卷 24, 编号 6 (2020)

Objective. The differential diagnostics of gynecological diseases with a picture of acute abdomen and acute appendicitis may be challenging and can cause a variety of complications, impaired reproductive function and infertility.

Purpose. To assess outcomes after diagnosing and treating girls with the syndrome of “acute abdomen” in whom an acute gynecological pathology was revealed.

Material and methods. Case histories of 85 girls with gynecological diseases who were hospitalized to the emergency surgical department of Children City Clinical Hospital No 9 in Yekaterinburg are analyzed. All children were admitted to the emergency department with a picture of “acute abdomen”.

Results. All children were operated on laparoscopically, and the cause of their acute abdominal syndrome was clarified. Acute inflammatory diseases of the uterine adnexa prevailed in the structure of causes (59%). In 21% of cases, there was uterine adnexa torsion . The rest of children had apoplexy (11%) and ovarian cysts (9%).

Conclusion. The differential diagnostics of acute appendicitis and acute gynecological pathologies is difficult due to various and similar clinical symptoms. Laparoscopy can not only identify the cause of pain syndrome, but also can help to chose a future curative tactics .

Relevance. The given literature review analyzes current approaches to the extracorporeal detoxification (ECD) in ICU in patients with sepsis. In case of severe polytrauma in a child, anatomical and physiological features of his/her organism, marked severity and rapid progression of multiple organ failure as well problems in taking anamnesis put specialists into a challenging situation. A pathogenetically differentiated approach to the choice of extracorporeal detoxification technique in the complex treatment of sepsis – with respect to the syndrome of endogenous intoxication - will increase the effectiveness of therapeutic measures of intensive care in children at their acute stage after severe combined injury

Objective. To improve outcomes in children at the acute stage of severe combined injury by applying differentiated techniques for extracorporeal detoxification in septic complications .

Material and methods. The most common techniques were analyzed: hemosorption, plasmapheresis, prolonged veno-venous hemofiltration and hemodiafiltration.

Results. A large number of works have been published which confirm ECD effectiveness in adult patients with severe sepsis and septic shock. However, in the available literary sources, there are almost no information on the differentiated approach to various ECD techniques in children with severe combined injury who have traumatic endotoxicosis and multiple organ failure. 

Conclusion. Clinical trials and prospective researches on practical aspects of extracorporeal treatment in pediatrics are priority and compulsory because of the gained world experience of its application in patients with septic endotoxicosis. This impels towards further clinical researches in this direction.

Introduction. In the majority of cases, acute abdominal pathology in premature newborns masks as necrotizing enterocolitis and, if there are no signs of intestinal perforation, conservative therapy is prescribed. The article discusses rare forms of acute surgical pathology in premature newborns.

Clinical observations. In the first clinical case, a premature baby had an initial air leak syndrome (pneumothorax and pneumoperitoneum). The Meckel’s diverticulitis with perforation without peritonitis was found during surgery. In the second case, a newborn child with body weight 1160 grams on the 21st day of his life developed ileoileal intussusception. In the third case, a newborn child had the duodenal membrane which was excised on the 5th day of life. On the 11th postoperative day, a picture of perforated hollow organ in the abdominal cavity developed. Destructive appendicitis was found intra-operatively. All patients clinically recovered.

Conclusion. Ultrasound examination, as an early diagnostic option, can help to suspect a surgical pathology at an early stage. The described clinical cases are rare in pediatric surgeon’s practice but they require a cautious approach from both narrow clinical specialists and diagnostic specialists.

Introduction. Calyx diverticulum is a rather rare pathology in pediatric practice. In the structure of cystic kidney malformations, it amounts up to 12-15%. In most cases, the disease is asymptomatic. To make a differential diagnostics and to define a technique for surgical treatment, computed tomography or magnetic resonance imaging are used. Currently, puncture-sclerotic method and endosurgical (laparoscopic, retroperitoneoscopic) one can be successfully applied. The main purpose of this clinical observation is to illustrate that little-traumatic laparoscopic access to the kidney and plasma ablation of the diverticulum epithelial lining can be used to have successful outcomes.

Material and methods. The authors describe a clinical case of renal cavities in a 12-year-old boy - calyx diverticulum of the right kidney and a cyst of the left kidney - which were successfully treated with a combined approach when puncture and laparoscopic corrections were used depending on lesion’s chracteriatics.

Conclusion. A rational approach and substantiation of the applied surgical technique with plasma ablation of calyx diverticulum cavity allowed to obtain good results - cavity size was reduced and renal parenchyma was preserved what is important for future organ functioning.