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

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.