Widespread peritonitis in penetrating gunshot wounds of the abdomen with damage to internal organs

Levchuk A.L., Ignatiev T.I., Vinogradov A.V.

Gunshot wounds to the abdomen are one of the most complex sections of military field surgery. The natural reaction of the body to this type of injury is the development and progressive course of widespread gunshot peritonitis. Multi-stage surgical sanitation and adequate drainage of the abdominal cavity using VAC systems are the main controlled technologies that determine the outcome of treatment of patients with this severe complication.

Aim. To evaluate the effectiveness of programmed relaparotomies with staged sanation and the use of vacuum-assisted (VAL) and vacuum-instillation laparostomy (VIL) techniques in the treatment of widespread peritonitis in penetrating gunshot wounds of the abdomen with damage to internal organs.

Materials and methods. A comparative analysis of the treatment results was performed for 118 patients with gunshot injuries to abdominal organs complicated by widespread peritonitis, who underwent multi-stage surgical treatment using various types of VAC therapy for drainage of the abdominal cavity.

Results. The first relaparotomy according to the program was performed in 75.7% of patients after 24 hours, in 24.3% – after 36-48 hours. The number and interval between subsequent repeated sanitations were determined individually. Each stage included revision, sanitation of the abdominal cavity by multiple lavage with antiseptic solutions and installation of VAC systems. An analysis of 213 cultures from the abdominal cavity was performed. In 82.2% of the wounded, intra-abdominal complications (prolonged necrosis of the intestinal segment, perforation of acute ulcers, failure of intestinal sutures and previously applied anastomoses, adhesive intestinal obstruction, developing limited purulent leaks and necrosis, the presence of foreign bodies of gunshot origin) were effectively eliminated during programmed relaparotomies. The use of abdominal cavity drainage techniques using VAC systems (VIL, VAL) ensured faster decontamination during the treatment of gunshot peritonitis, which made it possible to reduce the number of program sanitizations and decrease the risk of complications by 32%. There were no fatal outcomes.

Conclusion. The method of laparostomy with programmed sanation of the abdominal cavity, supplemented by the installation of a drainage VAC system (VAL, VIL) – made it possible to reduce the number of relaparotomies performed by increasing the time intervals, promptly eliminate complications of the wound process and even more effectively treat gunshot peritonitis.

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