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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.