Current treatment methods for patients with peritonitis and intestinal fistulas

Lutsevich O.E., Rozumny A.P., Pilat T.L., Mudarisov R.R., Mikhailov V.G., Fomin V.S.

1) Russian University of Medicine, Moscow, Russia; 2) Moscow Clinical Research Center, Hospital No.52, Moscow Healthvcare Department, Moscow, Russia; 3) Izmerov Research Institute of Occupational Medicine, Moscow, Russia

Background: Diffuse peritonitis complicated by intestinal fistulas is one of the most challenging problems in abdominal surgery, characterized by a vicious cycle of pathophysiology and high mortality rates (up to 40–60%). The management of patients with combined pathology - peritonitis, open abdomen syndrome, and small intestinal fistulas - is particularly challenging.
Objective: Systematization of current understanding of the etiology, pathogenesis, and comprehensive treatment of this patient population.
Methods: A review of domestic and international literature, including clinical guidelines, systematic reviews, and original studies on surgical tactics, intensive care methods, and nutritional support, was conducted.
Results: Treatment success is determined by a staged approach based on the principles of damage control surgery. The primary goal is surgical control of the source of infection and the use of an open-abdomen strategy using negative pressure wound therapy (NPWT). Conservative treatment of fistulas, including active drainage, targeted antimicrobial therapy, pharmacological secretion reduction (octreotide), and individualized nutritional support, is the first-line treatment. Radical interventions are deferred until the patient is stabilized. The choice of strategy should be based on comprehensive classifications (Belokonev-Izmailov, Bjorck) and prognostic scales (SOFA, APACHE II, MPI).
Conclusion: The management of patients with peritonitis and intestinal fistulas requires a multidisciplinary approach, a thorough understanding of pathophysiology, and strict adherence to the appropriate stages. Despite progress, further development and validation of unified algorithms based on evidence-based medicine is required.

For citations: Lutsevich O.E., Rozumny A.P., Pilat T.L., Mudarisov R.R., Mikhailov V.G., Fomin V.S. Current treatment methods for patients with peritonitis and intestinal fistulas. Pharmateca. 2026;33(1):33-42. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.1.33-42

Authors’ contribution: All authors made an equivalent contribution to the preparation of the publication.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.

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About the Authors

Oleg E. Lutsevich, Dr. Sci. (Med.), Physician of the Highest Qualification Category, Professor, Chief Surgeon of the Center for Endosurgery and Lithotripsy, Honored Doctor of the Russian Federation, Chief Specialist of the Moscow Health Department for Endosurgery and Endoscopy, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Faculty Surgery No. 1, Russian University of Medicine, Moscow, Russia
Arkady P. Rozumny, Cand. Sci. (Med.), Surgeon of the Highest Qualification Category, Associate Professor, Department of Faculty Surgery No. 1, Russian University of Medicine; Moscow Clinical Research Center, Hospital No.52, Moscow Healthcare Department, Moscow, Russia;
rozumny@mail.ru
Tatiana L. Pilat, Dr. Sci. (Med.), Leading Researcher Clinical Department of Occupational and Industrial Diseases , Izmerov Research Institute of Occupational Medicine, Moscow, Russia; tpilat@leovit.ru, ORCID: https://orcid.org/0000-0002-5930-8849
Rinat R. Mudarisov, Cand. Sci. (Med.), Surgeon of the Highest Qualification Category, Associate Professor, Deputy Chief Physician for Surgical Care, Moscow Clinical Research Center, Hospital 52, Moscow Healthcare Department, Moscow, Russia; docmr@rambler.ru
Vladimir G. Mikhailov, Cand. Sci. (Med.), Assistant Professor, Department of Faculty Surgery No. 1, Russian University of Medicine; Surgeon, 1st Surgical Department, Moscow Clinical Research Center, Hospital No. 52, Moscow Healthcare Department, Moscow, Russia; surgery_76@mail.ru
Vladimir S. Fomin, Cand. Sci. (Med.), Associate Professor, Department of Surgical Diseases and Clinical Angiology, Russian University of Medicine, Moscow, Russia; wlfomin83@gmail.ru (corresponding author)

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