Молодежный инновационный вестникМолодежный инновационный вестник2415-7805Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации7414UnclassifiedThe formation mechanism of the gastrointestinal fistulas in infected pancreatic necrosisAnorevNikita Ivanovichnikitaanorev@yandex.ruhttps://orcid.org/0000-0001-6315-4419IvanovSergey Anatolyevichdocisa@mail.ruhttps://orcid.org/0000-0001-7131-39850110202211214200403202227032022Copyright © 2022, Anorev N.I., Ivanov S.A.2022<p><strong>Abstract</strong></p> <p>Among all the complications of infected pancreatic necrosis, the leading place is occupied by severe gastrointestinal fistulas that occur in 6-20% of patients.</p> <p><strong>The aim of the study</strong> is to determine the mechanism of formation of gastrointestinal fistulas in infected pancreatic necrosis in order to choose the optimal treatment tactics.</p> <p><strong>Materials and methods</strong></p> <p>In 18 out of 142 patients with infected pancreatic necrosis (12.7%), the course of the disease was complicated by the formation of fistulas of the gastrointestinal tract. All patients were examined according to a single method, including laboratory tests of blood, urine, ultrasound of the abdominal cavity, overview radiography of the chest organs. CT of the abdominal cavity was performed to determine the degree of damage to the pancreas and retroperitoneal tissue. The diagnosis of "infected pancreatic necrosis" was established on the basis of the results of microbiological examination of the punctate of acute fluid accumulations and necrotic tissue from the necrosis zone.</p> <p></p> <p><strong>Results</strong></p> <p>From all 18 patients with gastrointestinal fistulas that complicated the course of infected pancreatic necrosis, conservative treatment was performed in 3 (16.7%) and surgical treatment in 15 (83.3%) patients. Conservative therapy was performed in patients with fistulas that arose after puncture under ultrasound control of infected fluid accumulations. From the 15 operated patients, 11 were diagnosed with colon fistulas. Gastrointestinal fistulas in 8 (53.3%) of the operated patients led to severe sepsis, multiple organ failure and death. The overall mortality rate among patients with infected pancreatic necrosis complicated by gastrointestinal fistulas was 44.5%.</p> <p><strong>Conclusions</strong></p> <p>The study showed that most gastrointestinal fistulas in infected pancreatic necrosis are associated with prolonged inflammation of the peripancreatic zone and infection. The mechanism of formation of the most severe colonic fistulas is necrosis of the mesentery and the wall of the colon, associated with anatomical features of its blood supply. It also follows from the results that with a minimally invasive approach, conditions are created for the successful treatment of emerging gastrointestinal fistulas.</p>gastrointestinal fistulasсвищи желудочно-кишечного тракта1.Острый панкреатит. Дифференцированная лечебно-диагностическая тактика / М. В. Лысенко [и др.]. – М.: Литерра 2010. – 152с.2.Недашковский Э.В. Острый панкреатит : руководство для врачей / Э. В. Недашковский; под ред. Э.В. Недашковского – М.: ГЭОТАР – Медиа 2009 –272с.3.Therapeutic intervention and surgery of acute pancreatitis / H. J. Amano [et al.] // J. Hepato-biliary Pancreat. Sci. – 2010. – Vol. 17, N. 1. – P. 57-59.4.Tsiotos G. G. Incidence and management of pancreatic and enteric fistulas after surgical man-agement of severe pancreatic // Arch. surg. – 1995. – Vol. 130. № 1. – P. 48–52.5.Warshaw A. Damage prevention versus damage control in acute pancreatitis // Gastroenterol-ogy. – 1993. – Vol. 104. – P. 1216–1219.6.Ванцян Э. Н. Наружные и внутренние свищи. – М.: Медицина, 1990. – С. 219.