卷 22, 编号 1 (2018)

Blunt abdominal trauma is one of the leading causes of the morbidity and mortality in all age groups. Among all the causes of deaths due to injury, abdominal damage accounted of about 10%, and in children - 8.5%. Timely imaging takes a key place in assessing abdominal injury in traumatized children. Computer tomography (CT) is a method of visualization that allows recognize and evaluate characteristic signs of the traumatic damage in hemodynamically stable children. Modern multislice spiral computer tomographs (MSCT) provide high quality of the image due to the improvement of both scanning methods and post-processing facilities. Currently, CT allows most accurately detect lesions of parenchymal and hollow organs, as well as reveal and quantify intraperitoneal and extraperitoneal fluid and blood. In addition, CT has an exceptional sensitivity in the diagnosis of the combined trauma of various organs and systems. The use of CT as the main screening method for the examination of traumatized children along with the improvement of maintenance therapy plays a crucial role in the success of the not operative treatment of trauma to parenchymatous organs. The rapid assessment of the state of traumatized children according to CT findings also contributed to the decline of the incidence of complications and mortality rate. The decision about surgical intervention in a small number of children in need of surgical treatment is primarily made on the basis of clinical criteria, not CT results. Thus, CT mainly determines non-operative decisions regarding, for example, duration of hospitalization, intensity of care and limitation of the activity. In this paper, we propose a standardized CT technique and the main symptomatology that determines the severity of the damage of abdominal organs in children, based on own experience, taking into account the world literature data on CT.

Introduction. Currently, there are different views on the treatment of non-parasitic spleen cysts in children. The choice of method of treatment is under discussion. The aim of our study was to evaluate and analyze the immediate and long-term results of surgical interventions performed on nonparasitic spleen cysts in children. Material and methods. There are presented results of surgical treatment of the 21 patient, who was on treatment at the Department of Abdominal Surgery of the Russian Children Clinical Hospital over the period from 2013 to 2016. Patients were examined by means of ultrasound of the abdominal cavity, CT, MRI. All patients have been operated. 22 surgical interventions were performed by using laparoscopic access, out of which 2 partial resections of the spleen, 1 splenectomy, 19 fenestrations of spleen cysts.Results. During the course of the operation and in the immediate postoperative period there were no complications. Patients were observed for the period of from 1 year to 3 years. Good results of treatment were obtained in 20 (95.2%) children. In a long-term period a relapse occurred in the one patient one year after the operation. The patient was reoperated, splenectomy was performed. Conclusion. The surgical treatment of spleen cysts is the basic one. It is indicated for cysts sized larger than 5 cm and cysts with clinical symptoms. Minimally invasive interventions in children are optimal because of their low traumatism and good cosmetic effect. Our study showed a high efficiency of laparoscopic operations in children suffered from non-parasitic spleen cysts with good long-term results.

The article presents the features of Crohn’s disease in childhood and adolescence, the modern classification of the disease, indications for surgical treatment and algorithm of the therapeutic tactics in the complicated course of the disease. The variants of surgical treatment of chronic complications of Crohn’s disease are demonstrated. Surgery for severe Crohn’s disease can be regarded not only as an aid in complications of the disease, but also as a good alternative to conservative treatment.

The article describes a clinical case in a child with a rare cause of hydronephrosis - a retrocaval localization of the ureter. This anomaly presents certain difficulties for diagnosis and is most often detected intraoperatively. In the given clinical example, a good result was obtained after laparoscopic pyeloplasty in a child with an intraoperatively detected retrovascular ureter.

The article presents the clinical observation of a child 9 months old with multiple perforations of the small intestine, which appeared against the background of acute enteritis of unknown etiology. Long-term surgical treatment was performed. At the first stage, a sanation laparotomy was performed with excision of jejuno- and ileostomy with the intubation of the small intestine. After the reversal phenomena of peritonitis, the closure of the jejunostomy with intubation of the small intestine was performed. The final stage was the closure of ileostomy. The total duration of the treatment is 2 months. A brief review of the literature devoted to multiple perforations of the small intestine in children with a description of the etiology, pathogenesis and treatment of this disease is given.