General information

Brief description
Granted
the Joint Commission on the Quality of Medical Se ices
the Minist of Health and Social Development of the Republic of Kazakhstan
by "13"July 2016
Minutes No7
Intestinal stula – unnatural communication between the lumen of the intestinal tube and other
organs or skin.
Correlation of ICD-10 and ICD-9 codes: See Appendix.
Date of development/revision of the protocol: 2016 year.
Protocol users: surgeons, therapists, GPs, endoscopists.
Categories of patients: взрослые.
Level of Evidence Scale:
The following classes of recommendations and levels of evidence for reference are used in this
protocol:
Level I – Evidence from at least one properly designed randomized controlled trial or meta-
analysis
Level II – Evidence from at least one well-designed clinical trial without proper randomization,
from analytical coho or case-control studies (preferably from a single center) or from dramatic
results obtained in uncontrolled studies.
Level III – Evidence obtained from the opinions of reputable researchers based on clinical
experience.
Class A – Recommendations that have been approved by agreement of at least 75%% of the
multisectoral expe group.
Class B – Recommendations that were somewhat controversial and did not meet agreement.
Class C – Recommendations that caused real controversy among the members of the group.
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Классификация
· by time of occurrence – congenital, acquired;
· on etiology – traumatic, imposed for therapeutic purpose, arising from intestinal diseases;
· by function - full, incomplete;
· the nature of the stula - lip-shaped, tubular;
· on the level of location on the intestine - high, low, mixed;
· the presence of complications - uncomplicated, complicated;
· by number – single and multiple.
Diagnosis (Ambulato )
DIAGNOSTICS AT THE OUTBULATORY LEVEL
Diagnostic criteria:
Жалобы: in intestinal stulas depend on the localization, their size, type of stula.
Patients complain of stula detached from the stula, pain in the stula area and in the
abdomen, itching, redness in the stula area, increased body temperature, ne ousness, sleep
disturbance, weakness.
Анамнез:
· Usually the patient goes to the doctor not immediately, but several weeks, months or even
years after the appearance of the intestinal stula.
· It should be clari ed:
- the presence of the patient underwent operations and injuries
- Intestinal Diseases (Crohn's disease, enteritis, ulcerative colitis, bowel cancer, infectious bowel
diseases)
- whether symptoms are increasing;
- whether there are manifestations of systemic pathology.
Physical examination: Patients with intestinal stula have an opening on the abdominal wall with
a detachable opening.
Internal intestinal stulas, as a rule, do not manifest themselves. However, with high small-
intestinal bones, progressive weight loss, diarrhea may be noted. The main sign of external
intestinal stulas is the presence of holes on the skin, through which the intestinal contents are
released
With high small intestinal stulas it is liquid, yellow-green color, foaming, with the remnants of
undigested food. The contents of low small intestinal stulas are more viscous, and large
intestinal stulas are decorated. Along with the excretion of feces in patients with large intestinal
stulas, there is a withdrawal of gases. The skin in the circumference of the external opening of
the stula is macerated, ulcerated. Patients with high long-existing small bowel stulas are
dehydrated and emaciated. Some of them lose up to 25-50% of their body weight. They're
always thirsty.
Laborato research provide for the preparation of the patient for surgical treatment in a
round-the-clock hospital There are no speci c criteria for laborato diagnostics:
· KLA;
· AAM;
· Blood biochemical analysis (total protein, urea, creatinine, bilirubin, ALT, AST, glucose);
Instrumental research:
· obse ational chest radiography – to exclude pathology from the chest organs;
· X-ray contrast examination - the main method that allows to determine the presence of
intestinal stula, its localization and size, the duration of barium retention in it, motor disorders of
the intestines, the presence of complications;
· obse ational radiography and computed tomography of abdominal organs in the presence of
intestinal stula reveals the localization of the stula, additional moves;
· endoscopic examination is used with great caution, as there is a high risk of intestinal
pe oration.
Diagnostic algorithm: (схема)

Diagnostics (hospital)
DIAGNOSTICS AT THE STATIONARY LEVEL
Diagnostic criteria at the stationa level:
Intestinal stula – unnatural communication between the lumen of the intestinal tube and other
organs or skin. Internal stulas often do not appear for a long time. External stulas are detected
by the presence of the mouth on the skin, through which the feces and gases escape, maceration
of the skin around the stula. There may also be progressive weight loss, increasing multiorgan
insu ciency.
Жалобы:
Clinical manifestations of intestinal stulas largely depend on their localization, morphological
characteristics, and time of occurrence. Formed stulas have a more favorable course, usually not
accompanied by severe common symptoms. Unformed stulas, even low, occur against the
background of intoxication due to the in ammato process in the mouth of the stula.
Internal interintestinal stulas may not manifest for a long time. In the presence of intestinal-
uterine, intestinal-bladder stula is usually noted fecal masses from the vagina, fecal impurity in
the urine when urinating, in ammation of the pelvic organs. High small-intestinal stulas are
accompanied by a fairly pronounced clinic: persistent diarrhea, gradual but signi cant weight
loss.
External stulas also have their own clinical features due to localization. High small intestinal
external stulas are characterized by the presence of a defect on the skin, through which
abundant yellow, foamy intestinal contents containing food chymus, gastric and pancreatic
juices, bile. Maceration and dermatitis rapidly develops around the stula passage. Fluid losses
on the high stula of the small intestine are signi cant, lead to gradual decompensation of the
general condition and the development of multiorgan insu ciency. Weight loss can reach 50%,
gradually unfolding clinic severe exhaustion, depression. Low stulas of the large intestine ow
more easily, they are not accompanied by large losses of uid. Considering that fecal masses in
the large intestine are already formed, pronounced skin maceration and dermatitis also do not
occur.
Анамнез:
· Usually the patient goes to the doctor not immediately, but several weeks, months or even
years after the appearance of the intestinal stula.
· It should be clari ed:
- the presence of the patient underwent operations and injuries;
- Intestinal Diseases (Crohn's disease, enteritis, ulcerative colitis, bowel cancer, infectious bowel
diseases);
- Increased symptoms;
- whether there are manifestations of systemic pathology.
Physical examination: See ambulato level.
Laborato studies: There are no speci c criteria for laborato diagnostics.
In case of emergency hospitalization, diagnostic examinations are carried out, which are not
carried out at the outpatient level: see paragraph 9, subparagraph 1.
Instrumental research (UD-B):
· chest radiography – to exclude pathology from the chest
· X-ray contrast examination - the main method that allows to determine the presence of
intestinal stula, its localization and size, the duration of barium retention in it, motor disorders of
the intestines, the presence of complications.
· obse ational radiography and computed tomography of abdominal organs in the presence of
intestinal stula reveals the localization of the stula, additional moves.
· endoscopic examination is used with great caution, as there is a high risk of intestinal
pe oration.
Diagnostic algorithm: See ambulato level.
List of main diagnostic measures (UD-B):
· X-ray contrast examination - the main method that allows to determine the presence of
intestinal stula, its localization and size, the duration of barium retention in it, motor disorders of
the intestines, the presence of complications.
· obse ational radiography and computed tomography of abdominal organs in the presence of
intestinal stula reveals the localization of the stula, additional moves.
· endoscopic examination is used with great caution, as there is a high risk of intestinal
pe oration.
List of additional diagnostic measures: Additional diagnostic tests carried out at the
stationa level – показаниям:
· AAM;
· KLA;
· Blood biochemical analysis: glucose, albumin, electrolytes;
· coagulology (PTI, brinogen, clotting time, INR);
· Blood group determination by AB0 system;
· determination of the blood rhesus factor;
· blood analysis for HIV;
· blood analysis for syphilis;
· determination of HBsAg in blood serum by ELISA;
· determination of total antibodies to hepatitis C virus (HCV) in blood serum by ELISA;
· ECG to exclude cardiac pathology;
· Review radiography of the chest organs;
· Ultrasound of abdominal organs;
· radiography of the chest organs;
· X-ray contrast examination
· Review radiography and computed tomography of abdominal organs
· Endoscopic examination
· Ultrasound of abdominal organs (liver, gallbladder, pancreas, spleen, kidneys);
· ECG to exclude cardiac pathology;
· Review radiography of the chest organs;
· computed tomography of the chest organs
· spirography.
 Di erential diagnosis
Диагноз Rationale for di erential diagnosis Обследования Diagnosis exclusion
criteria
In small intestinal
To determine the location of the X-ray methods: stulas, intestinal
Тонкокишеч stula, its appearance, the degree of passage and detached with
stulas change in the surrounding skin, the stulaojunography mucus and
nature and amount of the removed admixture of bile,
frothy, liquid
To determine the location of the X-ray methods, With colonic stulas
Толстокишеч stula, its appearance, the degree of endoscopic detachable form of
stulas change in the surrounding skin, the methods of decorated feces
nature and amount of the removed examination

Лечение
Drugs (active substances) used in treatment
Азитромицин (Azithromycin)
Albumin human (Albumin human)
Атропин(Atropine)
Hydrogen peroxide (Hydrogen peroxide)
Дексаметазон (Dexamethasone)
Дротаверин (The Robbe )
Imipenem (Imipenem)
Калия хлорид (Potassium chloride)
Кетопрофен (Ketoprofen)
Metamizole Sodium (Metamizole)
Метоклопрамид(Metoclopramide)
Омепразол (Omeprazole)
Пантопразол (Pantoprazole)
Plasma, fresh frozen
Повидон – йод (Povidone – iodine)
Ранитидин (Ranitidine)
Трамадол (Tramadol)
Тримеперидин (Trimeperidine)
Fluconazole (Fluconazole)
Хлоргексидин (Chlorhexidine)
Цефепим (Cefepime)
Цефтазидим (Ceftazidime)
Цефтриаксон (Ceftriaxone)
Leukocyte- ltered e throcyte suspension
Этамзилат (Etamsylate)
Этанол(Ethanol)

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 Treatment (outpatient)
TREATMENT AT THE OUTBULATORY LEVEL
Tactics of treatment: on the outpatient stage is not carried out.
Other treatments: None
Indications for expe consultation:
· consultation of narrow specialists – according to indications.
Preventive measures:
Prevention of intestinal stulas consists in timely adequate treatment of diseases of the digestive
tract.
Improving the quality of surgical care for patients with bowel diseases:
· correct choice of surgical treatment;
· Proper technique for pe orming these inte entions.
Patient monitoring:
· full recove of the patient;
· Restoration of reproductive function.
Indicators of treatment e ectiveness:
· Timely diagnosis of intestinal stulas;
· timely referral to the specialized hospital
Treatment (ambulance)
EMERGENCY DIAGNOSIS AND TREATMENT**
Diagnostic measures:
· External examination: the location of the ori ce and the condition of the skin are assessed;
· Finger examination: it determines the presence, level of location of the periphe .
Medication treatment:
· treatment of antiseptic solutions with povidone-iodine, chlorhexidine;
· Aseptic dressing.
 Treatment (inpatient)
IN-HOSPITAL TREATMENT
Tactics of treatment:
Non-pharmacological treatment:
Режим.
· Mode 2 – at medium severity of the condition.
· Mode 1 – in severe condition.
· Diet: Table No1. The purpose of diet therapy is a full- edged protein diet, if necessa -
parenteral nutrition.
Principles of Diet Therapy: First, conse ative measures are taken: a diet is prescribed, the
consumption of full- edged, chopped, non-hot food.
Medication treatment:
Conse ative treatment includes the patient's adherence to a diet and diet. Food should be
warm, rubbed, not irritating the slimy membrane. Prescribe antibacterial agents, secretolitics,
antacids, prokinetics, analgesics, antispasmodics are prescribed for pain syndrome.
Antibacterial therapy. In case of postoperative wound in ammation and for prevention of
postoperative in ammato processes, antibacterial drugs are used. For this purpose, cefazolin or
gentamicin is used for allergies to b-lactams or vancomycin for detection/high risk of methicillin-
resistant Staphylococcus aureus. According to the Scottish Intercollegiate Guidelines etc.
antibiotic prophylaxis in this type of operation is strongly recommended. In case of purulent-
in ammato complications, preference should be given to combinations (2-3) of antibiotics of
di erent groups. Change of the list of antibiotics for perioperative prophylaxis should be carried
out taking into account microbiological monitoring in the hospital.
Analgesic therapy: Non-narcotic and narcotic analgesics (tramadol or ketoprofen or ketorolac;
paracetamol). NSAIDs for pain relief. NSAIDs for postoperative analgesia should be sta ed 30-60
minutes before the expected end of the operation intravenously. Intramuscular administration of
NSAIDs for postoperative analgesia is not indicated due to variability in serum concentrations
and pain caused by injection, The exception is ketorolac (possible intramuscular administration).
NSAIDs are contraindicated in patients with ulcerative lesions and bleeding from the
gastrointestinal tract in anamnesis. In this situation, the drug of choice will be paracetamol, which
does not a ect the mucous membrane of the gastrointestinal tract. You should not combine
NSAIDs with each other. The combination of tramadol and paracetamol is e ective.
Surgical treatment: With lip stulas reso to operations, the nature of which is determined by
the type of stula - complete or incomplete. For small incomplete lip stulas, extraperitoneal
methods of closing the stulas are used. They consist in the isolation of the intestine wall in the
area of the stula and stitching the defect with a two-row suture. In large incomplete and
complete lip stulas apply intraperitoneal methods of closing them. In this case, the intestine is
isolated around the perimeter of the stula, it is removed into the wound, after which the stula
hole is sewn up (with incomplete stulas) or anastomosis is imposed (with complete stulas).
Sometimes reso to resection of the intestine, car ing the stula, with subsequent imposition of
anastomosis.
Features of postoperative period management include: 1) Transnasal injection of the probe
into the stomach (up to 6 days.) for its emptying and early feeding of the patient, sta ing from 3
days from the date of surge ; 2) replenishment of the water-electrolyte balance; 3) antibiotic
therapy for the prevention of purulent-in ammato complications; 4) prevention of
cardiorespirato complications; 5) symptomatic therapy.
Table of preparation comparisons:
Name INN Dose, кратность method of duration of Примечание
single administration treatment
Painkillers narcotic and non-narcotic drugs
narcotic analgesi
trimeperidine 2% - 1 ml eve hours
4-6 в/м 1-2 Days – for analgesia in
the postoperative
period
analgesic of mixe
Tramadol 100 mg - 2-3 Times внутримышечно within 2-3 type of action - i
2 ml days the postoperative
period
1-2 ml
50% or
Methamizole 2,0-5,0 2-3 Times в/в, в/м as the pain Non-narcotic
analgesic – for
Sodium ml-25% внутрь, stops anesthesia
500 mg
150 мг, Non-narcotic
кетопрофен 100 мг; 2-3 Times В/м, within 2-3 analgesic – for
100–200 in/out, inside days anesthesia
мг
Antibacterial therapy according to indications
ceftazime 0.5–2 g 2-3 day
once a in\m, in/in from 7-14
days
3rd Generation
Cephalosporins
1.0 g from 7-14
ceftriaxone eve 0.5–1 g 1-2 Times в\м, (depends on 3rd Generation
12 в/в the course of Cephalosporins
hours. the disease)
from 7 to 10
cefepime 0.5–1 g. 2-3 Times в\м, в/в days and 4th Generation
Cephalosporins
more
imipenem 0.5-1,0 g 3-4
day
once a в\м,
в\в
from 7-10
days
антибиотики -
карбапенемы
Azithromycin 500 mg 1 time a day внутрь 3 days antibiotics -
macrolides
Hemostatic according to indications
этамзилат 12.5%- by 2 times a day в/в, Up to 7 days hemostatic,
4.0 ml в/м angioprotector
Antifungal according to indications
antifungal agent,
Fluconazole 150 mg 1 time a day внутрь однократно for the preventio
and treatment of
mycosis
Anti-secreto according to indications
antisecreto dru
пантопрозол 40 mg
– 80 1-2 Times внутрь 2-4 Weeks - proton pump
inhibitor
1,4-20
mg/kg antisecreto dru
омепразол depending
on the 1 time a day внутрь 1 month - proton pump
patient's inhibitor
weight
ranitidine 2-3мг/кг 2 times a day внутрь 4–8 week antisecreto dru
– histamine
 receptor blocker
Antiemetics, antispasmolytics, steroids, remedies
for correction of electrolyte disturbances according to indications
5–10 mg;
metoclopramide 10 mg; 3 times a day inside, в/в
in/m, according to
indications
prokinetic,
antiemetic agent
10 mg
Inside –
0.04–0.08 2–3 times a
дротаверин g. W/m, day inside, p/c, w/m as the spasm
stops
antispasmodic
agent
p/c — 2–4
ml
0.00025-
0.005- before п/к, for
atropine sulfate 0.001 mg surge в/в, premedication M-choline blocke
1% в/м
solution
the Urgent depending on glucoco icostero
Dexamethasone 4мг/1мл States в/м the condition drug,
of the patient
duration means for
Potassium 40-50 ml в/в, depends on correction of
chloride 2.5 g in 1 time капельно the level of electrolyte
500 ml electrolytes in disorders
the blood
Antiseptics
antiseptic, for the
Povidone - 10% treatment of skin
iodine solution ежедневно наружно as required integuments and
drainage systems
for the антисептик
0.05% treatment of
хлоргексидин aqueous theeld,surgical
the наружно as required
solution surgeon's
hands
этанол, solution for the наружно as required
 70%; treatment of
the surgical
eld, the
surgeon's
hands
antiseptic –
hydrogen 3% For wound exterior locally as required oxidizing agent, f
peroxide solution treatment treatment of
wounds
Substitution therapy according to indications
The dose and means for
10%-200 concentration
альбумин ml, depends on in/in drip according to parenteral
20%-100.0 the level of indications nutrition - for the
correction of
ml. albumin in hypoproteinemia
the blood.
e throcyte According preparations of
suspension to the 1-2 Times in/in drip according to blood componen
leuko ltrated, indications indications - for correction o
350 ml anemia
preparations of
Fresh Frozen 220 ml 1-2 Times in/in drip according to blood componen
Plasma indications - for correction o
coagulopathy
Surgical inte ention in the conditions of a 24-hour hospital, according to Annex 1 to this IP.
Indications for expe consultation:
· consultation of anesthesiologist – in preparation for the operation;
· consultation of a resuscitation specialist – in cases of severe complications, the nature and
scope of detoxi cation therapy;
· consultation of a cardiologist, endocrinologist, urologist, gynecologist and other narrow
specialists - according to indications.
Indications for transfer to intensive care and intensive care unit: Patients with acute
hemodynamics disorders of various etiology are subject to hospitalization in intensive care and
intensive care wards. (acute cardiovascular insu ciency, traumatic shock, hypovolemic shock,
cardiogenic shock, etc.) acute respirato disorders, other disorders of functions of vital organs
and systems (central ne ous system, parenchymatous organs, etc.), acute metabolic disorders,
patients after surgical inte entions, which led to the dysfunction of life suppo systems or with
a real threat of their development, severe poisoning.
Indicators of treatment e ectiveness. Absence of intestinal stulas.
Fu her maintenance
· Diet. The basic principles of nutrition are d eating and fractional nutrition.
· Radiological control of the barium passage is carried out after 3 months.
Госпитализация
Indications for planned hospitalization: if there is a suspected intestinal stula.
Indications for emergency hospitalization: no.
Информация
Sources and Literature
I. Minutes of meetings of the Joint Commission on Quality of Medical Se ices of the Minist of
Health and Social Development of the Republic of Kazakhstan, 2016
. 1) Surge , a guide for doctors and students. Geoethar Medicine, 1997 translation from
English edited by Y.M. Lopukhina and V.S. Savelieva; 2) Private surge , textbook. Edited by
Professor M.I. Lytkina. Leningrad, Kirov VMA, 1990. 3) Joseph M. Henderson.
Pathophysiology of digestive organs. Bynom Publishers, 1997. 4) Abraham Bogoch,
Gastroenterology, New York, 1973. 5) Vitsyn B.A., Blagitko E.M. Formed and unformed
external intestinal stulas. Novosibirsk: Nauka, 1983. - 143c. 6) Gritsman Yu.Ya., Borisov A.I.
Postoperative intestinal stulas. Moscow: Meditsina, 1972. - 152c. 7) Dashkevich V.S.
Intestinal stulas. Minsk: Belarus, 1985. - 126c. 8) Kolchenogov P.D. External intestinal
stulas and their treatment. Moscow: Meditsina, 1964. - 234c. 9) Kurbanov Ch.Yu. External
postoperative intestinal stulas. Tashkent: Medicine of UzSSR, 1989. - 94c. 10) Makarenko
T.P., Bogdanov A.V. Gastrointestinal stula. Moscow: Meditsina, 1986. - 144c. 11) Ryabinsky
V.S., Stepanov V.N. Urine stulas. Moscow: Meditsina, 1986. - 236c. 12) Simic P. Intestinal
surge . Bucharest: Med. Publishers, 1979. - 400c. 13) Tobik S. Treatment of external
intestinal stulas. Moscow: Meditsina, 1977. - 86c. 14) Chukhrienko D.P., Belyi I.S. External
intestinal stulas. Kyiv: Zdorovya, 1975. - 192c. 15) Shalimov A.A., Saenko V.F. Surge of
the digestive tract. Kyiv: Zdorovya, 1987. - 568c.
Информация
Abbreviations used in the protocol
АД blood pressure
АЛТ аланинаминотрансфераза
АСТ asparataminetransferase
АЧТВ activated pa ial thromboplastin time
ВИЧ human immunode ciency virus
ЖЕЛ lung vital capacity
ЖКТ gastrointestinal tract
ИВЛ a i cial lung ventilation
ИФА enzyme immunoassay
КТ computed tomography
МНО international normalized relations
ОАК general blood count
ОАМ general urinalysis
СОЭ e throcyte sedimentation rate
УЗИ ultrasound examination
ФБС Fibrobronchoscopy
ФЭГДСFibroesophagogastroduodenoscopy
ЭКГ электрокардиограмма
КЩС acid-base state
ММВ maximum minute ventilation
МОД Minute breathing volume
ОГК thorax organs
ЩФ alkaline phosphatase
СКФ glomerular ltration rate
List of protocol developers with indication of quali cation data:
1) Zhuraev Shakirbai Shukirovich – doctor of medical sciences, professor, chief researcher of JSC
"National Research Center of A s and A s. A.N. Syzganov" Minist of Health and Social
Development of the Republic of Kazakhstan.
2) Izhanov Yergen Bakhchanovich – doctor of medical sciences, leading researcher of JSC
"National Research Center of A s and A s named after S.A. A.N. Syzganov" Minist of Health
and Social Development of the Republic of Kazakhstan.
3) Tashev Ibrahim Amanzholovich – doctor of medical sciences, professor, JSC "MUA.
4) Akhmedzhanova Gulnara Akhmedzhanovna - Candidate of Medical Sciences, Associate
Professor of the Depa ment of Surgical Diseases, KazNMU S.D. Asfendiyarova.
5) Kaliyeva Mira Maratovna – Ph.D., head Depa ment of Clinical Pharmacology and
Pharmacotherapy, KazNMU S.D. Asfendiyarova.
Indication of no con ict of interest: нет
Reviewer list:
Bigaliyev Madi Khodzhaevich – MD, Professor, Chief Physician of Shymkent City Hospital of
Emergency Medical Care
Revision of the Protocol 3 years after its publication and from the date of its ent into force or
where new methods are available with a level of evidence
Applications
Correlation of ICD-10 and ICD-9 codes:
МКБ-10 МКБ-9
Codeназвание Codeназвание
K Intestinal 44.31High bypass anastomosis
63.2 stulas
45.30Local excision of the small intestine
45.33 Local excision of the a ected area or small intestine tissue with the
exception of duodenal
45.61Multiple segmental resection of the small intestine
46.02Resection of the small intestine segment of the su ace of the body
46.74Closure of the stula of the small intestine, except the duodenal
45.40Local excision of the large intestine
45.41Excision of the a ected Uchaska or tanya of the large intestine
45.70Pa ial resection of the colon
45.79Other pa ial resection of the colon
46.04Resection of a segment of the colon exposed to the su ace of the body
46.76Colon Fistula Closure
46.50Closure of intestinal stoma unspeci ed otherwise
46.52Colon stoma closure
Annex 1
Methods of surgical and diagnostic inte ention
Methods of closing intestinal stulas and diagnostic inte ention
METHODS, APPROACHES AND PROCEDURES OF DIAGNOSIS AND TREATMENT – depends
on the type of surgical treatment:
· Extraperitoneal closure methods
· Intraperitoneal closure methods
Purpose of the procedure/inte ention: A lightning rod.
Indications and contraindications for the procedure/inte ention:
Indications for surgical treatment in an emergency order: нет
Indications for surgical treatment in a planned manner:
• presence of intestinal stula.
Contraindications to the procedure/inte ention: a contraindication for planned operations is
the presence of urgent pathology of organs and systems, as well as decompensation of chronic
diseases of the body.
List of main and additional diagnostic measures: See ambulato level.
Laborato studies:
· KLA;
· AAM;
· Blood biochemical analysis (total protein, urea, creatinine, bilirubin, ALT, AST, glucose);
· Ultrasound of abdominal organs (liver, gallbladder, pancreas, spleen, kidneys);
· ECG to exclude cardiac pathology;
· Review radiography of the chest organs;
· contrast radiography of the gastrointestinal tract
· endoscopic examination of the bowel
· radiography of the chest organs;
· Ultrasound of the abdomen;
· FBS;
· spirography.
Additional research – are carried out to identify complications and di erential diagnosis with
other diseases:
· Blood biochemical analysis (total protein, albumin, sialic acid, C-reactive protein, ALT, AST,
amylase, SPF) - on the testimonies.
Instrumental research:
· X-ray contrast examination - the main method that allows to determine the presence of
intestinal stula, its localization and size, the duration of barium retention in it, motor disorders of
the intestines, the presence of complications.
· obse ational radiography and computed tomography of abdominal organs in the presence of
intestinal stula reveals the localization of the stula, additional moves.
· endoscopic examination is used with great caution, as there is a high risk of intestinal
pe oration.
Procedure/inte ention method:
Types of surgical treatment:
· Extraperitoneal methods of closing stulas, the advantage of which is their low-traumaticity,
low lethality. Disadvantage - such operations are pe ormed blindly, the probability of stula is
quite high.
· intraperitoneal methods of closing the stula, while it is possible to car out a revision of the
abdominal cavity, separate adhesions, eliminate in ections of the intestinal loop. Methods:
disengagement of the intestinal loop, car ing stula; marginal, wedge and circular resection.
Pe ormance Indicators: complete removal of stula without signs of recurrence.

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