Transcript Intestinal fistulas

Department of the faculty and hospital surgery of the medical faculty of the Tashkent
medical academy
Intestinal fistulas
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
I. Congenital
III. Abnormal intestinal fistulas
Intestinal fistula - a message from the intestinal lumen surface of the
body lumen or other hollow organ.
Medical - artificial wormholes
In order to decompress the intestine
гастростома
энтеростома
колостома
Medical - artificial wormholes
In order to supply the patient
Гастростома
Энтеростома
Питательные вещества
Technical resources for feeding
Roller Pumps
Probes and catheters
Reservoirs
Medical - artificial wormholes
One of the stages of surgical intervention
Hartmann operation
The causes of fistula after
operation
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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%
The mechanism of development of intestinal fistula
The continued presence of
drainage tubes
The failure of sutures
intestinal fistula
Neglect
with the tissue during
operations
Capture intestine
on sutures
Intestinal fistulas
Internal
Moulded
Through
the cavity
Thinly intestinal
Outdoor
Complete
Moulmed
Opening
liping
Thick intestinal
Not complicated
Moulded
Кучимли
Mixed
Complicated
Tubular
Complex
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
Create optimal conditions for the formation of immature fistulas
• 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
Treatment
Compensate for the loss and prevent metabolic disease.
• 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
Treatment
Surgery, antibiotic therapy and anti-inflammatory
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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)
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 fistulas
Resection 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 enteroentero anastamoz
Methods for elimination of intestinal fistulas.
The wedge resection of enteral fistula
Methods for elimination of intestinal fistulas
Resection of the colon in place with a
fistula
Duties of the general practitioner in intestinal fistulas
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- 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.