Objective. To raise the efficacy of radiological diagnosis of the gun-shot abdominal woundings, using modern highly informative methods of medical visualization with determination of their sensitivity and specificity. Materials and methods. Retrospective analysis was done of the results of radiological diagnosis, endovideosurgical and invasive interventions under the radiological methods guidance in 70 injured persons with the gun-shot abdominal woundings, to whom a qualified surgical aid with some elements of specialized help was delivered in 2014-2020 yrs. Average age of the injured persons have constituted 30 complete years old. There were 68 (97.1%) men and 2 (2.9%) women. The results of digital roentgenography, ultrasonographic diagnosis, laparoscopy/laparocentesis, thoracoscopy/thoracocentesis, the puncture-draining interventions under the radiological methods guidance in the injured persons with the gun-shot abdominal woundings were compared to results of the multidetector computed tomography with dynamical contrasted enhancement as a “gold standard” of diagnosis of the gun-shot abdominal woundings and criterion of the foreign bodies visualization (metallic shrapnel, bullets, fragments of bone, drains etc.). Results. The main mechanism of damage in the affected persons with the gun-shot abdominal woundings were shrapnel, created as a result of application of various kinds of the gun-shot and explosive weapons. The part of the gun-shot shrapnel woundings statistically significantly prevailed over part of the bullet and explosive woundings. In accordance to the wound channel kind, the part of blind woundings have had prevailed over parts of the through and multiple woundings statistically significantly (p < 0,05). On a mobile tactical level the rate of application of ultrasonic diagnosis and digital roentgenography for primary selection and diagnostic monitoring was statistically significantly (p < 0.05) higher, than of other methods of medical visualization, what may be explained by improvement and optimization of the treatment and diagnosis tactics, application of urgent sonography in trauma and other modified protocols. Optimal diagnostic system was determined in accordance to indices of sensitivity and specificity of the medical visualization methods, endovideosurgical and puncture-draining interventions under the radiological methods of control - the multidetector computed tomography with dynamical contrasted enhancement. Conclusion. High sensitivity (99%) and specificity (98%) of the multidetector computed tomography with dynamical contrasted enhancement permits to apply it as a method of medical visualization of the gun-shot abdominal woundings for diagnostic selection of wounded persons and the diagnosis establishment.

Among the features of radiological diagnosis for the wounded with injuries of the gastrointestinal tract, we can point to a set of radiological methods of research, among which the leading place is occupied by X-ray contrast studies of the abdomen — vulnerography, fistulography, enterography, irigoscopy. The most important task of special methods of X-ray examination of gastrointestinal injuries, accompanied by the introduction of X-ray contrast agents, is the control of the postoperative period, radiological support during surgery and diagnosis of failure of sutures, anastomoses, intraperitoneal walls fistula, phlegmon of retroperitoneal tissue. Materials and methods. The results of retrospective analysis of radiological diagnostics of 76 (7.5 ± 1.6) % of wounded in the abdomen, waist, retroperitoneal space from the total mass of subjects (n = 1013 people), due to the mechanical and multifactorial nature of the lesion. Of these, 42 subjects with a predominant abdominal component of gastric injury injuries were in 6 cases out of 42 (14.3 %), 3 (7.1 %) cases of esophageal and duodenal injuries, small bowel injuries were observed in 12 cases (28, 6 %), colon damage in 14 cases (33.4 %) and rectal damage in 4 cases (9.5 %). All X-ray contrast studies of different parts of the digestive tract were performed with one-time double contrast and other methods in the X-ray diagnostic department of the clinic (radiation diagnostics and therapy) of the National Military Medical Clinical Center «GVKG» on modern X-ray machine expert class OPERA SWING. Discussion of results. There are no fundamental differences in the tactics of radiation control of injuries (TCU) of the gastrointestinal tract in abdominal injuries. However, in the preoperative period of urgent radiological diagnosis of damage to the esophagus, stomach, small, colon, and other parts of the colon, preference is given to non-contrast radiological examination of the abdomen (review radiography in direct projection standing / lying, lateroposition and lateral projection). In the future, the postoperative period of the wounded is accompanied by the widespread use of X-ray contrast studies of internal organs with gastrointestinal damage for radiation support during surgery and diagnosis of complications in the early and late postoperative periods. Conclusions. Given the multiple and combined nature of gunshot and non-gunshot injuries to the abdomen, lower back, retroperitoneal space in the wounded with injuries of the esophagus, stomach, small, colon and other parts of the colon, immediate radiological diagnosis should be provided to all wounded. preoperative period to address the clinical and diagnostic problem of emergencies. Since the natural X-ray contrast of the abdominal cavity and retroperitoneal space is very low, and damaged hollow organs increase pneumatization of the gastrointestinal tract, the use of artificial contrast (barium mixture, iodine-containing water-soluble X-ray contrast agents) significantly increases the diagnostic value. The use of special methods of X-ray examination with artificial contrast in the postoperative period is determined by the condition of the wounded and the specific clinical situation.