Kotiv B.N. 1
Ivanov F.V. 2
Gumilevskiy B.Y. 1
Mironova K.D. 1
1 Military Medical Academy
2 Military Academy of Logistics named after Army General A.V. Khrulev
The results of treatment of 249 patients with gunshot peritonitis were analyzed. All 249 wounded were operated on at the previous stages of medical care, and 212 of them with temporarily sutured abdominal cavity had previously undergone 1-2 control abdominal revision. During hospitalization, all 249 injured patients were examined, 37 patients had their abdominal cavity sutured in layers at the time of hospitalization, and 212 previously operated patients had their abdominal wall temporarily sutured. After examination, 4 of the 37 injured with a sutured abdominal cavity underwent a relaparotomy "on demand" with laparostomy. The remaining 33 out of 37 wounded with previously sutured abdominal cavities were examined and sent to the surgical department for further treatment. Control abdominal cavity revisions were performed in 216 wounded, including 4 patients after "on-demand" relaparotomy with a temporarily sutured abdominal wall. In all 216 patients, it was decided to continue treatment using the "open stomach" technique, including 162 injured patients with vacuum therapy, and 54 patients without it. Upon completion of laparotomy for gunshot peritonitis, in case of radical elimination of the surgical infection, it is necessary to suture the abdominal cavity. This made it possible to achieve favorable outcomes for the majority of the wounded (95%). If there are indications for control revisions of the abdominal cavity in the treatment of gunshot peritonitis, the "open stomach" technique is necessary. An analysis of the treatment of wounded with gunshot peritonitis showed that, against the background of the use of vacuum therapy, the relief of inflammation occurred much earlier. Earlier relief of the inflammatory process in the abdominal cavity allowed the laparostomy to be closed on average 5 days earlier (p=0.01). The wounded with gunshot peritonitis who received vacuum therapy were 27.1% less likely to develop intra-abdominal foci of inflammation (p=0.03) and 16.8% less likely to develop nosocomial pneumonia (p=0.04). If necessary, it is advisable to use the "open stomach" technique in the treatment of wounded with gunshot peritonitis in combination with vacuum therapy.
gunshot peritonitis
laparostoma
vacuum therapy
