Vol 6, No 2 (2016)

A clinical case of meningococcal meningoencephalitis in late postoperative period after laparoscopic omentosplenopexy for spleen injury. The Neisseria meningitidis on a par with the Haemophilus influenzae and the Streptococcus pneumonia are most common causative agents of overwhelming postsplenectomy infection. This clinical case demonstrates that immunodeficiency accompanies spleen regeneration after severe injury. The value of preventive measures during the regeneration of spleen requires further study and detalization.

Background: Until now no consensus has been reached on surgical approach to pancreatic pseudocysts and fistulas in children who suffered from acute pancreatitis (AP). Objective: To present our surgical tactics used to treat children with AP complicated by external pancreatic fistulas (EPF) and pseudocysts (PPC) in the Department of Pediatric Surgery of MONIKI. Materials and methods: Our retrospective research included 129 cases of AP in children (aged from 6 months to 17 years) who received treatment in the Department of Pediatric Surgery of MONIKI named after M.F. Vladsimirskiy from 1990 till 2014. Research data included age, sex, symptoms, blood levels of amylase and lipase, treatment procedure, hospital stay, PPC or EPF and treatment outcomes. Results: 80 (62%) children had mild pancreatitis, 8 (6%) - moderate and 41 (32%) suffered from severe disease. PPCs and EPFs were observed in 22 (17%) patients with destructive pancreatitis. Mean hospital stay made 31,3±15 days. 12 (9,3%) children had PPC, 7 (5,4%) patients had EPF and in 3 (2,3%) children the combination of both complications was observed. All patients with EPF received complex conservative treatment with its outcomes of total EPF repair without surgery in all cases within the period from 1 to 3-4 months. 7 children with PPC less than 5 cm in diameter and no communication between PPC and pancreatic duct received conservative treatment. In cases of PPC more than 5 cm in diameter and no communication to pancreatic duct our surgery options included percutaneous US-guided punctures. Endoscopic drainage was performed in 2 children with chronic large PPC located near head and body of pancreas and with communication to pancreatic duct. Conclusion: In cases of AP with EPF in children we recommend active conservative treatment for 3 months since fistula manifestation. The choice of either surgery or conservative treatment is to be determined by PPC size and location, how long it persists and whether there is a communication between PPC and pancreatic duct, the effect of therapy is also to be counted.

Aspects of diagnostics and surgical tactics are cited considering literature data on the ruptures of cysts and spontaneous perforation of biliary ducts and analysis of 6 proper observations. Possible reasons, peculiarities of clinical signs and results of supplementary methods of the study are analyzed. The need for proper intraoperative revision aimed at the establishment and elimination of obstruction in the distal area of the common bile duct and usage of the differentiated approach in rupture of the cyst complicated by bile peritonitis and perforation followed by a false cyst formation is underlined. Usefulness of two-stage application of T-shaped drainage with the subsequent cystectomy and Roux-en-Y hepaticojejunostomy is confirmed.

Purpose of the study: to determine the necessary shunt diameter and optimal shunting volume of portal blood in children with extrahepatic portal hypertension prior to portosystemic shunting. Methods of the study: a complex ultrasound examination was carried out (B mode in real time and duplex scanning in color flow mapping mode). Changes in the liver hemodynamics before and after portosystemic shunting were examined. In 30 children the surgery was done without determination of the necessary shunt diameter. Determination of diameter, speed characteristics and blood flow in the vessels of the portal system, hepatic and splenic arteries was done in 51 patients prior to the surgery to determine the necessary shunting volume. Material performance: 106 children aged 4 to 7 were examined. 25 of them were healthy and 81 children had extrahepatic portal hypertension. Results: it was established that before portosystemic shunting in patients with extrahepatic portal hypertension it is necessary to determine the diameter of the shunt and volume of blood shunting needed to preserve the portal blood flow in the liver and decrease the pressure in the portal system effectively. Conclusion: portosystemic shunting decreases the portal pressure, preserves hepatic hemodynamics and prevents esophagogastric hemorrhages in patients with extrahepatic portal hypertension with individual determination of the necessary volume of blood shunting.

Total and subtotal intestinal aganglionosis (hypogangliosis) is a severe and potentially lethal condition related to neuromuscular intestinal diseases. Some authors consider it as a rare, atypical and most severe form of rectocolic aganglionosis which constitutes 1% of all cases related to the disease [6,7,8]. According to meta-analysis performed by Ruttenstock, 68 patients with total aganglionosis were found in the world literature for 2009 [8]. Different surgical methods (Martin, Kimura, Zigler procedures (extended myectomy and myotomy), bringing down the ileum with formation of ileoanal anastomosis, Bianchi’s plasty and STEP-procedure, intestinal transplantation) are proposed for treatment of total intestinal aganglionosis; however, none of them were considered as superior to the others [3,6,8]. The article describes three clinical cases of total and subtotal intestinal aganglionosis in patients of the neonatal surgery department of Filatov Moscow Pediatric Clinical Hospital No. 13 in 2015-2016. According to our experience, the tactics of sparing resection with preservation of the small intestine maximum length is being optimal. However, it doesn’t exclude the need for durative parenteral nutritional support. Using domestic parenteral nutrition in the management of this group of patients is pharmaco-economically viable.

Introduction. The purpose of the study is to discuss treatment of atresia of the large intestine at a regional center of newborn surgery in the Russian Federation. Material and methods. 12 patients (8 boys and 4 girls) with atresia of the large intestine were treated in our hospital in 2006-2015. Anatomical types of atresia of the large intestine were distributed as follows: type 1 (membrane) in 3 patients; type 2 (separation of segments connected with the fibrous bridle) in 3 patients; type 3 (separation of segments with the V-shaped mesentery defect) in 6 infants. The most frequently occurred congenital obstruction of the large intestine was localized in the area of the transverse colon of 7 patients. This was followed by patients with atresia at the descending (3 patients) and ascending section (2 patients) of the large intestine in decreasing order of frequency of occurrence. Authors of the article reported of 2 technologies of surgical therapy of atresia of the large intestine i.e. direct end-to-end anastomosis in 10 patients and end-to-side anastomosis with the formation of the external Bishop- Koop colostoma (group 3) in 2 patients. Results. The mean age of patients during the surgery amounted to 2 days - 2 ± 0.28 days (range of 1-4 days). Gestational age of patients was 38 weeks - 38.2± 0.28 weeks (range of 3440 weeks). Weight of patients at the surgery was 3054 ± 258 g (range of 1200-4800 g). Average time of surgeries amounted to 55 ± 6 minutes (range of 50-60 min). The surgeries weren’t accompanied by blood loss. Duration of the patients’ stay at the surgical hospital was 16 days in average (range of 8-28 days). No complications related to the surgery were registered in the early postoperative period. Remote (1 month-1 year) observation revealed no negative consequences of the surgery. The second stage of surgery following Bishop-Koop operations and intended for the closure of the external intestinal stoma was performed not earlier than in a month after the 1^st surgery. Conclusion. Methods of treatment of atresia of the large intestine remain controversial but anastomosis of any type is one of the best variants of the state correction.

The results of the study examining the effectiveness of negative pressure wound therapy in children with the wounds of soft tissues. 50 patients with wounds of different etiology were examined. In a half of clinical studies vacuum therapy was implemented whereas other patients used modern wound dressings (comparison group). The influence of negative pressure on the process of wound retraction was estimated based on the results of computer photoplanimetric studies. It is shown that vacuum therapy forms favorable conditions for the retraction of wound defects significantly exceeding the corresponding indicators of wound area reduction in patients from the group of comparison.

Chronic intestinal syndrome of pseudo-obstruction is a rare syndrome manifested through recur-rent phenomena of bowel obstruction developed against neuropathies, myopathies and neuromyo-pathies of congenital or acquired genesis. The article deals with the peculiarities of ethiopathogen-esis of different forms of the disease including de nova mutations revealed within the last decades. The article is interesting both for surgeons who must diagnose intestinal pseudo-obstruction in a timely manner to avoid unnecessary surgeries and for other doctors who can come across the syndrome during their practice.

Clinical recommendations related to treatment of children with the craniocerebral injury at prehospital and hospital stages are presented. The possibilities of monitoring, intensive treatment and surgical treatment are determined. The recommendations are given as standards, options and recommendations.