Russian Journal of Pediatric Surgery

BACKGROUND: Magnetic foreign bodies in the gastrointestinal tract is a relatively rare problem in urgent pediatric surgery. Meanwhile, among cases with foreign bodies, they are the most difficult both in terms of timely diagnostics and timely treatment. There are no generally accepted therapeutic and diagnostic standards, and traditional algorithms of patient management are focused on the dynamic observation and are not correct. More so, algorithms described in the foreign literature contradict each other. The rate of surgical interventions and the risk of complications are high. Surgical tactics has many "white spots". All these issues remain open for discussion.

AIM: To analyze the experience of four medical centers in the diagnostics and treatment of patients with magnetic foreign bodies in the gastrointestinal tract.

METHODS: A retrospective analysis of diagnostic and treatment techniques applied in patients with magnetic foreign bodies in their gastrointestinal tract from four pediatric surgical hospitals in 2010–2023 was made. In the study there were patients with neodymium magnetic balls from the constructor (38 patients, 50%), neodymium magnets of other shapes and for other purposes (30 patients, 39.5%), ferrite magnets (6 patients, 7.9%), unknown types of magnets (2 patients, 2.6%).

RESULTS: Patients’ average age was (4±3.65) years. The fact of foreign body swallowing was revealed in anamnesis of 46 (60.5%) patients. Mental illnesses were diagnosed in 4 children — 5.3%, which is higher than the average incidence in pediatric population. Clinical symptoms were registered in 4 (11.8%) children with a single magnet foreign body and in 33 (78.6%) children with multiple ones. The basic diagnostic technique was an overview radiography of the abdominal cavity (70 cases, 92%), which allowed to identify both a foreign body and complications (signs of intestinal obstruction, free gas in the abdominal cavity). Esophagogastroduodenoscopy was performed in 50 cases (65.8%), out of which one foreign body was detected in 34 (68%) cases, and in 28 patients, foreign bodies were removed. Other diagnostic methods (ultrasound, spiral computed tomography) were used much less frequently. Among curative techniques, open surgeries prevailed — 32 cases (42%). Laparoscopy was used in few cases.

CONCLUSION: The timely diagnostics of magnetic foreign bodies in gastrointestinal tract often depends on anamnesis findings, and if there is no such, diagnostics most often is delayed and is made only intraoperatively. Among the diagnostic techniques, it is difficult to identify a universal one that can be recommended as the "gold standard"; however, the most widely used and well-informative is abdominal X-ray and esophagogastroduodenoscopy. As to surgical tactics, the role of laparoscopic interventions is relatively low. Most often, endoscopy or "open" surgery are performed.

BACKGROUND: Esophageal perforation is a rare entity in newborns. This condition is most common in premature babies with very low and extremely low birth weight. The major cause of such pathology is considered to be iatrogenic trauma of either pharynx or esophagus, their soft tissues being delicate and tender enough to produce delamination and perforation of their wall. As a rule, this occurs as a complication of either a difficult tracheal intubation soon after birth or during some troubles with oro- or nasogastric tube insertion.

AIM: To analyze our experience of revealing and treatment of esophageal perforation in preterm babies, and to demonstrate conservative approach as a possible as well as reasonable option in such cases.

METHODS: A retrospective study of neonatal esophageal perforation cases was performed, including newborns without any congenital esophageal malformations or previous surgical procedures. During 2017–2022 9 newborns with esophageal perforation were treated at neonatal intensive care unit and neonatal departments of Childrens’ City Multidisciplinary Clinical Specialized Center of High Medical Technologies of Saint Petersburg. All of them were premature, 2 having very low, and 7 having extremely low birth weight. The incidence of that condition appeared to be 1:1320 live births.

RESULTS: 8 patients were treated conservatively. This included adjustment of artificial lung ventilation, pain control, antibiotics, cancellation of gastric enteral feeding and administration of total parenteral nutrition. Babies with hydrothorax, pneumothorax or ascites underwent thoraco- or laparocentesis. 2 patients died, both being born at 23th week of gestation. In both cases death occurred from polyorganic insufficiency. The mortality rate appeared to be 22%.

CONCLUSION: In most cases the esophageal perforation in premature babies can be treated conservatively, the efficacy of such treatment being largely dependent on early diagnosis of this complication. An important key-point in it is a radiologic control of gastric tube location.

BACKGROUND: Diagnostics and management of varicocele in children, adolescents and males are issues of annual discussions in the professional community, yet the debates still continue. Pathophysiological changes in the testicular veins in children with varicocele are dubious and require further in-depth fundamental researches.

AIM: To study the difference in ultrastructural organization of testicular veins in boys with varicocele depending on the malformation degree.

METHODS: In the present study, the authors examined the ultrastructure of 58 bioptats taken from spermatic veins during surgeries in adolescent boys aged 11–17 with varicocele of degree II and III.

RESULTS: A comparative analysis of ultrastructural changes in the spermatic veins revealed that signs of endotheliocyte destruction of varying degree are met in 86% of biopsy samples in Group I and in 100% in Group II. Electron microscopy allowed to examine the muscular component of testicular veins in varicocele, as well as to examine the structure of connective tissue component in the venous wall, basing on an anatomical-functional paradigm of the connective tissue as the main "building brick" of organ and system structures.

CONCLUSION: Ultrastructural changes in the testicular vein wall were revealed in children with varicocele, what indicates the presence of congenital malformation in this wall and of accompanied endothelial dysfunction. Foldings of the vascular wall with hollows and pockets, connective tissue loosening and separation of fibers, endothelium destruction and detachment were equally met in boys and adolescents with varicocele of degree II and III.

Enlargement of the renal cavity system in a fetus is revealed at prenatal ultrasound in 1–5% of cases and can be caused by congenital hydronephrosis due to pelvic-ureteral junction obstruction, which is one of the most common nosologies in the structure of obstructive uropathies in childhood. A high risk of renal function decrease at the preclinical stage of disease development dictates a need to create highly informative diagnostic programs and treatment algorithms aimed at preventing complications. In this review, we discuss results of studies on diagnostic and prognostic value of cytokine biomarkers which are of a great interest in congenital hydronephrosis in young children. They include: kidney injury molecule-1, vascular endothelial growth factor-A, monocyte chemoattractant protein-1, neutrophil gelatinase-associated lipocalin, interleukin-1. Literature search for this review was made in Web of Science, PubMed, Russian Science Citation Index, CyberLeninka, Scopus databases.

BACKGROUND: To verify a source of obscure gastrointestinal bleeding leading to iron deficiency anemia is a challenging diagnostic problem. Intestinal polyps can be one of such sources. Sporadic juvenile intestinal polyps are extremely rare at the first year of life. The authors present a clinical case which demonstrates endoscopic diagnostics and resection of a jejunum polyp in a 12-month-old child weighing 6.3 kg. We did not find similar publications in literature.

CLINICAL CASE DESCRIPTION: A 12-month-old boy was admitted to our clinic with long-lasting complaints of dark stool and iron deficiency anemia. For the first time, gastrointestinal bleeding symptoms appeared at the age of one month. The child was repeatedly examined, but gastrointestinal bleeding source was not found. The child was prescribed symptomatic therapy for iron deficiency anemia including red blood cell transfusion. At current hospitalization in our clinic an intestinal polyp and transient small intestinal intussusception were suspected at ultrasound examination. The child underwent esophagogastroduodenoscopy, video capsule endoscopy, colonoscopy, laparoscopy. But the source of the bleeding was not found. During the repeated enteroscopy at 40 cm distally to the pylorus a sporadic juvenile jejunum polyp 17×15 mm was found and resected. The postoperative period was uneventful. In 1 month, there were no complaints as for the catamnesis, the child's stool had the usual characteristics, the indicators of "red blood" corresponded to the age norm.

CONCLUSION: A sporadic juvenile jejunal polyp may be a cause of obscure recurrent intestinal bleeding in children. Modern intraluminal endoscopy allows not only to put diagnosis, but also to perform a minimally invasive surgical intervention.

BACKGROUND: Dermoid cysts in the presacral and retrorectal space in children are relatively rare. However, even more rarely, they have clinical manifestations at patient’s early age and so, can be silent for a long time.

CLINICAL CASE DESCRIPTION: The article describes a rare clinical observation — a giant dermoid cyst in the retrorectal space in a 17-year-old girl. The child had a tendency to constipation from her early childhood. Menses started at age 13, painful. During the last year, disorders in her menstrual cycle were noticed. The girl was examined by a gynecologist. Ultrasound examination revealed a cystic formation in the pelvic cavity up to 9 cm in diameter. Non-malignant nature of the process was confirmed by: normal level of cancer markers (α-fetoprotein, β-human chorionic gonadotropin), single node, clearly defined formation capsule, homogeneous nature of its contents, no invasive growth and lesions in the regional lymph nodes. Magnetic resonance imaging with intravenous contrasting defined a true relationship of the cystic formation with other organs and structures of the pelvic cavity. The cystic formation caused deformation of the cervix, vagina, and rectum. The obtained findings allowed to plan surgical intervention correctly. Surgical access-transverse in the coccyx projection up to 10 cm long. The cystic formation was a thin-walled connective tissue capsule with a yellowish content. Due to very large cyst dimensions, first it was opened in a limited area and emptied. Then the capsule was isolated and completely removed. The cyst intimately adhere to rectum, vagina, and cervix walls. Histological conclusion: "Capsule of a dermoid cyst with hemorrhages". The postoperative period was smooth. The patient recovered, all disease manifestations disappeared. She was discharged home in a satisfactory state. Follow-up visits were in 6 and 12 months after surgery. No evidence of possible relapse.

CONCLUSION: There are only few descriptions of such cases in the available literature. Ultrasound and MRI examinations allowed to have a full picture of dermoid cyst position and its connection with other pelvic organs due to which surgeons could develop a correct plan for surgical intervention.

2025 will a year of the 100^th anniversary of Saint Petersburg State Paediatric Medical University and a year of the 120^th anniversary of the clinical hospital. The article presents a register of surgeries which were performed in 1925 in the surgical clinic of the University. The articles reviews nosological structure of surgical patients, surgical procedures and anesthesia techniques used one hundred years ago. In the article, one can also find brief historical biographical notes about surgeons who were at the origins of the department and clinic of pediatric surgery of Saint Petersburg State Medical University: N.E. Berg, V.N. Katin-Yartsev, M.A. Toporkova, V.D. Sokolov, V.L. Magsky, A.I. Savshinsky and many others. The role of outstanding orthopedic traumatologist Prof. Roman R. Vreden, who founded the department and headed the surgical clinic of the University (then the Institute of Maternal and Infant Health) from 1925 to 1934 is underlined separately. Dr. Nikolai E. Berg, one of the founders of paediatric surgery, worked at the clinic and subsequently at the department from 1905 to 1949, including the war years and the Leningrad siege. Little information has been found on functioning of the surgical clinic in 1905–1925. There is a lot of work ahead with archives so as to study the history of the clinic and department of paediatric surgery in Saint-Petersburg State Paediatric Medical University.