卷 23, 编号 2 (2019)

Introduction. Severe injury is referred to as types of child injury with a high mortality rate. One of the causes of fatal outcomes is bleeding from acute ulcers of the gastrointestinal tract. Bleeding from acute ulcers of the upper gastrointestinal tract is considered to be both not only the cause of deaths and also a factor in secondary hypoxic damage to organs and systems, leading to a complicated course of the post-traumatic period. Aim of the study. To substantiate the protocol of endoscopic monitoring of the state of the upper GI tract in the critical period of severe trauma in children. Material and Methods. 124 children aged from 0 to 18 years were examined. The severity of injury according to an ISS scale was 27.5 ± 10.1 scores. All patients were divided into 6 groups on the basis of leading damage. Esophagogastroduodenoscopy with the examination of the initial segments of the jejunum was performed on the 7-10th day of the post-traumatic period. In children with a severe spinal injury, esophagogastroduodenoscopy was performed on the 1-2nd day. The presence of pathological impurities, the condition of the mucous membrane, and peristaltic activity was evaluated. In the diagnosis of bleeding, combined endoscopic hemostasis was performed. Results. Erosions and ulcers were identified as the main endoscopic pathology in groups of children with leading skeletal and abdominal trauma, as well as with combined trauma with competing injuries. The group with abdominal trauma was leading in the number of gastrointestinal bleeding. Conclusion. Destructive changes in the upper GI tract are typical for the critical period of severe injury. It determines the mandatory planned conduct of esophagogastroduodenoscopy in the monitoring mode.

Aim of the study. To evaluate the results of treatment of sterno- mediastinitis using vacuum therapy in patients of the first year of life. Material and methods. The study included 25 children under the age of 1 year who had undergone cardiac surgery from median sternotomy in the period from August 2013 to August 2016 on the basis of the E.N. Meshalkin National Medical Research Center, , complicated by infection of the wound. Results. Vacuum therapy in the treatment of sterno-mediastinitis was used in 25 infants, aged 103 (average) (9 ÷ 167) days. Superficial infection developed in 10 (40%) patients, deep infection - in 15 (60%) children. The average duration of vacuum therapy was 6.9 (3 ÷ 8) days. The average time of artificial lung ventilation was 147 (12 ÷ 176) hours, the duration of treatment in the intensive care unit was 7.6 (3.2 ÷ 8.6) days. Complications were present in 7 (28%) patients and included multiple organ failure (8%), isolated renal dysfunction (12%), bleeding (4%), relapse of infection (4%). 2 (8%) patients died due to symptoms of severe multiorgan failure. The average length of the hospital stay was of 30 (23 ÷ 38) days. Conclusions. Vacuum therapy can be successfully used for the treatment of sterno-mediastinitis in children of the first year of life as also an excellent alternative to the traditional treatment method.

Capillary angiodysplasia of the skin presents by itself pathologically dilated capillaries located under the basal zone of the growth of the epidermis. There are many options for the correction of this vascular pathology of the skin, including general and local methods. In recent years, laser treatments for capillary angiodysplasia have become widespread. According to many authors, the most effective and promising method is laser photodestruction by radiation of the yellow-green spectral range. Unfortunately, the optimal ranges of the parameters of exposure to laser radiation in the treatment of specific forms of capillary angiodysplasia of the skin, taking into account nature and age characteristics of the skin in children, have not yet been determined.

The prevalence of inflammatory diseases of the pelvic organs in girls and girls is extremely high. Their clinical picture can imitate any disease, but most often the differential diagnosis of inflammatory diseases of the pelvic organs has to be carried out with acute surgical pathology. The most common clinical diagnosis at the admission is suspicion of acute appendicitis. The leading symptoms manifested by patients seeking for medical help are abdominal pains of various nature and localization, as a result of which an incorrect diagnostic algorithm is used and, as a result, the wrong choice of treatment tactics. This article presents an analysis of data that reveal the relevance of the problem of differential diagnosis of inflammatory diseases of the pelvic organs, the clinical picture of which can mimic acute surgical pathology.

Introduction. Lymphangiomas are mature benign tumors emanating from the lymphatic vessels making up 9-10% of all benign neoplasms in pediatric oncology. In our practice, we have encountered a rare complication of the lymphangioma of the abdominal cavity - an ileus Objective: To present a clinical picture, diagnostic and surgical tactics in a rare clinical observation of mesenteric lymphangioma, complicated by ileus. Material and methods. Boy aged of 6 years 4 months. He was taken to the emergency department of the Research Institute of NDHiT by an ambulance team (SMP) with suspected acute appendicitis 6 hours after the onset of the disease. Results. According to the results of clinical, laboratory and echographic examination, a child with a clinical picture of “acute abdomen” was suspected of an abdominal lymphangioma. For the purpose of the differential diagnosis of a complicated course of the lymphangioma of the abdominal cavity with complicated destructive appendicitis, 2 hours after hospitalization, laparoscopy was performed and there was confirmed lymphangioma of the ileum mesentery, complicated by the twisting of the latter. After elimination of the torsion, a section of the ileum with a tumor was resected with an end-to-end anastomosis. Histologically, the diagnosis of lymphangioma was confirmed. Conclusion. The cause of “acute abdomen” may be the development of complications of the mesenteric lymphangioma. Timely hospitalization of the child in a specialized hospital allows making a diagnosis in a timely manner, select the optimal surgical tactics and prevent life-giving complications

This article presents the experience of treating a child with stenosis of a colo-rectal instrumental anastomosis imposed due to Hirschsprung’s disease.

Congenital diaphragmatic hernia (CDH) occurs with a frequency of 1 per 2000 - 4000 live births, but at present, surgical treatment of EDC, especially in newborns, remains one of the difficult tasks of pediatric surgeons, anesthesiologists, and resuscitators. The numbers of postoperative lethality can reach high values, 35-50% of children die from surgery, besides, 32% of CDH children are born dead. The highest mortality rate is characteristic for agenesia of the diaphragm dome. False CDHs are more common, in one-sided cases left-sided defects in the diaphragm prevail occurring 4-16 times more often. The authors presented their own experience - a description of a rare clinical case of right-sided false diaphragmatic hernia in a newborn infant and its successful thoracoscopic treatment.