. According to our experience, gunshot penetrating wounds of the abdomen with damage to the pancreas make up 8.7 %. Of the 77 (100 %) patients with penetrating abdominal gunshot wounds with pancreatic injury, 73 (%) had shrapnel and 4 (%) bullet wounds. Among 77 (100 %) pancreatic injuries, foreign bodies in the pancreatic parenchyma were noted in 7 (9.1 %) cases. All foreign bodies in the parenchyma of the pancreas were ferromagnetic metal fragments. According to localization in the pancreatic parenchyma, the distribution was as follows: the head of the pancreas 3 (42.9 %), the body of the pancreas – 4 (57.1 %) cases. No foreign bodies were detected in the tail of the pancreas. According to the size of foreign bodies in the pancreas: large — 1 (14.3 %), medium 4 (57.1 %) and small 2 (28.6 %) cases. Conclusions. Foreign bodies of the pancreas of gunshot origin are a rare phenomenon. The most informative method of detecting foreign bodies of the pancreas is multispiral computer tomography of the abdominal organs using computer vision techniques. More often, foreign bodies of gunshot origin are localized in the parenchyma of the pancreas in the body and head. Removal of foreign bodies of gunshot origin of the pancreas is more often performed with the help of a modern magnetic surgical instrument during operative interventions with laparotomy access.