Vol 11, No 2 (2021)

Case reports

Surgical treatment of a newborn in critical condition with intrapericardiac teratoma: a case report

Kucherov Y.I., Zhirkova Y.V., Tarayan M.V., Samorokovskaya M.V., Shvets L.V.


This article presents a clinical case of the successful surgical treatment of a newborn with intrapericardial teratoma, which was initially diagnosed in the postnatal period, complicated by multiple organ failure, including severe cardio-respiratory disorders and acute renal damage. The systematized results of clinical, electrophysiological, radiation, and morphological diagnostics during the initial examination and at the stages of supervision of the newborn are reported. On the nineteenth day of life, significant multidisciplinary cooperation was implemented to perform a radical surgical intervention to remove the intrapericardial teratoma in a patient in critical condition due to heart compression and intrathoracic tension syndrome, which determined the needed prosthetics for vital functions. Two months after the operation, the efficiency of the intervention and complex therapy was confirmed by the direct results and data of the infant’s examination. The organizational aspects provided newborns with emergency multidisciplinary specialized medical care.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):169-175
pages 169-175 views

Fatal bleeding in a 1.5-year-old child with aortoesophageal fistula: case report and review of the literature

Bataev S.M., Magomedov Z.Z., Kibalnic D.V., Lello A.I., Akatiev A.S.


Aortoesophageal fistula in children is a very uncommon disease, which in most cases leads to death during the first days from the moment it occurs. Its high mortality is due to the lack of knowledge among doctors about the similarity of the disease in children and the lack of experience treating it. This paper presents the case history of a 1.5-year-old child who was admitted with bleeding from the upper gastrointestinal tract and died 36 hours after admission due to continued massive bleeding at the diagnostic measure stages. An autopsy revealed an aortic aneurysm with a diameter of 1.5 cm, which penetrated the esophageal lumen and formed an aortoesophageal fistula. This article analyzes the treatment results of 17 cases of successfully treating children with aortoesophageal fistula, which we found in the literature. It describes the leading causes and mechanisms of the development of this pathology in children. Also, the article describes the diagnostic and treatment methods for children with aortoesophageal fistula.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):177-184
pages 177-184 views

Clinical Practice Guidelines

Sepsis in children: federal clinical guideline (draft)

Lekmanov A.U., Mironov P.I., Aleksandrovich Y.S., Azovskiy D.K., Popov D.A., Pshenisnov K.V., Muzurov A.L., Degtyareva E.A.


The article publishes a draft clinical recommendation on sepsis in children, developed by specialists of the Association of Pediatric Anesthesiologists and Resuscitators (ADAR) of Russia and approved at the 2nd Russian Congress of Pediatric Anesthesiologists and Resuscitators in April 2021. The definitions of sepsis and septic shock in pediatric patients and their criteria are proposed and substantiated. Data on etiology and pathogenesis, epidemiology, clinical picture and diagnosis of shock are presented. The recommendations are based on a large clinical material of intensive care for sepsis and septic shock in children. The paper provides data on the rehabilitation, prevention and organization of medical services for sepsis in children. The editorial staff of the journal accepts all comments and additions to this project for transmission to the developers.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):241-292
pages 241-292 views


The days of pediatric surgery in Vyatsk Land

Razin M.P., Shumikhin V.S.


A brief report of the Russian Symposium of Pediatric Surgeons and the 60th Conference of Student Scientific Circles of Pediatric Surgeons held in April 2021. The topic of the symposium “Complications of acute appendicitis in children” aroused great interest among the delegates, 96% of whom were ill and vaccinated against COVID-19, and an extensive online audience. Based on the results of this symposium, the decision was made to transform its content into clinical guidelines. The winners of the student research papers were determined.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):215-220
pages 215-220 views

Short bowel syndrome in children: results of the conference

Rozinov V.M.


The paper provides information on the scientific and practical conference on the treatment of children with short bowel syndrome. The conference was attended by 188 Russian and 15 foreign specialists. The speakers shared their own experience on various aspects of treatment, answered numerous questions.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):221-225
pages 221-225 views


To the 90-th Anniversary of Maya K. Bukhrashvili

Petlakh V.I.


Description of the professional activities and merits of the chief physician of one of the oldest children's hospitals in Moscow - .K.A. Timiryazev Children's Hospital №20 - Maya K. Bukhrashvili, celebrating her anniversary.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):227-231
pages 227-231 views

The 50-th anniversary of Dmitry A. Morozov

Rozinov V.M.


Description of the professional activities and merits of the pediatric surgeon celebrating his anniversary.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):233-238
pages 233-238 views

Congratulations to colleagues

Gorbachev O.S.


Congratulations pediatric surgeons, celebrating their anniversaries.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):239-240
pages 239-240 views

Original Study Articles

Direct inguinal hernias in children

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


AIM: Based on the accumulated clinical material, this study aims to show the possibilities of diagnosing and treating direct inguinal hernias in children.

MATERIALS AND METHODS: During the period from 2000 to 2020, 3221 children with inguinal hernias were treated in the surgical department of the Republican Children’s Clinical Hospital in Syktyvkar. Of the above group of children with inguinal hernias, seven patients (0.22%) had direct inguinal hernias. The above was confirmed by ultrasound examination. In laparoscopic imaging, a rectal hernia was defined as a recess of the peritoneum of a stellate or rounded shape in the projection of the medial umbilical fossa. Two patients underwent the Bassini herniation procedure. Two children underwent laparoscopic hernia repair with intracorporeal suture insertion. In three patients, hernia repair was performed using the PRMS method.

RESULTS: Long-term results were followed up from six months to 15 years. Immediate and postoperative complications were noted. No recurrence of hernia was reported.

CONCLUSIONS: When establishing direct inguinal hernia diagnosis in children is clinically determined in the form of a rounded, soft-elastic formation localized medially and above the Pupart ligament next to the projection of the external (superficial) inguinal ring of the inguinal canal. It is easily set into the abdominal cavity with rumbling and confirmed by ultrasound examination results. The most preferred treatment method for direct inguinal hernia in children, in our opinion, is hernia repair using the percutaneous internal ring suturing (PIRS) method.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):161-167
pages 161-167 views

Diarrhea as a postoperative complication of surgically treated retroperitoneal neurogenic tumors in children

Tverdov I.V., Akhaladze D.G., Kachanov D.Y., Merkulov N.N., Uskova N.G., Rabaev G.S., Grachev N.S.


BACKGROUND: Diarrhea as a result of skeletonization of the superior mesenteric artery (SMA) and celiac trunk after retroperitoneal lymph node dissection is a common complication in adult patients with malignant neoplasms of the pancreas, colon, and retroperitoneal tumors. The reports mentioning this complication in the treatment of neurogenic tumors in children are scarce.

AIM: This study aims to improve the surgical treatment results of locally advanced retroperitoneal neuroblastomas by studying which factors influence the development of prolonged postoperative diarrhea.

MATERIALS AND METHODS: An analysis of the treatment results in patients with locally advanced neurogenic retroperitoneal neoplasms at the Dmitry Rogachev national medical research center of pediatric hematology, oncology, and immunology from 2018 to 2020 was conducted. All patients from this cohort underwent SMA and celiac trunk dissection.

RESULTS: During this period, surgeries with dissection of the SMA and celiac trunk were performed in 29 patients. In four (13%) cases, prolonged diarrhea was noted (median duration, 136.5 days with a frequency of up to 13 times a day). Assessment of the dependence of diarrhea frequency on complete dissection or preservation of the tumor component in the SMA and celiac trunk showed no significant differences.

CONCLUSIONS: The complete removal of a neurogenic tumor improves prognosis in patients with a locally advanced form of the disease, but it is associated with the risk of long-term intractable complications. This study does not confirm the opinion that preservation of the tumor component on the SMA prevents its denervation and postoperative diarrhea.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):121-130
pages 121-130 views

Laparoscopic dissection in children with celiac artery compression syndrome

Zainulabidov R.A., Razumovsky A.Y., Mitupov Z.B., Chumakova G.Y.


BACKGROUND: A cause of abdominal pain in children may be compression stenosis of the celiac trunk (Dunbar’s syndrome). This disease occurs when the median arcuate ligament of the diaphragm compresses the celiac trunk, thereby creating compression stenosis, causing the arterial hemodynamics in the artery to suffer and provide adequate blood circulation to the abdominal cavity organs. Medical statistics indicate that 10% to 15% of children and adolescents suffering from chronic abdominal pain have compression stenosis of the celiac trunk.

AIM: This study aims to improve the diagnostic results and identify the indications for the surgical treatment of children with compression stenosis of the celiac trunk.

MATERIALS AND METHODS: From 2015 to 2020 at the N.F. Filatov Children’s Hospital, 64 patients, aged 4 to 17 years underwent surgical treatment for compression stenosis of the celiac trunk. There are 42 boys (66%) and 22 girls (34%). The leading clinical manifestation in all patients was abdominal pain. Associated surgical pathology was observed in 34 of them. The diagnosis was based on anamnesis, examination, ultrasound examination with Doppler and celiac trunk blood flow measurements, multispiral computed tomography, and angiography.

RESULTS: After completing the examination, 61 patients underwent laparoscopic decompression of the celiac trunk, and three children were operated on using the laparotomic approach. In all cases, the leading cause of compression stenosis of the celiac trunk was the median arcuate ligament of the diaphragm combined with the neurofibrous tissue of the celiac plexus. The average duration of the operation was 50 minutes. Intraoperative blood loss did not exceed 5–30 ml. One conversion completed. There were no postoperative complications in the early postoperative period. The patients were discharged in satisfactory condition. The control examination was conducted in the period from six months to three years. In 97% of patients, clinical symptoms of abdominal ischemia were not detected.

CONCLUSION: Our experience indicates the possibility of diagnosing compression stenosis of the celiac trunk in children at early disease stages and laparoscopic treatment success of patients with this disease.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):131-140
pages 131-140 views

Strategy for the prevention of bacterial complications with inhaled nitrogen oxide in newborns

Pukhtinskaya M.G., Estrin V.V.


BACKGROUND: The nitrogen oxide molecule (NO) is a one of the most important factors in the anti-infectious resistance of the body’s immune system.

AIM: This study aims to improve the effectiveness of preventing bacterial complications by including nitric oxide inhalations as part of traditional intensive care.

MATERIALS AND METHODS: Ninety-seven full-term newborns without signs of bacterial complications were included in a controlled, randomized, blind clinical trial. The main group (n = 44) received inhaled nitrogen oxide (iNO). The control group (n = 53) did not receive iNO. On days 1, 5, and 20 the plasma concentrations of IL-1β, IL-6, IL-8, TNF-α, G-CSF, sFas, FGF, and NO were determined by capture ELISA; CD3+CD19, CD3CD19+, CD3+CD4+, CD3+CD8+, CD69+, CD71+, CD95+, CD3+HLA-DR+, CD14+, CD3CD56+, Annexin-V+/FITC; PI+/PE — immunophenotype analysis.

RESULTS: In the main group, sepsis developed in 4 patients and 13 controls (p1 = 0.04; p2 = 0.005). Fatalities occurred in 6 patients, and 10 controls (p1 = 0.37; p2 = 0.59) in the main group. The median duration of the IVL in the main group was 5 days, and 10 days for controls (p = 0.00007). Stays in ORIT were main — 11 days for patients in the main group, and 15 days for controls (p = 0.026). On day 3, when compared with controls, patients in the main group had significantly reduced (p < 0.05) of TNF-α, IL-8 and IL-6, CD3+CD69+, CD3+CD95+, lymphocytes in apoptosis, increasing (p < 0.05) G-CSF, sFas, FGF, NO; CD14+, CD3 +CD19.

CONCLUSIONS: iNO used as a part of intensive care decreases the frequency of sepsis development, the duration of mechanical ventilation, and hospitalization. iNO also tends to decrease the lethal outcome frequency, reduces cytokine aggression, inhibits lymphocyte apoptosis, activates the monocyte-macrophage immunity and proliferative processes. It is appropriate to continue research.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):141-150
pages 141-150 views

Extracorporeal detoxification for septic complications in children during the acute period of severe combined craniocerebral trauma

Novikova T.A., Yeletskaya E.V., Ivanova T.F., Amchislavsky V.G.


BACKGROUND: The clinical application of extracorporeal detoxification methods in patients with severe concomitant traumatic brain injury has several features and limitations due to intracranial hypertension, traumatic cerebral edema, and the risk of their growth during extracorporeal detoxification. The modern literature presents the results of using extracorporeal detoxification methods in severe concomitant trauma in children. However, practically no data are available on the possibility of their use in severe concomitant craniocerebral trauma, which determines the relevance of research in this direction.

AIM: This study aims to improve the treatment results of affected children with severe concomitant craniocerebral trauma with the addition of septic complications using extracorporeal detoxification methods.

MATERIALS AND METHODS: The experience using extracorporeal detoxification methods, including prolonged veno-venous hemodiafiltration combined with LPS sorption and plasma separation membrane in patient intensive care with severe concomitant craniocerebral trauma complicated by sepsis and septic shock development, is presented.

RESULTS: The use of extracorporeal detoxification methods contributed to eliminating septic shock, stabilization of hemodynamic and internal homeostasis parameters, and regression of multiple organ failure in patients with severe concomitant traumatic brain injury. Monitoring the intracranial pressure and preventing disequilibrium syndrome development enabled avoiding an increase in intracranial hypertension in studied patients.

CONCLUSIONS: Timely and adequate use of extracorporeal detoxification methods improves the clinical course of the acute period of traumatic illness in children with severe concomitant traumatic brain injury. The safe use of efferent therapy methods in patients with severe concomitant traumatic brain injury is ensured by invasive monitoring of intracranial pressure and preventing the development of disequilibrium syndrome.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):151-160
pages 151-160 views


Assessment of the patency of the left portal vein during mesoportal shunting in children with extrahepatic portal hypertension

Sokolova D.A., Mitupov Z.B., Kurtak N.D., Razumovsky A.Y.


BACKGROUND: One of the most common causes of extrahepatic portal hypertension in children is portal vein thrombosis. The causes of this disease are different and, in most cases, remain unrecognized. Along with this, the mesoportal shunt (Rex shunt) proved itself and today is considered the “gold standard” to treat extrahepatic portal hypertension in children. The restoration of hepatopetal blood flow eliminates gastroesophageal bleeding, splenomegaly, hypersplenism, and many other complications. For the results of mesoportal shunt to be successful, several conditions must be met, one of which is the patency of the umbilical portion of the left portal vein. Despite the importance of preoperative diagnostics of the patency of this area, the most optimal instrumental research method has not yet been found.

AIM: This literature review aims to highlight the main issues of extrahepatic portal hypertension etiopathogenesis, surgical treatment methods, and the most effective preoperative diagnostic methods to assess the patency of the left portal vein.

RESULTS: The authors analyzed the sources of domestic and foreign literature on the etiology, pathogenesis of HSV in children, and laboratory and instrumental diagnostic methods to assess the patency of the PVI to plan the mesoportal shunting operation.

CONCLUSIONS: Extrahepatic portal hypertension is a polyetiological disease with a possible hereditary predisposition to a thrombotic process under the influence of various triggers. The most common causes of portal vein thrombosis are omphalitis and umbilical vein catheterization in the neonatal period. Unfortunately, to date, none of the existing instrumental diagnostic methods can reliably answer the question about left portal vein patency. Due to the small number of works, the lack of a unified view on the problem of preoperative diagnosis of patients with extrahepatic portal hypertension, we could not reliably determine the specificity, sensitivity, and accuracy of each instrumental method. Therefore, we could not identify the “gold standard” method. Nevertheless, with further improvement of the methods for preoperative assessment of the left portal vein patency, surgeons will be more likely to predict the successful outcome of mesoportal shunting, which will generally affect the surgical treatment quality of extrahepatic portal hypertension in children.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):185-200
pages 185-200 views

Spina bifida: a multidisciplinary problem (a literature review)

Ivanov S.V., Kenis V.M., Shchedrina A.Y., Onufriichuk O.N., Khodorovskaya A.M., Osipov I.B., Sarychev S.A.


BACKGROUND: Congenital malformations of the spine and spinal cord can be combined with various clinical manifestations of the spine, spinal cord, and lower extremities. Children with these neurological disorders often lack sensitivity and motor activity of their lower extremities and, in most cases, have bladder infections and incontinence (lack of bladder and bowel control).

AIM: This study aims to analyze publications with the diagnostic and treatment results of patients with neurological, orthopedic, neurological, and ophthalmological problems with spina bifida.

MATERIALS AND METHODS: We searched PubMed, Web of Science, Scopus, MEDLINE, eLibrary, and RSCI databases and found about 2000 references and 374 articles. We selected 60 articles for review in orthopedics, neurosurgery, urology, and ophthalmology.

RESULTS: Neural tube defects are a wide range of congenital malformations, including skull defects and open or closed spinal dysraphism. The incidence of spine and spinal cord malformations in different countries is quite broad and amounts to 0.3–199.4 cases per 10,000 births worldwide. Spinal cord malformations often occur in combination with bladder infections and incontinence, limb deformities, and other central nervous system developmental anomalies. Among the orthopedic problems leading to impaired support function, the most common are foot deformities and hip joint instability. Orthopedic monitoring of a patient with spina bifida consists of mainly preventing or correcting deformities according to the rehabilitation potential of the child. The timely completion of treatment allows the child to maintain mobility and independence of movement daily activities. At the same time, such treatment must pursue realistic goals according to the potential motor level of the child. In addition to neurosurgical and orthopedic problems, most children with spina bifida (88%–94%) suffer from pelvic disorders. A urologist should observe a patient with spina bifida to perform ultrasound and laboratory monitoring of both the lower and upper urinary tract conditions from an early age. Timely procedures to eliminate urinary retention and sanitation can maintain normal kidney function and contribute to the adequate conduct of motor and neurological rehabilitation of the child. The most common complication of spina bifida is the Chiari II malformation, which is manifested by damage to brain stem structures and internal occlusal hydrocephalus with various symptoms, including neuroophthalmological signs.

CONCLUSIONS: A multidisciplinary team of specialists comprising a neurologist, neurosurgeon, urologist, orthopedic surgeon, ophthalmologist, orthosis specialist, and psychologist should be involved in treating the children with the above presented problems. The use of an integrated approach to treat this group is absolutely justified and enabled the maximum rehabilitation potential of the child to be achieved.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(2):201-213
pages 201-213 views

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