Treatment of postoperative unformed intestinal fistulae and general peritonitis. Diagnostic, tactical and technical errors (case report)

Abstract

The authors report the case of a patient with peritoneal adhesions, intestinal obstruction, postoperative peritonitis due to entero-enteroanastomosis leak, complicated by abdominal sepsis, intestinal failure, phlegmon of the abdominal wall, bilateral polysegmentary pneumonia. Fistula-bearing part of the small intestine was resected, several debridement relaparotomies were followed by entero-enteroanastomosing. In the postoperative period, a laporostoma was brought out because of phlegmon of the anterior abdominal wall and compartment syndrome. An vacuum pack system was used to sanify the abscess. After stopping peritonitis, the abdominal cavity was sealed with mobilized skin grafts. The patient was discharged on the 41st day after admission to the hospital and on the 53rd day from the onset of the disease. The male was examined 2.5 years later, the level of his health was good, he was engaged in work. The presented case reports the stages of surgical treatment of postoperative unstable intestinal fistulae associated with diffuse peritonitis and intestinal failure in the early terms of their onset. The authors discuss diagnostic, tactical, and technical errors and analyze the reasons.