Hemobiochemical profile and multiple organ dysfunction syndrome: a paradigm for objective assessment of small bowel fistula treatment

Abstract

When organizing the treatment process for small bowel fistula, timely diagnosis of significant pathophysiological changes arising from intra-abdominal complications is relevant. We studied the results of the treatment of 41 patients with an unformed small bowel fistula, caused by the failure of the intestinal suture placed in connection with the violation of the integrity of the enteral wall in technically difficult viscerolysis,against the background of diffuse peritonitis, as well as the suture failure after bowel resection in open and closed abdominal trauma and in a strangulated hernia. At three stages of the study (initial — 1–2, intermediate — 5–7, and final — 28 days from the start of treatment), the functional state of vital organs and systems and electrolyte imbalance were assessed by monitoring 10 biochemical blood parameters (total protein and bilirubin, alkaline phosphomonoesterase, alanine and aspartate aminotransferase, urea,creatinine, glucose, amylase and potassium), thereby objectifying the nature of multiple organ dysfunction in its three-stage gradation. It has been found that in the presence of an unformed small bowel fistula at the time of its occurrence, there are multisystem disorders of varying severity. Against the background of the traditional complex of therapeutic measures, including conservative treatment and surgical technologies, there are changes in the evaluated criteria, which become especially clear within the framework of the concept of hemobiochemical profile in its graphical presentation. At the final time interval of follow-up, a third of patients have a critical level of the main clinical and laboratory parameters, including hemobiochemical parameters. Preservation of severe forms of multiple organ dysfunction — sub- and decompensation (from 47 to 69 % of patients), in the process of implementing a three-stage follow-up model, as well as a high level of mortality (41.46 %) indicate the low effectiveness of traditional tactics for the treatment of an unformed small bowel fistula.