THIN AND THICK BOWL STOMAS: ETIOLOGY AND TYPES OF COMPLICATIONS
The eight-year armed conflict in eastern Ukraine, which escalated into a full-scale war over the russian invasion, has led to an increase in the number of wounded with injuries to the abdominal cavity, retroperitoneal space and pelvis. This has led to an increase in the number of patients with intestinal stoma.
The aim of our research was to analyze the surgical interventions that result in the formation of intestinal fistula, as well as the types of complications from the stoma.
Materials and methods. The results of treatment of 90 patients who were treated at the Military Medical Clinical Center of the Central Region and the Military Medical Clinical Center of the Northern Region, who underwent surgery with formation of intestinal fistula for the period from 2015 to 2022, were studied. The reasons for surgery in 19 cases were combat trauma to the abdomen, in 53 cases – intestinal disease of malignant origin, in 15 – diverticular disease, others: stab wound to the abdomen – in 1, pelviorectal paraproctitis – in 1, mesenteric thrombosis – in 1.
Results. In the postoperative period 24 patients had complications after stoma formation. These complications were divided into complications from the stoma and intestine of the stoma, as well as the skin around the stoma. Some patients had 2-3 complications, so the total number of complications exceeded the total number of patients with complications.
Early complications were most often observed. Among them were: parastomal dermatitis (17) with ulceration (8), parastomal infiltrate (3), parastomal abscess (1), retraction of the stoma (3), stoma deviation from skin and its failure (3), necrosis of the stoma (1), bleeding (1), failure of the gut stump (1), abdominal abscess (1). Parastomal infiltrate and abscess occurred in patients with perforated diverticulitis, which required urgent surgery: opening and drainage. The onset of stoma retraction is associated with a violation of the method of stoma formation and also required surgery. Failure of the stoma with its discharge from the skin, necrosis of the stoma required surgery in the form of its reconstruction. Bleeding from the stoma in one patient was stopped conservatively. Failure of the stump sutures of the distal intestine occurred in one patient and led to the formation of an abscess of the pelvic cavity, which also required urgent surgery.
Among the late complications we noted: prolapse of the stoma (3), ligature fistulas (7), stricture of the stoma (1), parastomal hernias (2), hypergranulation (6). The frequency of these complications, in our opinion, depends on the correct formation of the stoma with proper surgical techniques, taking into account the anatomical features of the structure of the anterior abdominal wall, the constitutional characteristics of the patient, the degree of infection of parastomal tissues.
Conclusions. The most common early complications after stoma formation are purulent-inflammatory, which occurred in 27.78 % of patients operated on urgently. At parastomal abscess, failure of stoma, its necrosis urgent surgical intervention is indicated.
Among late complications, complications such as ligature fistulas, prolapse and paracolostomy hernias were common – up to 14.4 %, which required surgical correction. The main reasons for the development of parastomal complications are non-compliance with the rules of stoma formation, constitutional features of patients, disregard for the anatomical features of the structure of the anterior abdominal wall, infection of paracolostomy tissues, defects of stoma care.
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