Novosti
Khirurgii

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Year 2016 Vol. 24 No 1

EXCHANGE OF EXPERIENCE

Ê.À. LINYOV, À.V.TORBA

SURGICAL TREATMENT MANAGEMENT OF ABDOMINAL GUNSHOT INJURIES

SE ''Lugansk Medical University'' ,
Ukraine

Objectives. To develop the surgical treatment algorithm for patients with abdomen gunshot injuries.
Methods. The work is based on case histories analysis of victims (n=100) with abdominal gunshot injuries. The nature of injury has been analyzed (isolated – combined, bullet – shrapnel, penetrating – non-penetrating); the nature of the organ damage, the results of the use of the following diagnostic methods: ultrasonography; plain abdominal radiography; spiral computed tomography; the type of operations performed, so as complications and treatment outcome.
Results. It was established that blast mine injury: (shrapnel wounds) constituted 93% of the victims; bullet wounds were noted only in 7%. Penetrating injuries of the abdomen constituted 79%. 29% had isolated abdomen gunshot injuries, 71% of victims – combined gunshot injuries. The wounding projectile inlet was located in the anterior abdominal wall in 41% only, but in 35% it was located on the back surface of the body. The survey procedures were limited to emergency ultrasound examination, plain abdominal radiography, spiral CT.
Conclusion. The indications for laparotomy in abdomen gunshot injuries are considered to be hemorrhagic shock, peritonitis, the presence of free abdominal fluid on ultrasound and intra-abdominal foreign bodies on X-ray and CT, the penetrating trauma according to the revision of wound channel and rectal hemorrhage. In the study of the incidence of organ injuries the small intestine damage was commonly noted – 27%, colon injury – 23%, liver – 23%, spleen – 19%, diaphragm – 13%, rectum – 10%. The penetrating abdomen gunshot injuries were treated by one-stage final operation in 19%, being guided by the "Damage control" principle – in 81%. The mortality rate was 29% mainly in combined gunshot injury, the number of septic complications – 39%.

Keywords: abdominal gunshot injuries, emergency diagnosis, surgical treatment tactics, indications for laparotomy, "damage control" strategy, septic complications, mortality rate
p. 93-98 of the original issue
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Address for correspondence:
91045, Ukraine
Lugansk, kv. 50-letiya Oboronyi Luganska, d. 1,
GU ''Luganskiy gosudarstvennyiy
meditsinskiy universitet'',
kafedra gospitalnoy khirurgii, ortopedii i travmatologii,
tel. office. 380954695178, 38 (0642) 63-02-36, 63-02-16,
e-mail: k_linev@mail.ru
Linyov Konstantin Alekseevich
Information about the authors:
Linyov K.A. PhD, an associate professor of the hospital surgery, orthopedics and traumatology chair of SE ''Lugansk State Medical University''.
Torba A.V. PhD, an associate professor of the hospital surgery, orthopedics and traumatology chair of SE ''Lugansk State Medical University''.
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