Vol 8, No 1 (2018)

The article describes two observations of acquired mechanical intestinal obstruction in children that occurred due to diospyrobezoars (phytobezoars formed in a persimmon). In the first case the obstruction was removed endoscopically. Thus, the major part of the diospyrobezoar was removed from the stomach using fibrogastroscopy whereas small fragments left the stomach spontaneously. In the second case diagnostic laparoscopy failed to reveal the reason for intestinal obstruction. Conversion was done; a foreign body was found in the jejunal lumen in the course of intestinal revision. The body was smashed palpatory and moved into the large intestine. The presented observations show that it is possible to apply the methods of removal of intestinal obstruction due to diospyrobezoars without dissecting the lumen of a hollow organ.

The clinical picture, diagnosis and surgical treatment of a child with cavernous hemangioma of the spleen are described.

St. Vladimir Children’s Municipal Hospital celebrated its 140th anniversary in 2016. The article is devoted both to the history of the hospital and development of domestic pediatric surgery on the hospital territory. In the next issues the editorial staff of the magazine is planning to expand on the scientific and clinical activity of the pediatric surgery department of the hospital-based Central Physicians’ Continuing Education Institute.

A lecture for practitioners who come across the issues of parenteral nutrition in children is presented below. The basic indications for parenteral nutrition given to children are considered in the lecture. The necessity of prescribing all parenteral nutritional components such as proteins, fats, carbohydrates, vitamins and microelements is determined.

The paper provides an overview of the reports at the surgical forum devoted to the problems of traumatological care for children. The information is of interest to pediatric surgeons, traumatologists and other pediatric specialists.

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The article contains the data related to the creation of the Project of Federal Clinical Recommendations on how to treat children with Hirschsprung’s disease applicable in the Russian Federation. The Project has been prepared for three years and consisted of several stages such as questioning of pediatric surgeons and the leading pediatric coloproctologists from Russia and neighboring countries (analyzing two questionnaires of 2015 and 2016), analysis of domestic and foreign literature depending on the topic, reporting the first results of the study during the XVII European Congress of pediatric surgeons, scientific discussion of specialists with a wide experience in treatment of patient with Hirschsprung’s disease in a profile academic periodical within two years.

During the study it was found out that they used different methods in diagnostics, treatment and postoperative rehabilitation of Hirschsprung’s disease and some issues are discordant.

The Project of Federal Clinical Recommendations made on the basis of the conducted work will be discussed at the All-Russia Symposium of Pediatric Surgeons with international participation ‘Hirschsprung’s disease and neurointestinal dysplasia in children’ in April 2018 and publicly available on the website of the Russian Association of Pediatric Surgeons. 

The structure of chemical intoxication in children from the city of Tomsk in the last five years has been analyzed. The average age was 7.4 ± 0.34 years old. The increased frequency of cases was associated with the following ages: 1 to 3 years old and 7 to 16 years old. There were more boys as compared to girls: 58.4 and 41.6 %, respectively. The average time of poison exposure was 4.8 ± 0.6 hours. Enteral intoxication predominated over inhalation (10.7 %), nasal (2.7 %) and parenteral (1.7 %) intoxication. The medicinal agents (49.6 %) associated with negligent storage and failure to comply with the dosage regimen occupied the leading role in the intoxication structure.

Purpose: to study roentgeno-anatomic peculiarities of ureters with various contractile activity in congenital non-refluxing megaureter in children.

Materials and methods: 47 children with congenital non-refluxing megaureter aged 3 months to 11 years underwent a complex urologic examination and X-ray ureteropyelometry with diuretic stimulation.

According to the study results, the patients were divided into 2 groups: those having a low contractile activity of the ureter (12 patients, the average frequency of ureter contractions of 0–3.6 per minute) and those with a normal contractile activity of the ureter (35 patients, average frequency of ureter contractions of 4–7.6 per minute).

The authors suggested such an integrated value as the ‘ureteral index’. It displayed roentgen and anatomic peculiarities of ureters with various contractile functions. The differences between the groups by the ureteral index are significant (p=0.000001).

Results and conclusions: the ureteral index over 0.19 with 87.5% sensitivity and 92% effectiveness characterize ureters with a low contractile function

Purpose. To estimate the results of surgical treatment of children with vasorenal hypertension.

Materials and methods. 11 patients with renovascular hypertension were operated from 1999 to 2015 with 9 boys and 2 girls among them. Their age varied from 5 months to 14 years old. Their weight was 4.6 kg to 40 kg. All children had high blood pressure values (130/80 to 250/120 mmHg) in spite of antihypertension drug therapy given.

Results. 10 patients had plasty of renal arteries affected both unilaterally (6) and bilaterally (4). An internal iliac artery was taken as a transplant in 10 cases whereas the great saphenous iliac vein was used in 2 cases. 1 child had undergone reimplantation of the renal artery. One patient in the group had the middle aortic syndrome (MAS) and pronounced hyperplasia of the renal arteries. Only abdominal aortic repair was performed in this case. In all cases a positive result was noted in the form of normalization of arterial blood pressure values until the complete withdrawal of antihypertensive agents (in 7 cases) or significant dosage reduction (4 patients).

Conclusions. Surgery is the basic method in the treatment of children with renovascular hypertension. Using the internal ileac artery as a transplant is accompanied with good early and remote postoperation results. The internal ileac artery and great saphenous vein can be used in a bilateral lesion. 

The issue of surgical treatment of children with incarcerated inguinal hernias is presented. The evolution of views on the incarceration pathogenesis in the presence of a non-obliterated Nuck’s diverticulum with subsequent ischemia and threatening necrosis of internal organs in the hernia sac is reviewed. Authors who are in favor of early correction of inguinal hernias in young children present their arguments. Techniques of the strategy that allows for preliminary conservative invagination and subsequent delayed surgical reconstruction are presented. Detailed advantages of endosurgical interventions and possible complications in the treatment of children with incarcerated inguinal hernias including the reasons for blood flow reduction in the testes following hernioherniorrhaphy are presented.