Vol 26, No 5 (2022)

The lecture presents the main definitions in the surgery of injuries in children. Special attention is paid to severe trauma, including the issue of assessing the severity of injuries. A modern strategy of providing assistance for severe injuries in children, including polytrauma, is presented.

Introduction. Gastrointestinal polyps are rare in newborn children, at the same time they are most common in children aged 2 to 10 years. Many aspects of endoscopic surgical treatment of polyps in children remain controversial, since they are not sufficiently covered in domestic and foreign literature.

The aim was to conduct a retrospective analysis of surgical treatment of abdominal polyps of the esophagus in 52 children in the surgical and endoscopic department of the Regional Children's Clinical Hospital of Rostov-on-Don.

Material and methods. For a 20-year period (2001-2020) and presentation of own material for the treatment of children with esophageal polyps based on modern pathogenetic views on the occurrence and development of this pathology. The main symptom of the disease in patients was dysphagia, which occurred in 79% of patients. Under anesthesia in the operating unit, patients underwent endoscopic polypectomy using diathermocoagulation, followed by covering the defect of the esophageal wall by clipping the edges of the mucous membrane.

Results. The authors found that it is sufficient to perform polyp removal within the unaffected areas and continue antireflux therapy in order to get a full recovery of patients. Polyps of the transition zone between the esophagus and the stomach seem to have, among other things, also a morphological cause of their origin and development.

The contact of two types of mucous membranes (esophagus and stomach) suggests, under certain conditions, the possibility of the development of polyps at the junction of two different morphological structure of mucous membranes. The benign nature of the polyps was confirmed histologically.

Conclusion. The authors found that in the treatment of juvenile esophageal polyps, the suppression of gastroesophageal reflux disease should be considered mandatory both before and after surgery. There were no relapses of the disease.

Introduction. Dissecting osteochondritis (RO) is based on damage to the subchondral bone, leading to its detachment and sequestration separately or together with articular cartilage with the possible formation of a free bone-cartilage fragment. The disease occurs more often in adolescents, accompanied by an increased risk of early arthrosis of the knee joint. Chronic traumatization of the subchondral bone leads to insufficient blood supply to a certain area of the growth zone of the secondary point of ossification of the femoral epiphysis, to ischemia and subsequent necrosis of the subchondral bone, which, according to modern literature, is the leading cause of the formation of the lesion. The typical localization of the RO focus is the lateral part of the medial condyle of the femur along the supporting surface. The present clinical analysis presents cases of atypical localization of dissecting osteochondritis with clinical features, specific signs on MRI, as well as various tactical approaches to treatment.

Material and methods. This clinical review presents 3 cases of sequestration of the posterior lateral condyle of the femur in adolescents. Despite the similarity of the clinical picture and the MRI data, the features of the foci of RO were found in all children, which determined the need for an individual approach to therapeutic tactics. All children required surgical treatment, which was performed in the Department of Traumatology and Orthopedics of the N.F. Filatov DGKB in different volumes in each case: from transchondral osteoperforations and fixation of an osteochondral fragment with a screw to debridement of a fragmented focus with removal of osteochondral fragments.

Results. All 3 clinical cases are united by atypical localization of the focus in the posterior lateral condyles of the femurs, the clinical course of the disease in the form of a low-intensity long-term pain syndrome, as well as the results of MRI of the knee joint. Most researchers adhere to the classical multifactorial etiological theory of dissecting osteochondritis, according to which the main mechanism of the origin of the lesion is mechanical overload of the subchondral bone with subsequent disruption of blood supply in it at the border with the secondary point of ossification of the femoral epiphysis. However, there is also data in the literature on congenital ossification disorder in the cartilaginous part of the growth zone of the secondary ossification point as the morphological basis of dissecting osteochondritis. The presented clinical cases cast doubt on the generally accepted model of primary damage to the subchondral bone as the only possible cause of the formation of the focus of RO, since patients have, among other things, signs of impaired ossification of the secondary ossification point of the femoral condyle, in one of whom a violation of ossification of the secondary ossification center was also determined in the patella in the form of patella bipartita.

Conclusion. Inspite of all similarities connecting these cases there is still lack of data to judge about separate type of the OCD because every separate type of disease usually have particular morphological basis. There is a need of partial biopsy of these lesions to confirm or refute our hypothesis of posterior condylar separation being separate type of OCD. However these cases undoubtedly require particular managementwith special attention to timing of appropriate diagnostic procedures and surgical management to perform in time prior to osteochondral fragment separation. In case of the absence of any complaintswith particular MRI appearance of fragmented bone in the lesion with impaired ossificationindividual treatment planneeds to be defined.

EDITORIAL COMMENT. Gripped aggressive foreign bodies (magnetic balls) in the gastrointestinal tract require emergency actions to clarify their localization and to remove them. The conservative approach with four-day observation described in the article should not be used.

Introduction. Internal fistulas in foreign bodies of the digestive tract is a very rare complication.

This publication is aimed to describe a rare case of fistula formation between the vermiform process and the ileum caused by magnetic foreign bodies.

Clinical observation. As his parents said, a 2-year-old child swallowed magnetic balls; no clinical manifestations were noted. Plain radiography 3 days after the ingestion revealed foreign bodies (3) in the right lower quadrant of the abdomen. No foreign bodies were found on colonoscopy. Laparoscopy revealed a fistula between the appendix and the terminal ileum. The following steps were made: disconnection of fistula, appendectomy, suturing of fistula opening in the ileum.

Conclusion. One of the complications after swallowing magnetic foreign bodies may be formation of internal intestinal fistulas. In our observation, the fistula was between the appendix and the ileum. No similar observations were found in literature.

A description of a rare clinical case of massive erosive bleeding from the external jugular vein against the background of neck phlegmon developed as a result of damage to the esophagus by glass is presented. The therapeutic and diagnostic errors at the stages of medical care are considered in detail.

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