When Multidisciplinary Collaboration Saves Lives: A Case Report of the Treatment of a Severely Injured Ukrainian Soldier

Christian Schmidt¹, MD, Rehne Lessmann Hansen¹, MD, PhD, Mette Cathrine Lauridsen², MD, PhD, Karen Rokkedal Lausch³, MD, PhD, Ingeborg Klindt Böing⁴, MD, Kristian Høy^{1, 5, 6}, MD, PhD

Department of Orthopedic Surgery¹, Department of Gastrointestinal Surgery², Department of Infectious Diseases³, Department of Cardiothoracic and Vascular Surgery⁴, Department of Clinical Medicine⁵, Department of Biomedicine⁶, Aarhus University & Aarhus University Hospital, Aarhus, Denmark

Case report

Following the Russian invasion of Ukraine, the Danish government agreed to receive Ukrainian patients for advanced medical treatment as part of humanitarian assistance efforts. Many of these patients are present with severe, complex war injuries complicated by infections requiring highly specialized care. This case report describes the successful management of a severely injured Ukrainian soldier, emphasizing the critical role and advanced possibilities of a highly specialized multidisciplinary collaboration. Objective: to describe the successful management and outcome of a patient with severe war injuries and widespread multidrug-resistant infections through a multidisciplinary collaboration approach at Aarhus University Hospital, Denmark.

Patient history and initial management

In March 2023, a Ukrainian soldier sustained a blast injury near the frontline, causing extensive trauma, including grenade fragment damage to the lumbar spine, inferior vena cava (IVC), and gastrointestinal tract. Initial lifesaving surgery in Ukraine included fragment removal, IVC graft placement, and bowel resection with loop ileostomy. Although initially stabilized, repeated surgical interventions and antibiotic treatments failed to achieve infection control. After three months of hospitalization in Ukraine, he was transferred to Aarhus University Hospital (AUH), Denmark.

Admission findings (June 2023)

On arrival at AUH, the patient was severely cachectic, weighing 40.3 kg (body mass index (BMI) 15.7), with hypoalbuminemia (23 g/L), severe electrolyte imbalance, inability to mobilize, and an infected loop ileostomy imbedded in a large abdominal wound. Remaining small bowel length was estimated at 50–70 cm with an output of 5,000 ml/day. CT and PET-CT revealed complete IVC graft occlusion by a septic thrombus formation; survival was possible only due to an anatomical anomaly with a duplicated IVC. Additional findings included L4 vertebral osteomyelitis and L4–L5 spondylodiscitis with fistulization to the IVC graft via a large intra-abdominal and paravertebral abscess (Fig. 1).

Figure 1. FDG-PET-CT scan after arrival at AUH, June 2023. Picture from transversal view at L4 level, showing L4 erosion with osteomyelitis. Anterior to this showing abscessation, involving IVC stent

Microbiological cultures from blood, feces, and wounds revealed a polymicrobial infection, including carbapenemase-producing organisms, methicillin-resistant Staphylococcus aureus, and hepatitis C virus infection. Despite broad intravenous suppressive antibiotic treatment, he experienced intermittent hyperpyrexia and C-reactive protein fluctuations between 75–120 mg/L.

Treatment

From the outset, it was evident that successful management would require profound surgical and medical intervention with a highly specialized multidisciplinary team (MDT) approach. The patient was admitted to the Orthopedic Department, where a dedicated team of infectious disease surgeons coordinated the MDT treatment effort, involving spine, vascular, and gastrointestinal surgeons, gastroenterologists, microbiologists, and infectious disease specialists.

Given his near-moribund state, with infection controlled only by high-dose intravenous antibiotics, surgical intervention was deemed inevitable. Through almost daily multidisciplinary bedside evaluations and weekly MDT conferences, the patient was systematically optimized for surgery.

Nutritional and electrolyte status was supported with intravenous therapy and parenteral nutrition, while stoma output was reduced with high-dose loperamide, leading to weight gain to 53.4 kg (BMI 20.7). Infection control was achieved with broad-spectrum triple antibiotic therapy (ceftazidime, colistin, and metronidazole), adjusted according to culture results. Pain management and rehabilitation enabled him to walk a few steps independently prior to surgery.

After 54 days of optimization, a one-stage procedure was performed involving vascular, gastrointestinal, infectious disease, and spine surgeons. The infected IVC graft was removed, the loop ileostomy resected with re-establishment of bowel continuity, and extensive abdominal and spinal debridement undertaken, followed by vertebral bone transplantation at L4 (Fig. 2).

Figure 2. Clinical picture from surgery. Showing anterior sanitation of L4 (blue arrow) following the abdominal and vascular surgical interventions

Postoperatively, intensive multidisciplinary treatment continued, resulting in gradual clinical and paraclinical improvement, enhanced mobilization, and transition to oral feeding. However, the patient experienced several setbacks, including infectious relapses with Candida auris fungemia and Clostridioides difficile colitis. Therapy was escalated to five-drug coverage, including vancomycin and anidulafungin.

Results

After 101 days of hospitalization, the patient was discharged with outpatient follow-up. At discharge, he weighed 48 kg (BMI 18.8), was independently mobile, and had completed antibiotic treatment with no clinical or paraclinical signs of infection, and no neurological deficits.

At one-year follow-up (October 2024), he remained neurologically intact and fully mobile, able to walk several kilometers unaided, with only intermittent moderate lower back pain. He had normal bowel function, weighed 65 kg (BMI 25.4), and was well-nourished. He had no relapses of infections, was well treated for Hepatitis C, abdominal wound well healed and his osteomyelitis and spondylodiscitis well treate­d (Fig. 3). He was attending Danish language courses, had applied for employment, and expressed optimism about his future.

Figure 3. A: Clinical picture of patient´s abdomen at arrival in Denmark, June 2023. Showing large, infected wound surrounding ileostomy. B: Sagittal view CT scan of lumbar spine at arrival in Denmark, June 2023. Showing severe bone destruction of L4 and L5, due to active infection C: Clinical picture of patients’ abdomen at ambulant follow-up, October 2024. Showing scar tissue and well recovering of prior wound. D: Sagittal view CT scan of lumbar spine at ambulant follow-up, October 2024. Showing bone recovery and synostosis of L4 and L5

Discussion

MDT management is well established in several medical specialties and is increasingly recognized as essential in the treatment of complex, multimorbid orthopedic patients, with demonstrated improvements in both treatment and outcomes [1–3]. This case exemplifies the critical benefits of an MDT approach. It demonstrates that in extreme trauma settings with severe multidrug-resistant infections and multi-organ involvement, sustained collaboration across specialties is essential to achieve survival in otherwise doubtful scenarios. In our assessment, the patient would not have survived without this MDT-based strategy.

Conclusion

Persistent, highly specialized MDT collaboration enabled the successful treatment of a patient with complex war injuries involving severe vascular, spinal, and gastrointestinal pathology. This case may serve as a model and motivational example for the management of similarly high-risk patients, both in primary and tertiary treatment centers.

References

Received/Надійшла до редакції: 06.10.2025
Accepted/Прийнято до друку: 11.10.2025