卷 25, 编号 3 (2021)

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Introduction. The present trial systematizes data, taken from one surgical center as an example, on treating patients with intestinal atresia and necrotizing enterocolitis with multiple intestinal anastomoses.

Material and methods. The trial is a retrospective review on the treatment of 13 newborn infants who since 2010 have been put multiple intestinal anastomoses; the treatment was approved by the Hospital Ethics Committee. The average gestational age of patients was 31.2 weeks. The average age at the time of surgery – 7,9 days. Average weight - 2007 grams. The average number of anastomoses was 3.7 (range: 2-7). The average length of remained small intestine after the second surgery was 67.4 cm (range: 12-120 cm). No other surgical procedures, including gastrostomy or enterostomy, were performed. In all cases, surgical intervention ended with hermetic suturing of the abdominal cavity. Among them, there were 6 patients with the multifocal form of necrotizing enterocolitis; 6 patients had type IV atresia of the small intestine; 1 patient had the Ladd’s syndrome. Connection of intestinal segments was made by constructing several “end-to-end” anastomoses, double-row precision seam with PDS II 7/0 suture.

Results. In the postoperative period, complications associated with anastomosis construction, such as leakage and narrowing, were not recorded. Transit function of the gastrointestinal tract restored on day 4, on average, after the surgery (range: 2-6 days). There were no early lethal outcomes within the first 28 days after the surgery which were associated with the surgery. 2 patients with short bowel syndrome (remained small intestine was 12 and 25 cm) and multivisceral disorders died on day 72 and 64 after the surgery. Survived patients were transferred to full enteral feeding in 56 days, in average, after the second surgery (range - 15-120 days).

Conclusion. In our study, we have demonstrated potentials of a new surgical approach: one-stage formation of multiple intestinal anastomoses in case of multiple intestinal atresias as well as in case of multifocal forms of necrotizing enterocolitis. Maintaining the bowel length with multiple bowel anastomoses is very important factor for better survival of patients with the short bowel syndrome.  

Introduction. The article presents the analysis of surgical treatment of children with choledochal malformations (CM) with mini-laparotomy and laparoscopy techniques.

Purpose. The aim of the study is to improve outcomes of surgical treatment of choledochal malformations in children.

Material and methods. For the last ten years (January 2010 - May 2020), 84 children with choledochal malformations (CM) (n = 84) were operated on with different surgical techniques in our hospitals. Group 1 - patients who had Roux-en-Y hepaticojejunoanastomosis (RYHJ, n = 68, 81%); Group 2 - patients who had hepaticoduodenoanastomosis (HD, n = 16, 19%). The authors compared outcomes because Roux-en-Y hepaticojejunostomosis and hepaticoduodenanastomosis were formed under mini-laparotomic (ML) and laparoscopic (LS) accesses. Surgical time, short-term and long-term postoperative outcomes were assessed.

Results. The groups were comparable in gender, age, clinical manifestations, CM complications before surgery, comorbidities (p > 0.05). A statistically significant (p = 0.0000001, Mann–Whitney U-test) decrease in the surgical time was revealed when using mini-laparotomy access. Independent defecation appeared 3 times faster in the subgroup with mini-laparotomy and Roux-en-Y hepaticojejunostomy (ML RYHJ) than in the subgroup of laparoscopic Roux-en-Y hepaticojejunostomy (LS RYHJ) (p = 0.033, Mann–Whitney U-test), mainly due to early enteral loading in the first subgroup (on 0-1 postoperative day). Long-term postoperative outcomes in laparoscopic subgroups revealed a statistically insignificant (p> 0.05) prevalence of 4 anastomotic stenosis requiring repeated surgical interventions. Good outcomes were seen in 90% of patients after ML RYHJ (p = 0.002, Pearson’s Chi-square with Yates’ correction) versus 52.6% after LS RYHJ.

Conclusion. Currently, laparoscopy is not a method of choice in children with CM due to the development of short-term and long-term postoperative complications. Minilaparotomy gives promising results in pediatric CM and can be “a gold standard” in the treatment of children with this pathology.

Introduction. The osteochondritis dissecans (OCD) is a pathologic condition of osteochondral tissue predominantly in the femoral condyles, which is met most often in adolescents and which can lead to the formation of early arthrosis in the knee joint in the remote time. By modern concepts, stable OCD foci are the foci with intact articular cartilage without the risk of migration into the joint cavity. To date, there are very few studies in the world literature on the treatment of early stages of osteochondrosis dissecans.

Material and methods. Two independent researchers have carried out a systematic review of literature sources (2000-2020 ) using Pubmed, Medline and GoogleScholar. 9 publications were selected for data analysis out of 5184 publications after the qualitative assessment by the Yang scale and the obtained consensus in disputable situations.

Results. Statistical analysis of the obtained data with the Statistica program revealed that the average rate of OCD foci healing was seen in 86.7% (from 70.6 to 100%). The most effective outcomes were in the group of antegrade drilling (95.3% of healed foci), then in the group with biodegradable implants fixation (88.5%), then the group of antegrade drilling with the introduction of bone marrow aspirate concentrate (BMAC) - 76.9%, and then the retrograde drilling - 76.8%.

Conclusion. The analysis performed have shown a significant heterogeneity in data reporting, different methods for diagnosing osteochondritis dissecans, different approaches to healing assessment as well as a small number of children in samples what determined the lack of statistical significance between different options of surgical treatment (p = 0.27). Carefully planned trials with a proper design, standardized techniques for healing assessment and time of their application as well as the assessment of comparison groups and of all other necessary factors affecting lesion healing are needed.

Introduction. At present, lymphadenopathy – as a cause of idiopathic intestinal intussusception in little children - comes to the fore. However, intestinal intussusception in case of destructive mesenteric lymphadenitis in combination with lymphoid hyperplasia of the ileocecal angle ( what does not exclude lymphoma intraoperatively) is extremely rare in clinical practice.

Purpose. To present a therapeutic and diagnostic algorithm in intestinal intussusception which was caused by the “volumetric“ abdominal lymphadenopathy.

Case Report. A 3-year-old boy was admitted by the ambulance with recurrent abdominal pain, single episode of vomiting and no stool for 4 days. The ultrasound examination revealed intermittent ileocecal intussusception. The risk factor which had triggered the disease was an acute respiratory viral infection complicated with purulent mesenteric lymphadenitis and lymphoid hyperplasia with ulcerative lesions of the mucous membrane in the ileocecal junction. Laparoscopic desinvagination with lymph node removal and colonoscopy with ladder biopsy were performed. A differential diagnostics of nonspecific lymphadenopathy, Burkitt’s lymphoma and Crohn’s disease was made. Immunohistological examination intraoperatively was made; examination of the biopsy material excluded tumor and inflammatory bowel disease (IBD). The inflammatory process regressed under conservative therapy (antibacterial, anti-inflammatory and antispasmolytic) ; there were no any recurrent intussusception episodes within one-year follow-up.

Conclusion. Successive ultrasound, laparoscopic and colonoscopic examinations followed by the immunohistological analysis of intraoperative and biopsy material allowed to put a correct diagnosis and, thereby, to minimize surgical aggression in ileocecal intussusception which was accompanied by volumetric lymphadenopathy.

Introduction. Congenital malformations of the gastrointestinal tract (GIT) are one of the most common causes of intestinal obstruction and require urgent surgical care in the neonatal period. In the overall structure of GIT, gastrointestinal defects amount up to 25%. Duodenal atresia accounts for 1 case per 7,000–10,000 newborns; jejunal and ileac atresia - 1 case per 1,000–3,000 newborns. Often, the diagnosis is made antenatal. In most cases, diagnostics of intestinal atresia is not difficult, and treatment is carried out in a timely manner. However, in rare cases, intestinal atresia is combined with other congenital malformations in GIT, for example, stomach or duodenum webs. In such a case, if during the atresia surgical correction, a gastric membrane was not suspected, then in the postoperative period there may be problems with treatment requiring additional diagnostics. As a result, web surgical correction is postponed, and the child’s general state can worsen.

Material and methods. The authors discuss two cases and their treatment in newborn children who had membranes in their stomach and duodenum combined with the intestinal atresia.

Results. The authors also discuss problems which they faced in the diagnostics and treatment. They give their recommendations how to improve diagnostics in children with combined congenital malformations in their gastro-intestinal tract.

Conclusion. The full range of diagnostic measures before surgery and a thorough revision of abdominal organs during surgery are key issues in children with gastric and duodenal abnormalities. Undiagnosed and undetected malformations during the first surgical intervention may require a repeated surgical intervention which can worsen the child’s general state.  

Introduction. Foreign bodies in the gastrointestinal tract are various objects of organic and inorganic origin, which are swallowed - not as food - either accidentally or intentionally. The article describes a clinical case of a 13-year-old child with multiple foreign bodies in his gastrointestinal tract which could cause serious complications, such as: perforation of hollow organs, peritonitis, intestinal obstruction, internal bleeding. By statistics, every fourth patient of the conscious age with foreign bodies in the gastrointestinal tract can potentially have problems in the neuropsychic sphere.

Material and methods. A 13-year-old boy was admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) with nausea, repeated vomiting after each meal and water drinking. The careful anamnesis revealed that before the boy’s state deteriorated, he had swallowed a large number of magnets and metal objects within a short period of time. X-rays examination found multiple foreign bodies in his gastrointestinal tract. They were removed during esophagogastroduodenoscopy (EGDS) and surgical intervention.

Results. The plain-film X-ray examination of the abdomen in the projection of the stomach revealed a radiopaque group of foreign bodies of a rounded shape as a conglomerate. At FEGDS, 54 objects were removed: 4 metal balls up to 0.5 cm in diameter, 47 round magnets up to 1.5 cm in diameter, a metal chain and two screws. During laparotomy and gastrotomy 99 foreign bodies were removed: 82 magnet balls 0.5 cm in size, 16 metal balls 1.5 cm in size, 1 bolt. The postoperative period was uneventful. The child was discharged on the 12 th day after surgery in the satisfactory state.

Conclusion. Due to timely diagnostics and proper curative tactics, multiple foreign bodies were revealed and removed from the child’s stomach endoscopically and surgically within a short period of time. A correctly chosen curative tactics resulted in a complete recovery of the patient without complications on the 12th hospitalization day.

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