Vol 10, No 4 (2020)

Case reports

Osteosarcoma of III metacarpal bone in a 13-year-old girl (case report)

Savlaev K.F., Petrichenko A.V., Nishonov D.K., Ivanova N.M., Sharoev T.A.


Osteosarcoma is the most common primary malignant neoplasm of bones in children; this tumor accounts for 50 to 80% of all skeletal sarcomas. Less often, osteosarcoma affects flat bones (scapula, ribs, bones of the skull and pelvis), bones of the foot, hand and spine.

Description of the observation. A 13-year-old girl, 8 months before admission to the clinic, began to complain of pain in her right hand, six months later, a swelling appeared in this area. After radiography, which revealed a bone tumor of the III metacarpal bone, a trepanobiopsy with histological examination was performed. Conclusion: subperiosteal telangiectatic osteosarcoma G II. The child was admitted to the oncology department in November 2018. Before the operation, the girl underwent 4 courses of chemotherapy, as a result of which the tumor reduced in size, which made it possible to perform organ-preserving surgical treatment — extirpation of the third metacarpal bone affected by the tumor, followed by autoplasty from the wing of the right iliac bone with fixation of the graft Kirschner needles. The postoperative period passed without complications. As a result of the operation, it was not only possible to radically remove the tumor, but also to preserve 3 fingers of the right (working) hand with good functionality. After surgery, the child received 5 courses of polychemotherapy and is currently in remission.

Conclusion. The above observation demonstrates the possibility of performing organ-preserving surgeries using bone autoplasty for rare tumor lesions of the metacarpal bones. This method is more physiological in comparison with the use of allo- or artificial grafts.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):445-451
pages 445-451 views

Features of treatment in children with fractures of the distal metaphysis of the shin bones: cases report

Dorokhin A.I., Adrianova A.A., Khudik V.I., Sorokin D.S., Goryunov A.K.


This case study discusses the treatment of distal methapyphiseal fractures of shin in children. The choice of this problem based on wide expansion of fractures and poor treatment results. Age of children ranges from 10 to 16 years. Examination was done with X-rays, computed tomography (CT), and ultrasound, especially in cases where damaged ligamentous apparatus was suspicious. The main method of treatment was surgical—osteosynthesis by pins, plates, and screws. In the rehabilitation period, the legs were immobilized by Plaster of Paris for 4–6 weeks. The first case demonstrated the probability of damage of the distal tibiofibularis ligaments and necessity of their reconstruction. In the management of the second case, the efficacy of CT scans in validation of the fracture is presented. The treatment of the teenager presented in the third case was based on biomechanical principles. In majority of cases, outcomes in the period of 6–8 weeks after trauma were good and satisfactory. In our opinion, diagnosis and treatment of distal methapyphiseal fractures of the shin in children must be different that was proved in the examination of bones and ligaments injuries. Creation of the special structure classification for understanding and effective treatment of these kinds of methepyphiseal fractures in children is believed to be necessar.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):453-460
pages 453-460 views

Necrotizing paraproctitis in a 5-year-old child: a case report

Stepanova N.М., Rudenko N.Y., Dyukov A.A., Lee I.B.


Authors present a rare clinical case of successful treatment of a 5-year-old child with purulent-necrotic paraproctitis, which developed against the background of a primary immune deficiency state.

Clinical case. A 5-year-old boy became acutely ill, against the background of diarrhea with hyperthermia. An area of hyperemia, edema, and tissue infiltration appeared in the perianal region. In anamnesis, with frequent respiratory infections and dysfunction of the intestinal tract in the form of diarrhea. He was admitted to the Regional Children’s Hospital on the 10th day of illness from the regional hospital, where antibiotic treatment was started. Upon admission, the condition was serious in the perianal region with an extensive wound necrotic tissues and a plaque of fibrin. To create favorable conditions for wound healing, a preventive sigmostomy operation was performed. Multidrug-resistant Pseudomonas aeruginosa was found in the wound culture. Thus, courses of antibiotics treatment, infusion therapy, and surgical debridement of the perianal wound and its local treatment were performed. Upon immunological status examination, a primary immunodeficiency was revealed, for which drugs with immunoglobulin G were administered. As a result of the treatment, the wound healed by secondary intention, thus, an operation was performed to close the sigmostoma. The child was discharged in satisfactory condition under the supervision of an immunologist and a surgeon.

Discussion. In this case, preventive sigmostomy is justified; however, authors limit themselves to surgical intervention on the perineum in other cases. Pseudomonas aeruginosa shows its pathogenicity in patients with impaired immunity. Therefore, courses of antibiotics, infusion therapy, and immunomodulatory therapy along with surgical treatment, favorable result were achieved.

Conclusion. Children with purulent-necrotic paraproctitis, which developed against the background of a primary immune deficiency should be hospitalized as early as possible in a specialized hospital.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):461-466
pages 461-466 views

Endoscopic removal of metal foreign bodies by magnet: case report

Petlakh V.I., Borovitsky V.A., Konovalov A.K., Strogova N.N.


The number of children swallowing magnetic foreign bodies has been a significantly high for the past decades, increasingly needing endoscopic or surgical interventions.

Case report. In our observation, a 12-year-old girl swallowed magnetic balls from children’s designer 10 days prior to hospital admission. Foreign bodies (5 balls) were found during X-ray examination in the projection of the cecum. Conservative therapy carried out for 4 days had no success, thus colonoscopy was performed to remove foreign bodies. Foreign bodies were fixed to the intestinal wall, and attempts to separate them were unsuccessful. When a medical magnet was placed outside the body in the right iliac region, a chain of magnetic balls detached from the intestinal wall and made it possible to be captured in a trap loop and be removed. The girl avoided a laparotomy with an opening of the colon.

Conclusion. External use of a medical magnet is effective for navigation and assistance during colonoscopic extraction when magnetic foreign bodies are found in the colon.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):467-472
pages 467-472 views


Results of the XII international congress "Stars of pediatric surgery in Baikal"

Kozlov Y.A., Baradieva P.Z., Rasputin A.A., Ochirov C.B., Cheremnov V.S.


For the first time, the congress was held online. For two days, 25 speakers from 9 countries shared their knowledge with the audience. Broadcasts of reports and symposia were attended by about 1,500 people worldwide.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):487-488
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VI forum of pediatric surgeons of russia (lessons and perspectives)

Rozinov V.M., Suvorov S.G., Gorbachev O.S., Petlakh V.I., Erokhina N.O.


The VI Forum of Russian Pediatric Surgeons was held on the online platform on October 23–24 and October 30–31, 2020. A total of 1,719 specialists from 20 countries took part in the work for the forum, which is 2.8 times higher than the corresponding figure from 2019. The daily audience of registered speakers and listeners ranged from 835 to 1.027 people. During the four days forum, 74 speakers presented 84 reports. The Forum of Russian Pediatric Surgeons promotes the broad promotion of innovative ideas and technologies and integration of domestic specialists into the international professional space.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):489-492
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In memory of Almaz K. Ormantaev (19.06.1959–13.12.2020)

Gorbachev O.S.


In respectful memory of the head of the department of pediatric surgery Ormantayev Almaz Kamalovich (Republic of Kazakhstan).

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):493-494
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Original Study Articles

Specific features of the adhesion process of the abdominal cavity in children with different degrees of connective tissue dysplasia

Minaev S.V., Timofeev S.I., Grigorova A.N., Vladimirova O.V., Pashneva E.I., Kolesnikov E.G.


Aim. To assess adhesions of the abdominal cavity in children with varying degrees of connective tissue dysplasia (CTD) severity.

Methods. A total of 91 children with average age of 10.6 ± 1.4 years were observed from 2005 to 2019. Composed of 53 boys (58.2%) and 38 girls (41.8%). Patients were divided into two groups: group 1 (69 children without CTD) and group 2 (22 children with CTD). Clinical data and screening cards were used to diagnose DST. All patients underwent an assessment for the clinical course, a macroscopic visual assessment adhesive process severity in the abdominal cavity according to three different scales (Nair, F. Coccolini, N.I. Ayushinova). Immunohistochemistry was performed against collagen I, III, IV type, Laminin γ1, angiogenesis factors, transforming growth factor beta (TGF-β), and Fibroblast Growth Factor Receptor 1 (FGFR1). A semi-quantitative counting method was used to record the relative number of immunopositive structures. Statistical analysis was carried out by methods of variation statistics using the Chi-square test and Mann–Whitney U-tests, as well as the Spearman rank correlation method for the reliability of differences between groups.

Results. In the adhesive process visualization, the N.I. Ayushinov scale was revealed to be the most informative, showing the average score of 7 ± 0.8 points in group 2 and 14 ± 1.2 in group 1 (rs < 0.35; p < 0.05). In group 2, the adhesive material showed no (56%) or chaotic fragments (44%) of type I collagen, and the ratio of type I to type III collagen is 2.7: 5.1. In group 1, the ratio of type I to type III collagen is 5.9:1.8. The ratio of collagen IV to type I is 6.5: 2.9. Both groups have a moderate (++) amount of TGF-β. TGF-β is positive with macrophages. FGFR1 was found in the control group (++++). A positive response was seen in fibroblasts and macrophages (U = 79.00; p = 0.006). Statistically significant analyzes of vascular endothelial growth factor in compared groups (rs = 0.632, p < 0.001) had a positive correlation..

Conclusion. Thus, the study showed features of clinical course and morphological changes during the development of adhesions in the abdominal cavity in children with varying degrees of severity of CTD. Data obtained dictate the need for an individual approach in predicting adhesive disease, as well as targeted preventive care.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):381-389
pages 381-389 views

Chemical pleurodesis using povidon-iodine for chylothorax treatment in newborns

Kozlov Y.A., Rasputin A.A., Kovalkov K.A., Poloyan S.S., Baradieva P.Z., Zvonkov D.A., Ochirov C.B., Cheremnov V.S., Kapuller V.M.


Introduction. Chylothorax is a rare condition that results from abnormal accumulation of lymphatic fluid in the chest and one of the most common causes of pleural effusion in newborns. The aim of our study is to present our own experience of chemical pleurodesis using povidone-iodine in newborns with chylothorax.

Materials and methods. In the present study, we studied data from 10 patients with chylothorax who, over the past years, starting in 2016, underwent chemical pleurodesis using the drug povidone-iodine. Congenital accumulation of lymph in the pleural cavity was recorded in 2 patients, acquired — in 8 patients. The indications for this procedure were the absence of response to total parenteral nutrition for at least 10 days and the appointment of octreotide at the maximum dosage. Pleurodesis consisted in the introduction into the pleural cavity of a 4% solution of povidone-iodine with a calculated dose of 1 ml/kg. The povidone-iodine solution was kept inside the pleural cavity for the next 4 hours.

Results. Chemical pleurodesis was successfully applied in all 10 patients. In 8 patients, a single prescription of the drug was sufficient, and in 2 remaining patients, the pleurodesis session was repeated. After the procedure of chemical pleurodesis, 2 patients developed respiratory distress syndrome caused by massive atelectasis of the homolateral lung, which was confirmed by X-ray examination. These patients required mechanical ventilation for 24 and 48 hours. The average time for the disappearance of chylothorax was 4 days. In the long-term follow-up, 1 patient died from progressive deterioration of pulmonary function against the background of lung hypoplasia.

Conclusions. Our data demonstrate that povidone iodine pleurodesis is a effective treatment for chylothorax in newborns.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):391-399
pages 391-399 views

Enteric nervous system with chronic mesenteric ischemia: experimental study

Pimenova E.S., Korchagina N.S., Korolev G.A., Zyuz′ko D.D., Saakyan M.S., Morozov D.A.


Introduction. The pathology of the enteric ganglia can lead to different diseases (Hirschsprung’s, neuronal intestinal dysplasia, ganglioneuromatosis, and Chagasse). Causes of acquired dysganglionosis remained unclear. Some authors hypothesized that pathology of the enteral nervous system may be secondary to intestinal ischemia.

Aim. To investigate the intestinal function and histological changes of the colon in rats with chronic ischemia.

Materials and methods. A total of 20 Sprague Dawley rats underwent surgery (ligation of the terminal mesenteric vessels next to the descending colon). The appetite of animals were checked, and stool were collected after the procedure. Reoperation was performed after 7 (n = 1), 9 (n = 2), 12 (n = 2), 14 (n = 1), 21 (n = 1), 42 (n = 1), 53 (n = 1), and 62 (n = 1) days. The diameter of the colon and changes of the serosa were visualized. In the experimental group, two samples biopsy was performed (ischemic and normal colon).

Results. Functional changes were observed in 90% of rats after the ligation of mesenteric vessels (constipation/impact, softening stool/diarrhea, and hemocolitis). Colonic stenosis of the ischemic area in 30% was detected. 70% animals have the intestinal dilatation above the ischemic segment (partial bowel obstruction). Necrosis of the ischemic colon was observed in 20%. Spontaneous fixation of the omentum to the ischemic segment was found in 40% animals. A microscopically inflamed infiltration of the mucosa in the ischemic zone (70%) and in normal colon (50%) was revealed in the ligation group. The number of the enteric ganglia decreased in the ischemic segment.

Conclusion. Functional disorders (colitis and obstruction) and morphological changes (inflammation and ganglion cells pathology) were found in rats with chronic mesenteric ischemia.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):401-410
pages 401-410 views

Video-assisted percutaneous hernia sac suturing: a new technique of inguinal hernia repair in children

Pavlushin P.M., Gramzin A.V., Krivosheenko N.V., Koinov Y.Y., Chikinev Y.V.


Background. Inguinal hernias are very important problem in pediatric surgery. It appears in 5–20 cases in every 1000 newborns, approximately 10 times prevalence in males. However, the incidence of inguinal hernia is bigger by 1.5–2 times in group of premature infants.

Materials and methods. In prospective study, that was performed in 2019–2020, 90 pediatric patients diagnosed inguinal hernia were included. All patients had open herniotomy (Duhamel method), subcutaneous endoscopic-assisted ligation of inguinal hernia using Tuohy needle, or video-assisted percutaneous hernial sac suturing (VIPS).

Results. The mean operating time in VIPS group was 13 ± 13.46 min in patients with unilateral inguinal hernia and 20 ± 6.12 min in patients with bilateral variant. In the 6-month follow-up period, any complications or recurrences were not observed. VIPS group included two extremely premature infant with uni- and bilateral inguinal hernia. Minimally invasive herniotomy was performed in 50 weeks post-conceptual age, with unremarkable postoperative period. A difference was found in the operating time between groups of minimally invasive herniotomy and group of Duhamel repair. No difference was found in the operating time of bilateral hernia between all groups.

Conclusion. Considered all things, assuming that announced method of video-assisted percutaneous hernial sac ligation to be a perspective minimal invasive way of treatment for inguinal hernia in children is reasonable. However, for final conclusions, further study of this surgical technique, also in a cohort of premature infants, is required, with the possible organization of multicenter clinical trials.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):411-418
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Rational perioperative antibiotic prophylaxis for open damages of brush in children

Gordienko I.I., Tsap N.A.


Introduction. Today, hand injuries are one of the most pressing and common problems in modern traumatology worldwide. Results obtained statistically indicate a fairly high frequency of hand injuries, including open ones. Often, an incorrect prescription of antibiotics in the form of unjustified antibiotic therapy in the absence of direct indications is done.

Aim. This study aimed to develop a rational algorithm for perioperative antibiotic prophylaxis for open hand injuries in children based on experimental and clinical research.

Materials and methods. The study was divided into two phases: experimental and clinical. The experiment was carried out on 60 sexually mature, outbred guinea pigs. During the experiment, the analysis of clinical signs of inflammation, complete blood count and biochemical blood analysis, spiral computed tomography, and morphological study of the consolidation zone were performed. The clinical part of the work is based on the analysis of surgical treatment results of 120 children with open hand injuries, which were divided into two groups: the main group that included 50 children receiving treatment according to the experimentally developed perioperative antibiotic prophylaxis (PAP) algorithm, and the comparison group included 70 children receiving a perioperative course of antibiotics from 0 to 7 days, without a well-defined algorithm.

Results. In the analysis of clinical results, laboratory, radiation, and morphological methods of studying the experimental material, the absence of antibiotic prophylaxis in open fractures of small tubular bones with a 90% probability was found to entail pro-inflammatory complications in the area of postoperative wound; however, a one day short-term course of PAP will prevent complications and will not have statistically significant differences with a longer course of three days.

Discussion. Results of a clinical study proved the effectiveness of the developed algorithm and showed better results in early and late postoperative period in comparison with the chaotic prescription of antibacterial drugs without a clear algorithm; however, no statistically significant differences in the level of postoperative complications were found.

Conclusion. On the basis of an experimental model of an open fracture of the tubular bone, osteosynthesis and various courses of antibiotic prophylaxis has proven that a short-term course of PAP within 24 h is the most optimal one, and achieving minimal risks of inflammatory complications and better anatomical and functional outcomes in clinical practice.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):419-428
pages 419-428 views

Method of spleen reduction in laparoscopic splenectomy in children with hereditary autoimmune hemolytic anemia

Svarich V.G., Kagantsov I.M., Svarich V.A.


Purpose. This study aimed to improve the results of surgical treatment of children with hereditary autoimmune hemolytic anemia by laparoscopic splenectomy.

Materials and methods. In the period from 1991 to 2020, a total 47 patients with hereditary autoimmune hemolytic anemia were treated in the surgical department of the Republican Children’s Clinical Hospital of Syktyvkar. Splenectomy was performed by the open method in 25 children, and laparoscopic method in 22 patients. Since 2019, the method of spleen reduction during laparoscopic splenectomy has been used in 3 patients when the large size of the mobilized spleen does not correspond to the size of the endoscopic container.

Results. On average, surgical intervention using the above-described method of spleen reduction lasted for 19 ± 2 min lesser than with laparoscopic splenectomy without the above method, due to the possibility of removing a significantly smaller volume of spleen tissue from the endoscopic sac outside the abdominal cavity. However, the most important achievement was the almost complete elimination of the risk of getting free fragments of a pathologically altered spleen with its possible replantation and recurrence of the clinic of autoimmune hemolytic anemia. The postoperative period was smooth, and all patients were discharged at their place of residence 7 days after the laparoscopic splenectomy. Intra-abdominal complications and relapses of the disease associated with the above-described method of operation did not occur in any patient within 6–12 months postoperative.

Conclusion. The proposed method of spleen reduction during laparoscopic splenectomy made it possible to avoid relapses of the disease, reduce the operation time, as a result, improved the results of surgical treatment in children with hereditary autoimmune hemolytic anemia.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):429-433
pages 429-433 views

Inhalation anesthesia in children in outpatient dentistry: xenon or sevoflurane?

Lazarev V.V., Khaliullin D.M.


Abstract. The choice of optimal anesthetic in outpatient dental practice is an important stage in treatment plan preparation for children who need oral sanitation under general anesthesia. Few works were devoted to the comparative characterization of sevoflurane and xenon, especially in conditions of outpatient dental practice.

Aim. This study aimed to compare the characteristics of xenon and sevoflurane inhalation anesthesia at the stage of maintaining anesthesia in outpatient dental practice.

Materials and methods. This is an open, comparative, and randomized study, in parallel groups with random sampling. A total of 103 patients of both sexes aged 2–12 years were included. Children were divided into 2 groups: group 1 (35 children), with sevoflurane anesthesia and group 2 (68 children), with xenon anesthesia. In each and between groups at stages of anesthesia, data from the bispectral (BIS) index, heart rate, blood pressure, lung ventilation, glucose, acid-base status, and ionic composition of venous blood were monitored.

Results. Significant differences between groups were observed in the BIS-index values at the end of anesthesia, indicating a faster awakening of patients under xenon anesthesia. Blood pressure and heart rate indicators in the xenon group at the beginning and end of the study are not statistically significant compared to the sevoflurane group. Remaining indicators did not show significant differences between groups.

Conclusion. The use of sevoflurane and xenon during general anesthesia in outpatient dental practice characterized by the stability of the acid-base state, ion composition, and glucose concentration allows adequate conditions for spontaneous ventilation with pressure support. However, a faster awakening of the patient at the end was observed when using xenon. Diastolic blood pressure and heart rate in the xenon group after the end of anesthesia are close to baseline values.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):435-443
pages 435-443 views


Surgical treatment of newborns with small bowel atresia (literature review)

Batchenko N.Y., Mokrushina O.G., Gogichaeva A.A.


Intestinal atresia is a congenital obstruction of the lumen of the jejunum or ileum and is one of the most common causes of congenital obstruction in newborns. This literature review is devoted to the surgical treatment of newborns with various types intestinal atresia. Causes of intestinal atresia are considered, where a special role is assigned to the genetic theory, the expression of the nucleotide sequences ITGA2 873G/A and NPPA 2238T/C and antenatal circulatory disorders of the developing intestine. Topographical-anatomical and morphological characteristics of the intestine in newborns with intestinal atresia are studied in detail in articles. A table of revealed histomorphological features of the small intestine in children with atresia was compiled. In addition, processes occurring in the mucosa, submucosa, muscle, and serous membranes are described in detail. A relationship was found related to the size of the atresia site and duration of ischemia. The theory of neuromuscular regulation of the intestine is considered, in which an important role is assigned to interstitial pacemaker cells of Cajal. Variants of anastomosis depending on the difference in diameters of the adductor and excretory parts of the intestine are analyzed, and results of treatment in patients with laparoscopic access are described. The postoperative course of disease, development of complications, recurrent operative interventions, duration of parenteral nutrition, and onset of enteral load was evaluated.

Conclusion. The choice of surgical technologies used to restore the patency of the intestinal tube is determined by the degree of discrepancy between diameters of anastomosed segments. The prognosis is not determined by tactics of surgical treatment, type of atresia, time before treatment, and presence of associated anomalies.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(4):473-486
pages 473-486 views

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