Intestinal fistulas

Department of the faculty and hospital surgery of the medical faculty of the Tashkent medical academy

Prevalence of intestinal fistulas

• Each surgeon has to observe patients with fistulas of the stomach and intestines, but such patients are uncommon.

• Intestinal fistulas occur only 1-2% of all operations on the abdominal organs.

• Development of surgery and critical care medicine, not only did not decrease, but rather increased the number of complications due to perform complex surgical procedures, reconstructive operations on the abdominal organs, including the elderly and debilitated patients.

• Particular difficulties arise in the treatment of immature intestinal fistula, mortality in this case varies from 20 to 71.7%.

Intestinal fistula

II. Medical - artificial wormholes

III. Abnormal intestinal fistulas

Intestinal fistula - a message from the intestinal lumen surface of the body lumen or other hollow organ.

I. Congenital

In order to decompress the intestine

гастростома

энтеростома колостома

Medical - artificial wormholes

In order to supply the patient

Medical - artificial wormholes

Гастростома

Энтеростома Питательные вещества

Technical resources for feeding

Probes and catheters

Reservoirs

Roller Pumps

One of the stages of surgical intervention

Medical - artificial wormholes

Hartmann operation

The causes of fistula after operation

• Acute appendicitis 49.3%

• Acute cholecystitis 14.8%

• Acute intestinal obstruction 12.3%

• Hernia strangulation 8.4%

• The trauma of the abdomen 8.7%

• Other diseases 6.5%

intestinal fistula

The failure of sutures

Capture intestine on sutures

The continued presence of drainage tubes

Neglect with the tissue during

operations

The mechanism of development of intestinal fistula

Intestinal fistulas

Internal OutdoorComplete

Moulded MouldedMoulmed

Through the cavity

Opening liping Кучимли Tubular

Thinly intestinal Thick intestinal Mixed Complex

ComplicatedNot complicated

Varieties of immature (open) intestinal fistulae

Moulded intestinal fistulas

liping Tubular

Complete and incomplete intestinal fistulas

incomplete intestinal fistulas

incomplete intestinal fistulas

Complete intestinal fistulas

Treatment

• Prevent the spread of intestinal contents into the abdominal cavity, to create conditions for the restriction of the process (the formation of intestinal fistula)

• Create conditions for free outflow of intestinal contents

• Decompression of the afferent loop

• Active aspiration

• Install drainage and other

Create optimal conditions for the formation of immature fistulas

Treatment

• Return of the lost intestinal juice through the fistula

• Infusion (electrolyte solutions, carbohydrates, amino acids, blood, plasma, vitamins, etc.)

• Parenteral nutrition (Infezol, Selemin, Selepid) • Enteral nutrition through a tube

Compensate for the loss and prevent metabolic disease.

Treatment

• Broad-spectrum antibiotics, sulfonamides

• Restorative therapy

• Immunotherapy

• Prevent stagnation of intestinal contents in the fistula

• Prevention of inflammation of the skin around the wound (Lassara pasta, etc.)

• During the attempted operation (elimination of intestinal fistula)

Surgery, antibiotic therapy and anti-inflammatory

Methods return a lost of intestinal contents into the intestine.

Methods return a lost of intestinal contents into the intestine.

Methods return a lost of intestinal contents into the intestine.

Methods for elimination of intestinal fistulasResection of the small intestine with fistulas course and

entero-entero anastamoz

Methods for elimination of intestinal fistulas

Resection of the colon with fistulas course and entero-entero anastamoz

Methods for elimination of intestinal fistulas.

The wedge resection of enteral fistula

Methods for elimination of intestinal fistulasResection of the colon in place with a

fistula

Duties of the general practitioner in intestinal fistulas

• - Provision of primary health and social care;

• - Health education (promoting healthy lifestyles);

• - Preventive work (timely detection of early and latent forms of the disease, risk groups);

• - Dynamic monitoring;

• - Emergency assistance in case of emergency and acute conditions;

• - Timely consultation and hospitalization in the prescribed manner;

• - Medical and rehabilitation work in accordance with the qualifying characteristic;

• - An examination of temporary disability;

• - The organization of medical and social care and household together with the bodies of social protection and services of mercy alone, the elderly, the disabled, the chronically ill;

• - Maintaining the approved forms of records and reports.