Russian Journal of Pediatric Surgery

BACKGROUND: Hyperammonemia and hepatic encephalopathy (HE) after portosystemic shunt surgeries in children with portal hypertension (PH) is still a pressing problem in modern pediatric surgery.

AIM: To date, there are very few information in the literature on hyperammonemia prevalence after various vascular bypass surgeries in large groups of patients with PH. To study this problem is an important step in making an adequate choice of treatment modality in children with PH regarding the risk of HE development in future.

METHODS: This paper analyzes the results of studies of ammonia content in venous blood in 173 children, of whom 153 had PH (most had undergone vascular bypass surgery).

RESULTS: The analysis performed has shown that the risk of hyperammonemia in non-operated patients with PH is low, but it increases after certain vascular bypass surgeries on the portal system vessels. To the least extent, this applies to the physiological mesoprotal shunt (MPS) and selective distal splenorenal anastomosis (DSRA), and to the greatest extent — to total portosystemic shunts: splenorenal anastomoses (SRA) (side-to-side splenorenal anastomosis, splenosuprarenal anastomoses) and mesocaval shunt (MCS).

CONCLUSION: Our findings have confirm advantages (low risk of hyperammonemia in childhood) of the mesoportal shunt and distal splenorenal anastomosis compared to splenorenal anastomoses and mesocaval H-shunt. At the same time, the study proves the effectiveness of reconstruction of the splenorenal anastomosis into a distal splenorenal anastomosis in reducing the level of ammonia in the blood (this operation was developed at the N.F. Filatov Children's City Clinical Hospital).

By to the domestic and foreign literature, non-palpable testes are found in 20% of cases among children with cryptorchidism. Approximately 50% of them are located in the abdominal cavity and 50% are atrophied or vanished ones. Purpose: To systematize data of the scientific literature on the syndrome of non-palpable testes in children. For the review, original articles found in the scientific source engines, such as eLibrary, PubMed, and Scopus, were used.

Most often, literature sources divide non-palpable testes into three types: intra-abdominal, extra-abdominal, and non-viable. Extra-abdominal gonads are often of the normal volume, unlike intra-abdominal gonads which are mostly hypoplastic. Testicular ectopia is one of the variants of non-palpable testes when a testis cannot be detected on the usual migration path from the abdominal cavity. In children with cryptorchidism, testicular ectopia is observed only in 5% of cases, thus making it a rare case which poses certain challenges in diagnostics. There are many controversial issues regarding diagnostic methods and treatment strategies for different types of non-palpable testes in children. Most researchers recommend to use additional visualization options such as ultrasound, computed tomography, magnetic resonance imaging, and laparoscopy to confirm the presence or absence of the gonad. However, a definitive diagnosis is not always possible when based solely on ultrasound findings, as this method has limited sensitivity and specificity in detecting non-palpable gonads. The current publications state that an intra-abdominal testis can be visualized during diagnostic laparoscopy in 49% of case in boys with the non-palpable testicular syndrome and with no gonad found at ultrasound examination. Management of non-palpable testes in children, especially with high intra-abdominal gonad location, remains a highly relevant issue and requires further researches and observations.

BACKGROUND: Acute appendicitis is the most common surgical pathology requiring emergency intervention in children worldwide. The gold standard in the treatment of the disease is laparoscopic appendectomy. At the same time, advances in technology increasingly incline specialists to the introduction of robotic systems in surgical practice. This fact once again confirms the importance of research aimed at determining the feasibility of using robot-assisted appendectomy in emergency surgery in children.

CLINICAL CASE DESCRIPTION: The authors made a retrospective review of the medical history of a child with acute appendicitis. A 11-year-old boy was admitted to the Irkutsk State Regional Children's Clinical Hospital with abdominal pain in the right iliac region. At the time of admission, disease duration was 20 hours. For surgery, the Versius robot manufactured by CMR company (UK) was used. Robot-assisted appendectomy followed the same principles as those used in open or laparoscopic approaches: (1) appendix exposure, (2) mesoappendix bipolar coagulation, (3) appendix removal using an endoscopic mechanical stapler.

The total surgical time was 30 minutes, out of which the robot installation time was 10 minutes and the main console time was 20 minutes. The entire procedure was performed completely intracorporally and without conversion to laparoscopic or open surgery. There were no any intraoperative problems and complications. The surgery was successful. Patient’s enteral feeding started on the same day after the surgery. He was discharged from the hospital on Day 3 day after the surgery. Ultrasound of the abdominal cavity, performed 1 month later, did not reveal any signs of abnormalities observed at this age. The patient did not complain of any digestive problems during the entire observation period for 3 months after the surgery.

CONCLUSION: Robotic appendectomy has its advantages and disadvantages in the treatment of acute appendicitis. Robotics provides faster postoperative recovery of patients, but requires longer time for surgery; besides, it is an expensive surgical intervention. However, over time the robot-assisted appendectomy may become a cost-effective one that will be successfully used by all surgeons, as it happened with laparoscopic appendectomy several decades ago.

BACKGROUND: The performed work is on the front burner because of the increased intensity of terroristic acts with blasting devices directed to the civilian population. Besides, explosive injury is one of the damage to the population in wartime. The present article discusses the management of a teenager in the Children's Republican Clinical Hospital in Saransk (Russia) who was injured with a grenade launcher when he was in enclosed space.

CLINICAL CASE DESCRIPTION: Patient AA (17 y.o., male) was delivered to the hospital with a combined open craniocerebral injury, non-penetrating mine-explosive damage of the scalp, barotrauma, thermal lesion of the scalp and the left half of the face. He was injured by a RPG-18 grenade launcher found in the basement of a residential building. The shot was made inside the car.

CONCLUSION: To know the specific course of explosive injuries is necessary for correct diagnostics and management algorithm. In this particular case, the patient was discharged in 55 hospital days when he was recovering.

BACKGROUND: Magnetic foreign bodies of the gastrointestinal tract are not uncommon in children. A feature of the magnetic foreign bodies of the intestine is their tendency to stick together with each other, thus causing intestinal perforation, intestinal fistulas or obstruction. Sometimes serious complications can be asymptomatic which can lead to late diagnostics.

CLINICAL CASE DESCRIPTION: In the article, the authors present a case of an accidental detection of intestinal magnetic foreign bodies during X-ray examination of a 3-year-old child without any clinical symptoms in the form of a chain in the projection of the mesogastrium. Duration of these magnets’ location in the intestine is unknown; child’s condition was satisfactory. During surgery, pathological anastomoses between intestinal loops without signs of peritonitis were found. The postoperative period was uneventful, and the child was discharged in the recovering state. A median laparotomy was performed, and foreign bodies were removed from the child — round multicolored magnetic balls 0.3 cm in diameter, interlocked, in an amount of 34 pieces.

CONCLUSION: The absence of specific clinical symptoms prevented the timely diagnostics of pathologically formed interintestinal anastomoses. The presented clinical case describes a serious complication caused by multiple magnetic foreign bodies in the gastrointestinal tract in a child.