PROBLEMATIC ISSUES IN THE TREATMENT OF GUNSHOT WOUNDS TO THE ABDOMEN IN THE CONTEXT OF THE SPECIAL MILITARY OPERATION (A REVIEW OF RUSSIAN LITERATURE FROM 2023–2025)

<jats:p>Background. This review is dedicated to analyzing modern approaches to the diagnosis and treatment of gunshot wounds to the abdomen sustained during the Special Military Operation (SMO). The relevance of this topic is determined by the high incidence of abdominal trauma (up to 16.2% of all injuries), persistent mortality rates (up to 80% in cases of combined trauma), and a significant number of postoperative complications (up to 65%), primarily associated with the development of peritonitis. Main Contents. The work systematizes data from Russian literature reflecting the evolution of combat trauma. It demonstrates the predominance of shrapnel wounds (up to 85%) and combined injuries, which leads to extensive damage zones and multiple internal organ injuries. Key attention is paid to the pathogenesis of gunshot peritonitis, which is characterized by polymicrobial flora (microorganism associations in 94.8% of cases) and high antibiotic resistance, determining the severity of the postoperative period. The review examines in detail modern surgical tactics based on the "damage control" strategy. The key role of vacuum-assisted laparostomy in treating peritonitis and preparing the abdominal cavity for closure is emphasized. Separate sections are devoted to diagnostic algorithms (MSCT, videolaparoscopy), the specifics of treating injuries to individual organs (pancreas, liver, spleen), as well as the analysis of causes and prevention of postoperative complications, including intestinal fistulas and abdominal compartment syndrome. The work also systematizes the criteria for abandoning primary radical intervention in favor of a staged approach, based on assessing the severity of the wounded patient's condition (shock, coagulopathy, acidosis) and the nature of the peritonitis. Conclusions. The synthesis of current evidence indicates the necessity of implementing staged surgical tactics (damage control) with the active use of vacuum-assisted laparostomy as the standard of care for severe abdominal gunshot wounds complicated by peritonitis. Further improvement of diagnostic algorithms and prevention of postoperative complications is required, taking into account the antibiotic resistance of hospital strains of microorganisms.</jats:p>