TREATMENT OF PERISTOMAL COMPLICATIONS IN CHILDREN WITH EXTERNAL ARTIFICIAL SMALL INTESTINE FISTULAS
Department of Pediatric Surgery, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
Objective: To improve the results of treatment of peristomal complications (PC) in children
Methods: The results of treatment of 120 patients with artificial external intestinal fistulas of various etiologies at the age from 1 year to 15 years are studied. PC was noted in 26 patients, which was 21.7%. The most frequent PC were: intestinal eventration, stomal prolapse, retraction of the stoma, intestinal necrosis, stenosis of the stoma, inflammatory changes in the skin of the peristomal region, irritation and maceration of the skin around the fistula, etc.
Results: With each type of PC, the treatment tactic was individual. Surgical correction of the PC was carried out by 8 patients out of 21. Two patients underwent dissection of the stoma with stenoses. Reconstructions of the stoma were performed in 6 cases: 2 patients with necrosis of the stoma, 2 – in connection with the retraction of the stoma and 2 – the reconstruction was performed in connection with the intestinal eventration. The remaining 13 patients of PC were corrected by conservative methods with the use of modern means of care for intestinal fistulas.
Conclusions: Timely diagnosis and correction of the PC in children with external artificial small intestinal fistulas positively affected the further fate of the child and the results of a radical operation of the underlying disease. Multi-stage correction of pathology and inflammatory diseases of the gastrointestinal are the cause of long-term rehabilitation, large financial expenses. One of the most important tasks of this problem is undoubtedly the provision of qualified medical care to the children who carry the stoma and the education of the parents, as well as the patients themselves, to care for the intestinal stoma. These measures, undoubtedly, will allow avoiding a number of various peristomal complications, tactical and technical mistakes.
Keywords: Stoma, intestinal fistula, peristomal complications, treatment.
- Akselrov MA, Ivanov VV, Svazyan VV. Reabilitatsia detey s iskusstvennymi kishechnymi svishchami [Rehabilitation of children with artificial intestinal fistulas]. Meditsinskaya nauka i obrazovanie Urala. 2009;10(2):96-9.
- Velichko AV, Dundarov ZA. Patogeneticheskoe obosnovanie primeneniya rannego enteral’nogo pitaniya v lechenii bol’nykh s vysokimi kishechnymi svishchami [The pathogenetic explanation of early application enteral nutrition in the treatment of patients with high intestinal fistulas]. Novosti khirurgii. 2007;15 (3):27-34.
- Sukhin IA. Surgical treatment of complete unformed high complicated fistula of the small intestine. Klin Khir. 2011;8:13-6.
- Smolentsev MM, Razin MP, Sukhikh NK. Sravnitel’naya kharakteristika razlichnykh metodov operativnogo lecheniya spaechnoy kishechnoy neprokhodimosti u detey [Comparative characteristics of various methods of operative treatment of commissural intestinal obstruction at children]. Rossiyskiy vestnik detskoy khirurgii, anesteziologii i reanimatologii. 2015;3:20-7.
- Alyamac Dizdar E, Oguz S, Nur Sari F. Enterocutaneous fistula secondary to purpura fulminans in a preterm infant. J Pediatr Hematol Oncol. 2009;31(10): 753-5.
- Vorobyov SA. Etapnoe lechenie bol’nikh s naruzhnymi tonkokishechnymi svishchami [The stage treatment of patients with external small intestinal fistulas]. Vestnik khirurgii imeni I.I. Grekova. 2008;167(6):114-8.
- Doday VA, Teryushkova ZhI, Pyshkin SA. Opyt primeneniya vakuum-terapii v lechenii gnoyno-septicheskikh oslozhneniy parastomal’noy oblasti [The experience of using vacuum therapy in the treatment of purulentseptic complications of the parastoma region]. Nepreryvnoe meditsinskoe obrazovanie i nauka. 2015; 10(3):169-71.
- Nazarov ShK, Alimov KhN. Antibiotikoprofilaktika posleoperatsionnykh ranevykh infektsionno-vospalitel’nykh oslozhneniy v khirurgii organov bryushnoy polosti [Antibiotic prophylaxis of postoperative wound infectiousinflammatory complications in surgery of the abdominal cavity]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;2:31-6.
- Sakala MD, Dillman JR, Ladino-Torres MF. MR enterography of ileocolovesicular fistula in pediatric Crohn disease. Pediatr Radiol. 2011;41(5):663-7.
- Belokonev BI, Fedorin AI. Opredelenie pokazaniy k nalozheniyu anastomozov i vyvedeniyu kishechnykh stom u bol’nykh s peritonitom i ostroy kishechnoy neprokhodimost’yu [Determination of indications for the application of anastomoses and removal of the intestinal stoma at patients with peritonitis and acute intestinal obstruction]. Vestnik Avitsenny [Avicenna Bulletin]. 2012;3:30-3.
- Shestopalov SS, Ekimov AV. Lechenie bo’lnikh s vysokimi tonkokishechnymi svishchami [The treatment of patients with high intestinal fistulas]. Meditsinskaya nauka i obrazovanie Urala. 2013;2:116-8.
- Ahmed AM, Hassab MH, Al-Hussaini AA. Magnetic toy ingestion leading to jejunocecal fistula in a child. Saudi Med J. 2010;31(4):442-4.
Sultonov Sherali Rahmonovich, Doctor of Medical Sciences, Head of the Department of Pediatric Surgery, Avicenna TSMU
Pulatov Kholbozor Kakulovich, Competitor of the Department of Pediatric Surgery, Avicenna TSMU
Shernazarov Ibragim Begmirzaevich, Candidate of Medical Sciences, Assistant of the Department of Pediatric Surgery, Avicenna TSMU
Rahmonov Shokhin Jalolovich, Candidate of Medical Sciences, Assistant of the Department of Pediatric Surgery, Avicenna TSMU
Dododzhonov Yuldoshboy Tukhtaboevich, Assistant of the Department of Pediatric Surgery, Avicenna TSMU
Atoev Ilkhom Kamolovich, Candidate of Medical Sciences, Assistant of the Department of Pediatric Surgery, Avicenna TSMU
Guriev Kholid Jomahmadovich, Laboratory Assistant of the Department of Pediatric Surgery, Avicenna TSMU
Conflict of interest: No conflict
Address for correspondence:
Sultonov Sherali Rahmonovich
Doctor of Medical Sciences, Head of the Department of Pediatric Surgery, Avicenna TSMU
734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139
Tel.: (+992) 918 629817