Relationship between intestinal insufficiency syndrome and risk of external intestinal fistulas in patients with severe acute pancreatitis

Kiselev V.V.; Zhigalova M.S.; Yartsev P.A.; Novikov S.V.; Kuzmin A.M.; Tkeshelashvili D.T.

doi:https://doi.org/10.17116/hirurgia202504179

Kiselev V.V.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0002-0170-7775

Zhigalova M.S.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0003-4520-1124

Yartsev P.A.

Sklifosovsky Research Institute for Emergency Care

SPIN RSCI: 4044-9661
Scopus AuthorID: 55970485700
ResearcherID: P-9151-2017
ORCID: 0000-0003-1270-5414

Novikov S.V.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0002-1068-0252

Kuzmin A.M.

Sklifosovsky Research Institute for Emergency Care

Tkeshelashvili D.T.

Sklifosovsky Research Institute for Emergency Care

Relationship between intestinal insufficiency syndrome and risk of external intestinal fistulas in patients with severe acute pancreatitis

Authors:

Kiselev V.V., Zhigalova M.S., Yartsev P.A., Novikov S.V., Kuzmin A.M., Tkeshelashvili D.T.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2025;(4): 79‑85

DOI: 10.17116/hirurgia202504179

Read: 756 times

Contact the author

Table of contents

To cite this article:

Kiselev VV, Zhigalova MS, Yartsev PA, Novikov SV, Kuzmin AM, Tkeshelashvili DT. Relationship between intestinal insufficiency syndrome and risk of external intestinal fistulas in patients with severe acute pancreatitis. Pirogov Russian Journal of Surgery. 2025;(4):79‑85. (In Russ.)
https://doi.org/10.17116/hirurgia202504179

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

OBJECTIVE

To identify the risk factors of external intestinal fistulas in patients with severe acute pancreatitis (SAP) and pancreatic necrosis.

MATERIAL AND METHODS

A retrospective and prospective study included 537 patients (354 (65.9%) men and 183 (34.1%) women) with SAP. Mean age was 51.2±18.5 years. To assess the effectiveness of intensive therapy, patients were divided into 2 groups. The control group (n=207) included patients who underwent examination and treatment according to the national guidelines «Acute pancreatitis», 2020). In the main group (n=330), examination and treatment were supplemented with original protocol.

RESULTS. P

Atients with intestinal failure score< 5 had no purulent-septic complications and multiple organ failure. Among patients with 6—9 scores, purulent-septic complications were observed in 11.7% of cases, multiple organ failure — 14.8% of cases. Among patients with 10—12 scores, the incidence of purulent-septic complications was 24.6%, multiple organ failure — 30% of cases. Thus, intestinal failure score > 10 is an important prognostic criterion of purulent-septic complications and multiple organ failure. In addition, external intestinal fistulas occurred in 8.5% of patients with intestinal failure score > 10.

CONCLUSION. P

Rogression of intestinal failure correlates with purulent-septic complications and external intestinal fistulas in patients with SAP and pancreatic necrosis. Original diagnostic algorithm is valuable for early detection of functional gastrointestinal disorders, severity and localization of these changes. Original scoring system makes it possible to predict the risk of purulent-septic complications and multiple organ failure on the first day after admission. Moreover, timely therapy improves treatment outcomes in patients with SAP. In our study, the incidence of purulent-septic complications including external intestinal fistulas decreased from 10% to 7% in the main group.

Keywords:

intestinal insufficiency syndrome

external intestinal fistulas

severe acute pancreatitis

pancreatic necrosis

intestinal barrier

Authors:

Kiselev V.V.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0002-0170-7775

Zhigalova M.S.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0003-4520-1124

Yartsev P.A.

Sklifosovsky Research Institute for Emergency Care

SPIN RSCI: 4044-9661
Scopus AuthorID: 55970485700
ResearcherID: P-9151-2017
ORCID: 0000-0003-1270-5414

Novikov S.V.

Sklifosovsky Research Institute for Emergency Care

ORCID: 0000-0002-1068-0252

Kuzmin A.M.

Sklifosovsky Research Institute for Emergency Care

Tkeshelashvili D.T.

Sklifosovsky Research Institute for Emergency Care

Received:

11.12.2024

Accepted:

10.01.2025

Close metadata

References:

Baron TH, DiMaio CJ, Wang AY, Morgan KA. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology. 2020;158(1):67-75. https://doi.org/10.1053/j.gastro.2019.07.064
Glushkov NI, Safin MG, Lobanov MYu, Andrusenko AV, Belsky II, Yukhimik AV, Zoteev AN. Optimization of surgical tactics in acute pancreatitis. HERALD of North-Western State Medical University named after II. Mechnikov. 2016;8(2):7-13. (In Russ.).
Umapathy C, Raina A, Saligram S, Tang G, Papachristou GI, Rabinovitz M, Chennat J, Zeh H, Zureikat AH, Hogg ME, Lee KK, Saul MI, Whitcomb DC, Slivka A, Yadav D. Natural history after acute necrotizing pancreatitis: a large US tertiary care experience. Journal of Gastrointestinal Surgery. 2016;20(11):1844-1853. https://doi.org/10.1007/s11605-016-3264-2
Bendersky VA, Mallipeddi MK, Perez A, Pappas TN. Necrotizing pancreatitis: challenges and solutions. Clinical and Experimental Gastroenterology. 2016;(9):345-350. https://doi.org/10.2147/CEG.S99824
Sulimov MG, Avakimyan SV, Shneivais SS. On the issue of treatment of gastrointestinal fistulas in pancreatic necrosis. Kuban Scientific Medical Bulletin. 2013;3(138):116-118. (In Russ.).
Yartsev PA, Teterin YuS, Vodyasov AV, Levitskiy VD, Kuzmin AM, Rogal MM, Nugumanova KA. Endoscopic treatment of benign gastrointestinal fistulas. Pirogov Russian Journal of Surgery. 2020;(1):46-52. (In Russ.). https://doi.org/10.17116/hirurgia202001146
Vazquez-Sandoval A, Ghamande S, Surani S. Critically ill patients and gut motility: Are we addressing it? World journal of gastrointestinal pharmacology and therapeutics. 2017;8(3):174-179. https://doi.org/10.4292/wjgpt.v8.i3.174
Reintam Blaser A, Malbrain ML, Starkopf J, Fruhwald S, Jakob SM, De Waele J, Braun JP, Poeze M, Spies C. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Medicine. 2012;38(3):384-394. https://doi.org/10.1007/s00134-011-2459-y
Sertaridou E, Papaioannou V, Kolios G, Pneumatikos I. Gut failure in critical care: old school versus new school. Annals of Gastroenterology. 2015;28(3):309-322.
Rowland I, Gibson G, Heinken A, Scott K, Swann J, Thiele I, Tuohy K. Gut microbiota functions: metabolism of nutrients and other food components. European Journal of Nutrition. 2018;57(1):1-24. https://doi.org/10.1007/s00394-017-1445-8
Yu LC, Wang JT, Wei SC, Ni YH. Host-microbial interactions and regulation of intestinal epithelial barrier function: From physiology to pathology. World Journal of Gastrointestinal Pathophysiology. 2012;3(1):27-43. https://doi.org/10.4291/wjgp.v3.i1.27
Rooks MG, Garrett WS. Gut microbiota, metabolites and host immunity. Nature Reviews. Immunology. 2016;16(6):341-352. https://doi.org/10.1038/nri.2016.42
de Jong PR, González-Navajas JM, Jansen NJ. The digestive tract as the origin of systemic inflammation. Critical Care. 2016;20(1):279.
Kuteesa J, Kituuka O, Namuguzi D, Ndikuno C, Kirunda S, Mukunya D, Galukande M. Intra-abdominal hypertension; prevalence, incidence and outcomes in a low resource setting; a prospective observational study. World Journal of Emergency Surgery. 2015;(10):57. https://doi.org/10.1186/s13017-015-0051-4
Kiselev VV, Zhigalova MS, Teterin YuS, Shavrina NV, Selina IE, Novikov SV, Staleva KV, Odintsova VE, Koshechkin SI, Tyakht AV, Yartsev PA, Petrikov SS. Diagnostic criteria for the degree of intestinal failure in patients with severe acute pancreatitis. Vysokotekhnologicheskaya meditsina. 2023;10(2):43-58. (In Russ.).
Novikov SV, Rogal ML, Yartsev PA, Titova GP, Bognitskaya TV, Kuzmin AM. Ultrasonic diagnosis of acute pancreatitis in the first phase of the disease. Diagnostic and Interventional Radiology. 2019;13(2):21-30. (In Russ.). https://doi.org/10.25512/DIR.2019.13.2.02
Beresneva EA. Ability and value of x-ray radiography at the acute abdomen. Medical Visualization. 2004;(3):6-37. (In Russ.).
Beresneva EA, Grishin AV. Significance and possibilities of fistulography in destructive pancreatitis in the postoperative period. Russian Journal of Gastroenterology, Hepatology and Coloproctology. 2001;5(Suppl.15):63. (In Russ.).
Kiselev VV, Petrikov SS, Zhigalova MS, Novikov SV, Shavrina NV, Yartsev PA. Restoration of Intestinal Propulsion in Patients With Severe Acute Pancreatitis in the Conditions of the Resuscitation and Intensive Care Unit. Russian Sklifosovsky Journal of Emergency Medical Care. 2023;12(2):210-216. (In Russ.). https://doi.org/10.23934/2223-9022-2023-12-2-210-216
Kiselev VV, Zhigalova MS, Klychnikova EV, Petrikov SS, Novikov SV, Staleva KV, Yartsev PA. Serum iron as a predictor of severe acute pancreatitis. Russian Journal of Anesthesiology and Reanimatology. 2023;(6):68-74. (In Russ.). https://doi.org/10.17116/anaesthesiology202306168
Rogal’ ML, Yartsev PA, Zhigalova MS, Kiselev VV, Shavrina NV, Staleva KV, Teterin YuS, Petrikov SS. Therapeutic and diagnostic complex in intestinal failure syndrome in patients with closed abdominal trauma. Pirogov Russian Journal of Surgery. 2024;(9):57-65. (In Russ.). https://doi.org/10.17116/hirurgia202409157
Kislyakova EA, Tropskaya NS, Popova TS. Enteral administration of tributyrin as an element of nutritional support in the treatment of disruption of the intestinal electrical activity during experimental endotoxemia. Biomeditsina. 2015;(4):77-83. (In Russ.).
Cai J, Su W, Chen X, Zheng H. Advances in the study of selenium and human intestinal bacteria. Frontiers in Nutrition. 2022;(9):1059358. https://doi.org/10.3389/fnut.2022.1059358
Savvina IA, Nucalova HS, Petrova AO, Bykova KM, Tkebuchava IV. Replacement Selenium Therapy in Acute Cerebral Damage. In: Gelen V, Kara A, Kükürt A, eds. Selenium and Human Health. Ebook. 2023:81-102. https://doi.org/10.5772/intechopen.110505
Roth E, Oehler R, Manhart N, Exner R, Wessner B, Strasser E, Spittler A. Regulative potential of glutamine--relation to glutathione metabolism. Nutrition. 2002;18(3):217-221. https://doi.org/10.1016/s0899-9007(01)00797-3
Sauer AK, Grabrucker AM. Zinc Deficiency During Pregnancy Leads to Altered Microbiome and Elevated Inflammatory Markers in Mice. Frontiers in Neuroscience. 2019;(13):1295. https://doi.org/10.3389/fnins.2019.01295
Baklykova NM. (compiler) Sostav i prigotovlenie sred dlya vnutrikishechnogo vvedeniya pri peritonite: metodicheskie rekomendatsii MZ RSFSR. Moscow; 1986. (In Russ.).
https://patentimages.storage.googleapis.com/68/45/84/163e1887b17e76/RU2190412C2.pdf https://patentimages.storage.googleapis.com/68/45/84/163e1887b17e76/RU2190412C2.pdf(InRuss.).
Petrikov SS, Yartsev PA, Kiselev VV, Ryk AA, Selina IE, Teterin YuS, Shavrina NV, Zhigalova MS, Protsenko DN, Klypa TV. Therapeutic and preventive complex for intestinal insufficiency syndrome against the background of infected pancreatic necrosis. Methodical recommendations №81. Moscow: State Budgetary Healthcare Institution «Research Institute for Emergency Medicine named after IV. Sklifosovsky, Department of Health of Moscow»; 2022. (In Russ.).