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

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.

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

DOI: 10.17116/hirurgia202504179

Downloaded: 7

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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 2025-2 (Pirogov Russian Journal of Surgery)

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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

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