Current trends in the treatment of intestinal fistulas after combat abdominal injuries

Objective. To improve the results of treatment of intestinal fistulas after combat abdominal injuries. Materials and methods. Seventeen wounded patients with intestinal fistulas were examined: type I fistula was found in 6 (35.3%), type II in 4 (23.5%), type III in 6 (35.3%), and type IV in 1 (5.9%) wounded patients. Frozen abdomen syndrome was diagnosed in all patients with type III and IV fistulas. Results. The average length of stay of patients in the clinic was (38.64 ± 19.2) bed-days. Patients underwent 24 ultrasound-guided procedures (from 1 to 5) and 36 endoscopic procedures, including fistula clipping, enteral feeding tube placement, fistuloenteroscopy, and endoscopic vacuum therapy. A total of 39 vacuum system replacements were performed. Systemic inflammatory response syndrome or sepsis was diagnosed in 11 (64.7%) of the wounded. All high-flow fistulas observed in 9 (52.9%) patients were successfully converted to low-flow fistulas; in 4 wounded patients, they healed spontaneously within 3–6 weeks, and in 5 patients, remote reconstructive surgery was performed. Of the 8 patients with low-flow unformed intestinal fistulas, 6 healed within 3–6 weeks, and 2 underwent surgery at a later date. Three patients had a recurrence of small intestine fistula. The time of rehospitalization for reconstructive surgery ranged from 2 to 12 months and was determined individually. Conclusions. Treatment of enteric-atmospheric fistulas and frozen stomach syndrome is based on the use of minimally invasive methods, is individualized, long-term, and depends on many factors. Indications for surgical intervention in the early period are limited.