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 I. Congenital 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.

In order to decompress the intestine Medical - artificial wormholes In order to decompress the intestine гастростома энтеростома колостома

In order to supply the patient Medical - artificial wormholes In order to supply the patient Гастростома Питательные вещества Энтеростома

Technical resources for feeding Roller Pumps Probes and catheters Reservoirs

One of the stages of surgical intervention Medical - artificial wormholes One of the stages of surgical intervention 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 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 Tubular Internal Mixed Complete Outdoor Moulded Moulmed Through the cavity Opening liping Кучимли Tubular Thinly intestinal Thick intestinal Mixed Complex Not complicated 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

Create optimal conditions for the formation of immature 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

Compensate for the loss and prevent metabolic disease. 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

Surgery, antibiotic therapy and anti-inflammatory Treatment Surgery, antibiotic therapy and anti-inflammatory 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 entero-entero 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 - 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.