1. Department of the faculty and hospital surgery of the medical faculty of the Tashkent medical academy
Intestinal fistulas

2. 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.

3. 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%.

5. 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.

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

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

8. Technical resources for feeding
Roller Pumps
Probes and catheters
Reservoirs

9. One of the stages of surgical intervention
Medical - artificial wormholes
One of the stages of surgical intervention
Hartmann operation

10. 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%

11. 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

12. 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

13. Varieties of immature (open) intestinal fistulae

14. Moulded intestinal fistulas
liping
Tubular

15. Complete and incomplete intestinal fistulas

16. incomplete intestinal fistulas

17. incomplete intestinal fistulas

18. Complete intestinal fistulas

19. 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

20. 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

21. 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)

22. Methods return a lost of intestinal contents into the intestine.

23. Methods return a lost of intestinal contents into the intestine.

24. Methods return a lost of intestinal contents into the intestine.

25. Methods for elimination of intestinal fistulas
Resection of the small intestine with fistulas course and entero-entero anastamoz

26. Methods for elimination of intestinal fistulas
Resection of the colon with fistulas course and entero-entero anastamoz

27. Methods for elimination of intestinal fistulas.
The wedge resection of enteral fistula

28. Methods for elimination of intestinal fistulas
Resection of the colon in place with a fistula

29. 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.