Russian Journal of Pediatric Surgery

Peer-review bimonthly medical journal.

Editor-in-Chief

  • Leonid M. ROSHAL (ORCID: 0000-0002-6920-7726)
    MD, PhD, Dr. Science, Professor
    president of the National Medical Chamber
    Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russia 

Founder

Publisher

About

Russian Journal of Pediatric Surgery is the oldest journal for pediatric surgeons in Russia. The journal was founded in 1997 by Academician of the Russian Academy of Medical Sciences Yu.F. Isakov  whose name is on the journal’s  cover.  Since 2016, the Editor-in-Chief of the journal has been  Professor Leonid  M. Roshal. The Editorial Board of the journal - since its foundation and up to now -  consists of  leading scientists of Russia  who took part at the journal’s foundation and currently  continue  and develop the school of Russian pediatric surgery.

The main goal of the journal is to inform specialists working in  pediatric surgery about modern researches and recommendations for making right decisions in clinical practice. The journal publishes reviews of literature on basic problems in pediatric surgery, pediatric traumatology-orthopedics, anesthesiology-resuscitation which put readers  in the epicenter of modern innovative technologies, trends and unsolved issues of their specialties. The section of original articles presents evidence-based researches in all areas of pediatric surgery, critical medicine, anesthesiology and resuscitation. One can also find there  discussions and exchange of experience; the section of clinical practice publishes unique clinical observations and approaches to  diagnostics and treatment of pediatric  surgical diseases in various domestic clinics  and abroad.  The journal pays  a great attention to the  treatment of critical conditions, anesthesiologic support  and surgical correction of congenital malformations in newborns. The journal also covers issues of healthcare management  and training of specialists in surgical specialties. An obligatory part of each issue is the section of   history of pediatric surgery   and news of scientific life. The geography of articles accepted for publication has no restrictions.

The journal is designed for pediatric surgeons, anesthesiologists-resuscitators and physicians of related specialties.

 


Announcements More Announcements...

 

Eco-Vector — the new publisher for the Russian Journal of Pediatric Surgery

Posted: 30.01.2024

Since 2024, Eco-Vector Publishing group became the publisher of the "Russian Journal of Pediatric Surgery" (ISSN 1560-9510 (Print) ISSN 2412-0677 (Online)). The the Editor-in-Chief, Professor Leonid M. Roshal, and the editorial board of the journal has not changed. 

The new official address of the journal's website is https://jps-nmp.ru/

From 2024, the editorial board asks authors to submit manuscripts for publication only through the electronic editorial system on the journal's website.


 

Current Issue

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Vol 28, No 4 (2024)

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Full Issue

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ORIGINAL ARTICLES

Some aspects of the application of magnetic resonance imaging for differential diagnostics of acute hematogenous osteomyelitis in children
Sinitsyn A.G., Perepelkin A.I., Kopan G.A., Novikov N.V.
Abstract

BACKGROUND: Acute hematogenous osteomyelitis is a purulent septic disease found in children at any age. This pathology still occupies a leading place in the structure of urgent pathologies in children which is characterized by difficult diagnostics, severe course and long-term complications leading to orthopedic problems and disability. Outcomes after its treatment directly depend on the effectiveness of early diagnostics. X-ray and CT examination at the first week of the disease are not effective in terms of accuracy and informativeness. Ultrasound is recognized as an effective method for diagnosing metaepiphyseal processes which are specific for young children. Osteoscintigraphy can be used, but in fact, it is rarely found in emergency departments; and besides, there is a probability that this technique in children can give false negative results. Osteotonometry and exploratory osteoperforation are invasive therapeutic and diagnostic procedures and should be used in case of strict indications. Magnetic resonance imaging (MRI) is an informative and non-invasive method that can be applied at the early intramedullary stages of the disease. MRI for differential diagnostics allows to avoid needless osteoperforation.

AIM: To conduct a retrospective analysis on MRI effectiveness for differential diagnostics in children with acute hematogenous osteomyelitis.

METHODS: The authors present their own experience in examining and treating children who were admitted to the City Emergency Clinical Hospital No 7 in Volgograd with acute pain in extremities and suspected arthritis or osteomyelitis in 2018-2021.

RESULTS: Patients were comparable in age, complaints, anamnesis and laboratory findings. In two clinical observations, retrospective analysis was done. In other two patients, MRI has proven its effectiveness when, in the first case, surgical aggression was avoided, and the patient was successfully cured with conservative techniques in a short time. In the second case, MRI helped to verify the diagnosis and to objectively justify indications for surgery.

CONCLUSION: MRI in children with suspected acute hematogenic osteomyelitis is justified and informative even at early stages of the disease. In some cases, it allows to avoid such invasive methods as exploratory osteoperforation.

Russian Journal of Pediatric Surgery. 2024;28(4):341-351
pages 341-351 views
Matching of endoscopic and histologic semiotics in 500 colonoscopies in children
Shavrov A.A., Ibragimov S.I., Shavrov A.A., Morozov D.A., Tertychnyy A.S., Kharitonova A.Y.
Abstract

BACKGROUND: For the past 40 years, it has been a common practice to perform “routine” biopsies during any colonoscopy in children. Proponents of the “routine” approach to biopsies argue that there is a risk of missing such pathologies as collagenous and lymphocytic colitis; opponents say about the low incidence of such pathologies, especially in children, which makes the strategy of routine biopsy ineffective.

AIM: To identify the level of matching between endoscopic and histologic findings in colonoscopies in children. The secondary aim — 1 to identify predictors that impact the matching level between endoscopy and histology, as well as predictors which are highly informative on the consequent histologic changes.

METHODS: A retrospective analysis of findings of colonoscopies in patients, aged 0–18, was made. Descriptive statistics and binary logistic regression were used to determine the level of matching and potential predictors of matching with abnormal histology.

RESULTS: 500 colonoscopies were analyzed. Endoscopists revealed pathological changes in 92 (19.8%) patients, and histologists in 89 (17.8%). If to take histology as “the gold standard”, specificity of colonoscopy was 90.5%, sensitivity — 66.3%, accuracy — 86.2%, positive and negative predictive value — 87.5% and 72.5%. Endoscopic verification of the normal mucous was highly associated with the matching level [odds ratio (OR) 22.494, p <0.001]. The established diagnosis of inflammatory bowel disease (OR 3.598, p <0.001) and blood in stool (OR 2.557, p=0.022) were strong predictors of pathological findings at histologic examination. Other factors (abdominal pain, weight loss, developmental delay, diarrhea, juvenile rheumatoid arthritis, endoscope model and endoscopist’s experience) did not have a statistically significant impact at the matching level and we’re not predictors of pathological findings at histology (p >0.05).

CONCLUSION: Our data have demonstrated a good matching level between endoscopic and histologic findings, especially in case of the normal colon mucous. Predictors of abnormal histology were also identified: inflammatory bowel disease and blood in stool. At the same time, abdominal pain, weight loss, diarrhea and juvenile rheumatoid arthritis in combination with normal colon mucous at the endoscopic examination were not associated with abnormal histology. Future multicenter researches are needed to obtain the evidence base for the strategy of selective biopsies during colonoscopy in children.

Russian Journal of Pediatric Surgery. 2024;28(4):352-363
pages 352-363 views

SCIENTIFIC REVIEWS

Medical expulsive therapy in children with urolithiasis in the foreign practice: a literature review
Kyarimov I.A., Zorkin S.N., Lobanova A.D., Kosobutskaya S.A.
Abstract

Urolithiasis in children is a common disease nowadays. In many countries, medical expulsive therapy is actively used in such cases. The purpose of this research is to highlight principles and effectiveness of medical expulsive therapy, as well as advantages and disadvantages of α1-blockers over other pharmpreparations in children with urolithiasis. In the present review, the researchers have analyzed literature publications from 2004 to 2023. This systemic review was made using databases of Cochrane, PubMed, Web of Science, Scopus for the period from 2004 to 2023. The following Key words were used for search: urolithiasis, medical expulsive therapy. 32 full-text articles were included in the study.

While assessing results of medical expulsive therapy application in children with urolithiasis, it was noted that α1-blockers can significantly increase stone expulsion rate and reduce expulsion time. Side-effects of the discussed technique are insignificant. They include: headache, dizziness, orthostatic hypotension or nasal congestion. Medical expulsive therapy is reasonable for application due to its high efficiency and due to α1-blockers safety in children with urolithiasis. At present, adrenergic receptor blockers for medical expulsive therapy in children with urolithiasis are not allowed in Russia.

Russian Journal of Pediatric Surgery. 2024;28(4):364-371
pages 364-371 views

LECTURES

Semi-elemental mixtures in the practice of a pediatric surgeon
Erpuleva J.V.
Abstract

Since the first days of life nutrition is a necessary component of child's harmonious development. A particularly acute problem of child’s feeding is faced by physicians, if the child underwent any gastrointestinal surgery. Numerous studies have shown that malnutrition affects 50% of hospitalized children and 25–70% of seriously ill children. Natural nutrition is a real challenge for children in critical conditions. Currently, enteral nutrition is considered to be a preferred modality in pediatric patients with surgical pathology. A significant development of enteric formula industry over the past few years has put this type of nutrition at the forefront in helping operated children. Specialized mixtures for enteral nutrition which contain split protein or amino acid fragments gain an advantage over whole-protein mixtures. The lecture highlights main approaches to the prescription of enteral nutrition for children at the early postoperative and post-traumatic period.

Russian Journal of Pediatric Surgery. 2024;28(4):372-376
pages 372-376 views

CASE REPORTS

Vaccum-therapy for treating a wound of difficult anatomic location in a 17-year old boy with systemic arthritis
Dyakonova E.Y., Gusev A.A., Bekin A.S., Yatsyk S.P., Tishkin G.V.
Abstract

BACKGROUND: Vacuum therapy (VAC© Therapy, NPWT) is an effective method for treating wounds. Its principle is the following: a wound is covered with an airtight dressing, and negative pressure (50–125 mm Hg) is applied. Vacuum therapy is recommended for treating complex wounds.

CLINICAL CASE DESCRIPTION: In 2017, a patient, born in 2005, was diagnosed with “Juvenile arthritis with systemic onset, activity grade 2–1, X-ray stage 3, functional class 2”. Since then, he has been treated with immunosuppressants and corticosteroids. On November 9, 2022, edema, hyperemia, and hyperthermia of the medial half of the right gluteal region developed under immunosuppressive therapy. On November 11, 2022, necrotic discharge from the wound in the right gluteal region was noted. Diagnosis “Necrosis of subcutaneous fat of the right buttock spreading to the scrotum root” was put. On November 16, 2022, MRI was performed — a picture of widespread edema of fatty tissue to the right, in pararectal and gluteal regions with purulent content was revealed. The patient was transferred to the surgical department. Surgical debridement was performed under general anesthesia, and apparatus Suprasorb CNP P1 with intermittent negative pressure was put. On postoperative day 9, a stable positive effect was achieved in the form of wound healing with a tendency to secondary intention. During the wound revision on December 2, 2022, wound edges were clean; on December 16, 2022, the wound had a skin defect about 5×7 cm and no granulation in the wound depth. The wound was sutured. At the control examination on February 23, 2023, complete wound healing was seen.

CONCLUSION: Vacuum therapy is an effective tool for managing complex wounds in pediatric surgery which leads to positive outcomes. At the same time, such outcomes largely depend on the whole set of measures, including adequate surgical debridement, careful monitoring and appropriate antibiotic therapy. Comorbidities also play their role in the disease process.

Russian Journal of Pediatric Surgery. 2024;28(4):377-383
pages 377-383 views
A diffuse scalp neurofibroma in a 4-year-old child
Kletskaya I.S., Serebrennikova P.A., Gassan T.A., Narbutov A.G., Makarova O.V.
Abstract

BACKGROUND: Structures resembling Meissner's tactile corpuscles have been revealed in various peripheral nerve tumors, including schwannomas and neurofibromas, as well as in congenital melanocytic nevi and neural crest hamartomas. As a rule, Meissner's tactile corpuscles are few in number, but in rare cases they represent the predominant component of the formation tissue.

CLINICAL CASE DESCRIPTION: The authors describe a case of their observation: a 4 y.o. patient with diffuse neurofibroma consisting of structures resembling tactile corpuscles. Clinically, this fibroma looked like a defect in the occipital soft tissue region with excessive folding and alopecia. At the histological examination, the dermis and subcutaneous adipose tissue were seen involved in the pathological process. The formation tissue consisted mostly of "neuroid" structures resembling tactile corpuscles located among fibroblast-like cells with mast cell admixture in the infiltrate. An immunohistochemical examination revealed expression of S100 in them, EMA, GLUT1 in the perineuria, and CD34 in the stroma. Melanocytic marker (MelanA, HMB45) expression was not detected.

CONCLUSION: The case presented by the authors is of interest to professionals due to the rarity of this morphological variant, difficulties of clinical and histological differential diagnostics with other tumors and tumor-like processes in children.

Russian Journal of Pediatric Surgery. 2024;28(4):384-391
pages 384-391 views
Necrosis of the liver round ligament in a 12-year-old child
Gumerov A.A., Tukaev A.V., Asfandyarov B.F., Valitov I.O., Khakimov A.I., Gumerov R.A., Kolodko S.V.
Abstract

BACKGROUND: The round liver ligament (RLL) is a fibrous cord-like remnant of the umbilical vein that fixes the liver to the anterior abdominal wall. Complications such as RLL abscess and necrosis are extremely rare in children compared to adults. Only isolated observations are described in the literature.

The etiopathogenesis of RLH necrosis has not been fully studied. Discussion on etiopathogenesis of this disease is still under way. A number of authors state that the inflammatory process spreads along the umbilical vein in case of inflammatory diseases of the abdominal organs. Timely diagnostics of RLL necrosis is extremely difficult, not only in the preoperative period, but also during surgery. Only in isolated cases, the diagnosis is put before surgery. In most cases, children are operated on with diagnosis of acute appendicitis, cholecystitis, perforated gastric ulcer.

AIM: To draw the attention of practicing doctors to such a rare pathology as necrosis of the round ligament of the liver.

CLINICAL CASE DESCRIPTION: The authors describe a clinical case of managing a 12-year-old child who was admitted to the pediatric surgical clinic by the ambulance with clinical signs of acute abdomen and acute cholecystitis. The authors mark difficulties which they faced in diagnosing and treating the case both before and during surgery. Coccygeal cartilage necrosis was put only intraoperatively. The early postoperative period was uneventful. The patient was discharged on day 12 after the surgery in the satisfactory state.

CONCLUSION: This clinical observation is of undoubted interest to specialists as a rare pathology which is difficult for diagnosing both before and during surgery.

Russian Journal of Pediatric Surgery. 2024;28(4):392-396
pages 392-396 views
Multiple foreign bodies (magnetic balls) in the bladder in a 16-year-old teenager
Kovarskiy S.L., Zakharov A.I., Sklyarova T.A., Tekotov A.N., Kuznetsova M.S.
Abstract

BACKGROUND: In the practice of a pediatric urologist, foreign bodies in the bladder and urethra are quite rare. Foreign bodies can be variable in shape, composition, size, and most often enter the bladder via the urethra in the retrograde route.

CLINICAL CASE DESCRIPTION. The above case demonstrates the long-term location of a large number of foreign bodies (60 magnetic balls) in the bladder of a 16-year-old teenager who was treated at N.F. Filatov Children's City Clinical Hospital in December 2022. The authors describe challenges of differential diagnostics and management of this pathology that they faced. The total number of foreign bodies was determined after surgical treatment.

CONCLUSION: This clinical observation is of interest to pediatric urologists and andrologists, since foreign bodies of the bladder is a rare pathology that leads to serious consequences during their long-term location in the organ.

Russian Journal of Pediatric Surgery. 2024;28(4):397-402
pages 397-402 views
An ovarian cyst complicated with intrauterine torsion of the fallopian tube followed by self-amputation of appendages: a case report
Gebekova S.A., Makhachev B.M., Meylanova F.V., Magomedov A.D., Batirmirzayeva P.Z.
Abstract

BACKGROUND: The most common abdominal formations in fetuses and newborns of the female sex are ovarian cysts. The development of these cysts is induced by the excessive stimulation of fetal ovaries with maternal estrogens and placental chorionic gonadotropin which causes follicle dysgenesis. The diagnosis is put at antenatal and postnatal echography, computed tomography and magnetic resonance imaging.

CLINICAL CASE DESCRIPTION: The authors present their own clinical observation of an ovarian cyst complicated by intrauterine fallopian tube torsion and uterine appendages self-amputation in a patient operated at the age of 4 months.

CONCLUSION: Ultrasound screening is the main diagnostic technique for early detection of congenital ovarian pathology at the antenatal and postnatal stages. The authors suggest that the absence of clinical manifestations after birth, focal hemorrhages and diffuse massive petrifications in the macropreparation may be indicative of in utero torsion of the fallopian tube and self-amputation of uterine appendages. Like most other authors describing such observations, we consider that large size of the cyst, presence of suspension and additional echostructures in cyst liquid component may be indicative for surgical treatment of newborns.

Russian Journal of Pediatric Surgery. 2024;28(4):403-408
pages 403-408 views
Medical and epidemiological features of acute appendicitis in the Arkhangelsk region
Yanitskaya M.Y., Kharkova O. ., Shiltsev N.V.
Abstract

BACKGROUND: Acute appendicitis is the most common inflammatory disease of the abdominal cavity which requires emergency surgery. Currently, we still face the problem of both late diagnostics and overdiagnostics of appendicitis.

AIM: To analyze basic reasons for late diagnostics of the disease and for unnecessary appendectomies in children in Arkhangelsk region.

METHODS: We have analyzed the frequency of appendectomies and forms of the disease in children in various hospitals in Arkhangelsk region in 2016–2021. Two groups of patients were compared: with destructive appendicitis and with non-destructive appendicitis (NDA). The following parameters were assessed: sex, age, appendectomy justification and surgical technique.

RESULTS: Appendectomies in NDA cases were more often performed in girls aged 10–15 (р=0.002). Open surgeries in NDA patients were performed much more often than laparoscopic ones (р <0.001). The longer total time from the disease onset and diagnostics till surgery in the hospital, the larger is the risk of complicated appendicitis (р <0.001)

CONCLUSION: Open surgical approach increases the chance of appendectomy in NDA cases. Open appendectomies in NDA cases are more often registered in adolescent girls. The increased time from the disease onset till surgery increases the risk of complicated appendicitis.

Russian Journal of Pediatric Surgery. 2024;28(4):409-417
pages 409-417 views
Postoperative pneumoperitoneum in children: two clinical cases as an example
Yusifova U.I., Chundokova M.A., Golovanev M.A., Ushakov K.V., Dondup O.M.
Abstract

BACKGROUND: The literature describes various causes of free gas in the abdominal cavity, or pneumoperitoneum, in the immediate postoperative period. In such cases, surgeons should find out if the residual gas is postoperative pneumoperitoneum, or it is some postoperative complication requiring surgical intervention. In the present article, the authors describe two clinical cases of pneumoperitoneum in children after elective surgeries.

CLINICAL CASE DESCRIPTION: First case: free gas was fund in a 6-year-old child at ultrasound examination and overview radiography of the abdominal organs. Perforation of some hollow organ was suspected. After conservative measures (infusion therapy with glucose-salt solution, anesthesia, cleansing enema), which did not give any positive dynamics, diagnostic laparoscopy was performed. No perforation in genital organs was detected. On the second postoperative day, the child was discharged in the satisfactory state.

Second case: ultrasound examination and overview radiography of the abdominal organs revealed free gas under the diaphragm dome in a 13-year-old patient. Taking into account the clinical picture and instrumental diagnostic findings, diagnostic laparoscopy was performed which revealed swollen intestinal loops without signs of perforation. The child was discharged on the third postoperative day. Control ultrasound examination of the abdominal cavity organs showed no any free gas; in the left iliac region, moderate edematous tissue 1×1.5 cm was seen.

CONCLUSION: Dynamic monitoring of patients with postoperative pneumoperitoneum and without signs of peritonitis should be performed. If there is no positive dynamics in child’s condition, diagnostic laparoscopy or laparotomy are recommended.

Russian Journal of Pediatric Surgery. 2024;28(4):418-424
pages 418-424 views

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