Vol 11, No 3 (2021)

Case reports

Incomplete pentalogy of Cantrell: a case report and review

Kagantsov I.M., Bairov V.G., Sukhotskaya A.A., Pervunina T.M., Li O.A., Petrov D.V., Malysheva D.A., Nikulina T.S.


BACKGROUND: The pentalogy of Cantrell is a rare congenital malformation characterized by five component defects in the anterior abdominal wall, lower sternum, anterior diaphragm, and diaphragmatic pericardium and congenital heart disease. The occurrence of the five features is quite rare. The pentalogy of Cantrell is classified as complete, partial, and incomplete. Few studies have described the successful treatment of neonates with the pentalogy of Cantrell, with even fewer publications about an incomplete defect.

CASE REPORT: We report the successful surgical treatment of a newborn boy with an incomplete pentalogy of Cantrell. In this patient, the diaphragmatic hernia was eliminated at the first stage, and a temporary container for umbilical cord hernia was made by suturing the silastic sac to the edges of the defect in the anterior abdominal wall for subsequent gradual immersion of the hernia contents into the abdominal cavity. These steps made it possible to reduce intra-abdominal and, accordingly, intrathoracic pressures, provide favorable conditions for the healing of the diaphragm, and thus stabilize the child’s respiratory and cardiovascular systems. Subsequently, the cardiovascular system was examined under more favorable conditions and intracardiac defects were excluded. Moreover, the proposed technique made it possible to safely perform the second stage of surgical correction, i.e., radical plasty of the anterior abdominal wall on day 14 of life with full restoration of the normal anatomical and physiological relationships, by which time the diaphragm and mediastinum had taken their correct topographic position. The literature review provides data from 32 sources.

CONCLUSION: The pentalogy of Cantrell is a severe congenital malformation with a high risk of poor outcomes. Reporting of all possible variants of the pentalogy of Cantrell (complete, partial, or incomplete), regardless of the outcome, is important for the accumulation of experience in treating such patients, which by focusing on the clinical situation and the combination of various defects in the pentalogy of Cantrell will improve the strategy and prognosis for this defect.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):375-386
pages 375-386 views

Extrathoracic lung sequestration in newborns: cases report

Patrikeeva T.V., Karavaeva S.A., Kotin A.N., Levadnev Y.V., Golubeva M.V., Simonova T.V.


BACKGROUND: Extrathoracic lung sequestration is a rare variant of a developmental malformation that can be diagnosed prenatally and should be included in the differential diagnosis of abdominal tumor-like formations.

CASES REPORT: From 1996 to 2020, 70 children with confirmed lung sequestration were treated at the Children's City Hospital No. 1 in St. Petersburg. Of these, 29 had intralobar sequestration, and 41 had extralobar sequestration. Four of these patients were diagnosed with a rare extrathoracic (intraabdominal) form. All four were born full-term without clinical manifestations of the defect. Ultrasound examination of all children revealed a solid formation up to 3 cm in diameter, located in the upper left quadrant of the abdominal cavity or retroperitoneal space in the projection of the left adrenal gland. Due to the location of the formation and the inability to visualize the aberrant arterial vessel during ultrasound examination, the first two patients were differentially diagnosed with an adrenal tumor (neuroblastoma). The cancer markers were negative, and adrenal cortex hormones were normal. The children underwent multispiral computed tomography-angiography to clarify the diagnosis. In both cases, the diagnosis of intraabdominal extrapulmonary sequestration with a feeding arterial vessel extending from the thoracic aorta was confirmed. Two children, previously treated in the last two years, were diagnosed by the ultrasound examination results that enabled the visualization of an aberrant arterial vessel feeding the sequester. Indications for surgical treatment have been set. The parents of one child refused treatment. Three children underwent sequestration removal (two by laparoscopic access, one had a laparotomy). Histologically, extrathoracic sequestration in combination with cystoadenomatosis was confirmed. The postoperative period proceeded without complications.

RESULTS: Long-term treatment results were observed in all operated patients for a period of four to 10 years. The assessment was performed based on complaints and ultrasound data. All patients matured and developed according to their ages.

CONCLUSIONS: Extrathoracic lung sequestration is a rare type of defect that is subject to surgical treatment. This pathology should be included on the spectrum of differential diagnosis of tumorous formations of the abdominal cavity and retroperitoneal space in newborns. The main methods for postnatal diagnosis of the defect are ultrasound and multispiral computed tomography-angiography.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):387-394
pages 387-394 views

Treatment of a patient with COVID-19 and adverse premorbid background: A case report

Tulokhonova J.S., Obarchuk O.G., Averina I.A.


BACKGROUND: In the presence of severe comorbid pathology, children get sick with coronavirus disease 2019 (COVID-19) as severe as adults.

CASE REPORT: This paper describes the treatment of a 17-year-old patient with severe bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 that damage a large volume of the lung tissue (69% on the right, 87.1% on the left, and grade IV lung lesions according to computed tomography) with an unfavorable premorbid background (grade IV obesity with a body mass index of 54.5 kg/m2, Down syndrome, moderate mental retardation, and primary hypothyroidism). The child was admitted to the hospital on day 10 of illness in an extremely serious condition. On admission, she received artificial lung ventilation and then high-flow mask ventilation with an oxygen flow of 12 L/min. In addition to respiratory support, she received etiotropic (hydroxychloroquine), anticoagulant (enoxaparin), antibacterial, (ceftriaxone), and antihypertensive treatments. Levothyroxine sodium was administered for hypothyroidism. Permanent monitoring of the acid–base balance, general and biochemical blood tests, and coagulography were performed. Gradual positive dynamics of the respiratory status was observed, and oxygen flow decreased. The case was constantly consulted to a pulmonologist, endocrinologist, and cardiologist, who corrected antihypertensive therapy depending on blood pressure indicators. Oxygen support was given for 13 days. After receiving a double-negative PCR test for COVID-19, the patient was transferred to the pulmonology department, from which she was discharged in satisfactory condition for outpatient observation.

CONCLUSION: Our patient with COVID-19, severe lung damage with a combination of comorbid pathologies, extremely unfavorable prognosis (grade IV obesity, Down syndrome, and hypothyroidism), who received active complex treatment in accordance with modern guidelines, recovered despite late admission to the hospital.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):395-402
pages 395-402 views

Idiopathic omentum infarction in children — the law of "paired cases": cases report

Shidakov I.H., Kalniyazov B.M., Urusova M.N.


BACKGROUND: One of the rare causes of abdominal pain in children is an omental infarction. In the literature, there are few descriptions of this pathology in childhood. The disease is often diagnosed only intraoperatively because of its nonspecific clinical picture. Therefore, the clinical cases presented in the article may be of interest to pediatric surgeons.

CASES REPORT: In the pediatric surgical department of our clinic, two patients aged five and six years old were treated after being admitted with abdominal pain syndrome, the clinical picture of which did not allow to exclude an acute surgical pathology. A laparoscopy was performed to clarify the diagnosis. Isolated lesions of the segments of the greater omentum were revealed without signs of torsion and pathology of other organs. The operations were completed by resection of the altered omental sections. Histopathological examination revealed hemorrhages and tissue necrosis.

DISCUSSION: The localization of pain in the right abdomen necessitates differentiating the disease from acute appendicitis, cholecystitis, and acute gynecological pathology. In the treatment of patients with omental infarction, there are supporters of conservative and surgical strategies. We performed a resection of the affected omental segment, which enabled us to achieve complete recovery in both cases.

CONCLUSION: Laparoscopy in unclear diagnostic situations permits the timely diagnosis of an omental infarction, and surgical minimally invasive intervention leads to a successful cure.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):403-408
pages 403-408 views


Letter to the article “Sepsis in children: federal clinical guidelines (draft)”

Savin I.A.


In the letter, the author relies on data from the foreign and domestic literature and his own experience and confirms the relevant creation of clinical guidelines, “Sepsis in children.” The letter summarizes the main advantages of domestic recommendations and notes the provisions requiring critical assessment. In general, the author of the letter highly appreciated the work done by the authors of the recommendation.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):409-412
pages 409-412 views

Reply to the Commentary on the article “Sepsis in children: federal guidelines (draft)” I.А. Savin

Lekmanov A.U., Popov D.А.


The authors of the Clinical Guidelines are grateful to Professor I.A. Savin for his comments and provide answers to the comments made regarding the appointment of antibacterial drugs and immunoglobulins for sepsis in children.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):413-416
pages 413-416 views


Letter to the article “Spina bifida: a multidisciplinary problem (literature review)”

Nikolaev S.N.


In the letter, the author relies on data from the foreign and domestic literature and his own experience and confirms the urgent problem of myelodysplasia syndrome in children. The letter summarizes the main advantages of the given abstract review and notes the provisions requiring addition. In general, the author of the letter highly appreciated the work done by the authors of the review.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):417-420
pages 417-420 views


2nd Russian Congress of Pediatric Anesthesiologists-Reanimatologists (Mini-Review)

Lekmanov A.U.


A brief overview of the content of the Russian Congress of Pediatric Anesthesiologists and Reanimatologists that occurred in April 2021 and discussed topical problems of the specialty. The Congress was held in an online format and convened over two thousand participants from all regions of Russia and 20 countries. A significant event of the Congress was the adoption of the draft federal clinical guidelines, “Sepsis in children.” Also, the round table, “Legal aspects in anesthesiology and resuscitation. For what the anesthesiologists are being tried,” was held. Video recordings of all speeches are posted on the Internet, which allows a wide range of specialists to familiarize themselves with the reports and speeches.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):421-424
pages 421-424 views


To the 85th Anniversary of Anatoly F. Dronov

Kholostova V.V.


This paper describes the professional activities and merits of the pediatric surgeon Anatoly F. Dronov in celebration of his 85th anniversary.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):425-428
pages 425-428 views

To the 75th Anniversary of Vyacheslav V. Parshikov

Karpova I.Y.


This paper describes the professional activities and merits of the pediatric surgeon Vyacheslav V. Parshikov in celebration of his 75th anniversary.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):429-431
pages 429-431 views

Original Study Articles

Systemic inflammatory response in infants with craniostenosis sedated with propofol

Gurskaya V.I., Ivanov V.P., Novikov V.Y., Draygina N.V., Savvina I.A.


AIM: This study aimed to investigate the possible effect of intravenous anesthesia (sedation) with propofol on the levels of several cytokines (interleukin [IL]-6, IL-8, IL-10, and tumor necrosis factors-α) and S100B protein in the blood plasma of children aged <1 year with craniostenosis.

MATERIALS AND METHODS: Twenty patients aged 1–12 months diagnosed with non-syndromic forms of craniosynostosis, who underwent magnetic resonance imaging (MRI) of the brain under propofol sedation, were classified according to ASA I-II class. Peripheral blood sampling was performed before and after the drug administration, followed by laboratory analysis.

RESULTS: A significant increase was found in the serum level of IL-6 (p = 0.004) when intravenous sedation with propofol was used for 29 ± 4.93 min.

CONCLUSION: Short exposure of children aged <1 year with craniostenosis to hypnotic propofol during brain MRI significantly increased the level of the pro-inflammatory cytokine IL-6 in the blood plasma.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):297-306
pages 297-306 views

Ultrasound technologies in the diagnosis, treatment, and rehabilitation of children with testicular torsion

Komarova S.Y., Tsap N.A., Karachev I.A.


AIM: This study improves the diagnosis of testicular inversion in children to select different treatment strategies by determining the effectiveness of conservative and surgical testicular detorsion criteria.

MATERIALS AND METHODS: The clinical data from 2010 to 2020 included 110 children with testicular torsion. In 64% of cases, the left testicle predominated. Testicular torsion occurred in 50% of children in the 12- to 14-year-old age group. The time from disease onset to seeking medical help ranged from 1.5 hours to 11 days. It was less than 6 hours in 41.8% of children, from 6 to 12 hours in 13.6% of boys, 12 to 24 hours in 11% of patients, and more than 24 hours in 33.6% of boys and adolescents. The protocol for the diagnosis, treatment and rehabilitation of all children included various techniques for ultrasound examination of the scrotal organs.

RESULTS: The analysis showed the absence of reliable criteria for detecting testicle torsion in the early periods (61%–100%): spiral course of the spermatic vessels (63.9%), change in the position of the testicle (19.8%), increase in the volume of the testicle and appendage (98.3%), a change in testicle shape and the inability to withdraw its poles (47.5%), and a hydrocele (67.2%). The index of false-negative results of the ultrasound scan of the scrotal organs reaches 40%. Conservative navigation detorsion was performed in 39 (35.5%) boys and adolescents during the early disease stages. The ultrasound criteria for the effectiveness of conservative detorsion were established. The main criteria normalized blood flow in the testis (100%). Surgical treatment of testicular inversion was performed in 71 (64.5%) boys and adolescents.

CONCLUSIONS: Compliance with the protocol for diagnosing, treating, and rehabilitating children in different age groups with testicular torsion allowed us to determine adequate emergency treatment strategies and follow-up. An ultrasound differential diagnosis is performed with testicular hydatid torsion and inflammatory diseases of the scrotal organs. The informativeness of the ultrasound methods amounted to 60%.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):351-358
pages 351-358 views

Biochemical markers of surgical stress in endoscopic rhinosinus surgery under combined anesthesia in children

Ovchar T.A., Lazarev V.V., Korobova L.S.


BACKGROUND: Endoscopic rhinosinus surgery in children is associated with a high anesthetic risk because of intraoperative stress. This study aimed to, considering the dynamic picture of the biochemical markers of surgical stress, to assess the effectiveness of regional methods of combined anesthesia in rhinosinus surgery in children.

MATERIALS AND METHODS: A comparative study was conducted in parallel groups composed of 100 patients aged 6–17 years who had undergone an assessment of their physical condition using the ASA I-II scales and planned endoscopic endonasal surgery lasting up to 2 h under combined anesthesia. In all groups, the introductory anesthesia was combined, i.e., inhalation of sevoflurane in an oxygen–air mixture in combination with intravenous administration of propofol. To ensure the patency of the respiratory tract, endotracheal anesthesia was administered. Patients were divided into two groups of 50 people each, depending on the method of maintaining anesthesia. Group 1 received inhalation of sevoflurane in an air–oxygen mixture with a target value of the minimum alveolar concentration of (MAC) 0.7–0.9, and regional blockage was performed bilaterally, i.e., pterygopalatine anesthesia with palatine access (palatinal) and infra-orbital intraoral access with ropivacaine solution. Group 2 received inhalation of sevoflurane in an air–oxygen mixture with a target value of 1.5 МАС, and 5% tramadol solution was used intravenously for analgesia.

RESULTS: Data on the dynamics of glucose, lactate, and cortisol levels in both groups proved the effectiveness and stability of the anesthesia methods used. However, the concentration of the inhaled anesthetic agent in the tramadol group was used was twice as high as the concentration in the regional anesthetic group.

DISCUSSION: The dynamics and deviations of biochemical markers of surgical stress were not significantly different in the intergroup and intragroup interstage parameters beyond the reference values.

CONCLUSIONS: The proposed anesthesia methods did not induce stress reactions to surgical intervention, and the anesthesia methods in both groups were adequate and effective.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):307-314
pages 307-314 views

Treatment of children with incomplete duodenal membrane

Nafikova R.A., Gumerov A.A., Galimov I.I., Neudachin A.E.


BACKGRAUND: An incomplete or perforated duodenal membrane is a rare developmental pathology of the gastrointestinal tract.

AIM: This study aimed to analyze the diagnostic and treatment results of children with an incomplete duodenal membrane in the Republican Children’s Clinical Hospital in Ufa.

MATERIALS AND METHODS: This study retrospectively analyzed case histories of 34 children who underwent surgery for incomplete duodenal membrane from 2005 to 2020. Features of the life history of the children, clinical picture of the disease, presence of concomitant developmental anomalies, laboratory and instrumental examination data, surgical correction methods, and postoperative period were analyzed. All children underwent ultrasound examination of the abdominal organs and contrast-enhanced radiography of the upper gastrointestinal tract with barium sulfate. Esophagogastroduodenoscopy was performed in 17 cases.

RESULTS: Antenatally, the diagnosis was made in 21 cases. Patients’ age at the time of hospitalization was 9.7 ± 2.7 days. Children were presented with symptoms such as persistent regurgitation or vomiting of curdled milk, which was sometimes mixed with bile (22 cases). Bloating in the epigastric region, retraction of the lower abdomen, and low weight gain after birth were found in nine children, and in five children, no weight changes were observed. Moreover, 13 (38.2%) children had concomitant developmental anomalies; 4 (11.7%) children had Down syndrome. Surgical treatment of 10 children was performed laparoscopically. Of the 24 children, three received laparotomic access, including conversion. The procedures included duodenotomy, partial excision of the membrane, and suturing of the duodenum. Enteral feeding was started 4.9 ± 0.6 days after surgery. The average duration of hospitalization was 27 ± 1.4 days.

CONCLUSION: Vomiting or frequent regurgitation in infants and low-weight gain should alert pediatricians and pediatric surgeons. Malformation of the duodenal membrane in combination with other malformations necessitates a comprehensive examination. Laparoscopic excision of the duodenal membrane is the preferred treatment.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):359-366
pages 359-366 views

Ultrasound-guided thoracoscopic debridement in children with fibrinothorax

Pavlov A.A., Sergeeva A.I., Zolnikov Z.I., Dianova T.I., Ivanova O.N., Andreev S.N., Egorova I.G.


BACKGROUND: With the spread of endoscopic procedures, thoracoscopy has become an ideal method for the surgical treatment of pleural complications. Ultrasound examination of the pleural cavity made it possible to differentiate the nature of the pleural contents and timely use of thoracoscopic sanitation of the pleural cavity.

AIM: This study aimed to conduct ultrasound monitoring of the complete restoration of the pleural cavity after video-assisted thoracoscopic debridement in children with fibrinothorax.

MATERIALS AND METHODS: The study was conducted in the children’s surgical department of the Republican Children’s Clinical Hospital of Health Ministry of the Chuvash Republic. From 2011 to 2019, 31 children aged 1 month to 18 years were diagnosed with community-acquired pneumonia complicated by fibrinothorax, and thoracoscopic debridement and drainage of the pleural cavity were performed. During hospitalization, before thoracoscopy, 1–3 ultrasound examinations of the pleural cavities and lungs were performed in all children, which made it possible to determine methods of management. After thoracoscopic debridement, ultrasound examination of the pleural cavities was performed 3–7 times during hospitalization and 1–2 times monthly for 3–6 months after discharge from the hospital until the pleural cavity was completely restored.

RESULTS: Ultrasound monitoring of the pleural cavities and lungs after thoracoscopic debridement at the outpatient stage showed that changes in the pleural cavity and lung parenchyma can last up to 6 months, while children’s health status was satisfactory.

CONCLUSIONS: Preoperative and postoperative ultrasound monitoring can adequately assess the overall state of the pleural cavities and lungs. Changes in the pleural cavity after thoracoscopic debridement under ultrasound guidance are observed later than by X-ray. In this regard, after discharge from the hospital, children with complicated purulent and destructive pneumonia who underwent thoracoscopic debridement need ultrasound monitoring of the pleural cavity until it is completely restored.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):367-374
pages 367-374 views

Results of treatment of fifty children with persistent cloaca in one center

Mokrushina O.G., Shumikhin V.S., Levitskaya M.V., Chundokova M.A., Halafov R.V., Shugina J.V., Petrova L.V., Koshko O.V., Emirbekova S.K.


BACKGROUND: The preserved cloaca is a particular type of anorectal anomaly. The combination of urological, genital, and rectal abnormalities makes radical reconstruction difficult.

MATERIALS AND METHODS: This study examined operations performed in 50 patients with persistent cloaca treated from 2010 to 2021. Two groups are presented: the first with 35 children and a short canal (<3 cm), and the second with 15 children and a long canal (>3 cm). We examined the prognosis for bowel control, the type of operation, the need for vaginal reconstruction, complications after surgery, and the days of hospital stay.

RESULTS: Anomalies of the Müllerian ducts in the second group (94%) were higher than in the first (36%) (p < 0.001). The sacral index and myelodysplasia did not differ in both groups. The sacral index in the first group was 0.62 ± 0.14, and in the second group, it was 0.58 ± 0.14 (p = 0.520). Myelodysplasia in the first group was 33%, and in the second group, it was 38% (p = 0.744). Total urogenital mobilization (51%) was used in the first group, and abdominal reconstruction (54%) was used in the second group. Vaginal reconstruction was required in 28% of patients in the first group and 60% in the second group. Complications were 3.5 times more likely in the first group (60% versus 17% in the second) (p = 0.003). The length of hospital stay in patients in the second group was longer than that of patients in the first group.

CONCLUSION: Our study data demonstrate that the reconstruction of a persistent cloaca requires individual planning of the operation, considering the length of the canal and the state of all structures forming the cloaca.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):315-324
pages 315-324 views

“Bowel Management” program for children with congenital malformations and neurogenic bowel after surgery

Pimenova E.S., Korolev G.A., Klementyev M.V., Kezhenbayeva K.M., Romanova O.E., Morozov D.A.


BACKGROUND: After the surgical treatment of children for anorectal malformations, spinal pathology, and Hirschsprung’s disease, their quality of life is significantly reduced due to fecal incontinence. For patients with persistent defecation disorders, the “Bowel Management” program is offered.

AIM: This study analyzes the “Bowel Management” program implemented in the clinic.

MATERIALS AND METHODS: A prospective analysis of the program used in children after surgical correction of malformations was conducted. The program comprised the following components: lectures for patients/parents, hospitalization, irrigography with water-soluble contrast, teaching patients/parents about cleansing enemas, keeping a bowel movement diary, plain abdominal X-ray, changing the recipe for enema solution, monitoring the effectiveness, and correcting recommendations.

RESULTS: A total of 66 children from 1.5 to 17 years old were treated. Three groups were identified: (I) anorectal malformations (n = 26), (II) spinal pathology (n = 30), and (III) Hirschsprung’s disease (n = 10). The results were considered satisfactory if the bowel cleansing procedure was painless for the child and did not cause stress reactions; the parents were satisfied with the result of the prescribed program if after the enema a sufficient amount of stool was removed within 45 minutes, there were no episodes of defecation during the day. With the help of the Rome IV revision criteria, fecal incontinence was noted in all cases against the background of stool retention. In 11 (16.7%), there was no fecal incontinence even in cases of prolonged stool retention. A correlation was found between “high” lesions (in the lumbar spine) in spinal hernias with the absence of fecal incontinence with prolonged stool retention compared with the “low” sacral localization of the hernia. In group I, 91.7% had spinal cord fixation. In group II, 86.7% had it, and none were present in group III. The effectiveness of the program was 83.3%.

CONCLUSION: The Bowel Management is easy to use and effective in 83% of patients. It can be recommended for the rehabilitation of children with defecation disorders, fecal incontinence after surgical correction of congenital malformations (anorectal malformations, spinal pathology and Hirschsprung's disease).

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):325-338
pages 325-338 views

Comparative evaluation of the results of conservative and surgical methods of treatment of children with destructive forms of pyelonephritis

Kuzovleva G.I., Grushitskaya E.V., Staroverov O.V., Rostovskaya V.V., Shmyrov O.S., Zakharov A.I.


BACKGROUND: The relevance of destructive pyelonephritis in pediatric practice is determined by frequency of various complications of the disease associated with a high risk of irreversible morphofunctional changes in parenchyma of affected kidney, the lack of tactical consensus in the professional community and regulatory documents regulating the procedure for diagnostic and therapeutic support of this contingent of patients.

AIM: Substantiation of the tactics of effective treatment children with destructive pyelonephritis, based on the results of a multifactorial retrospective analysis of the course and outcomes of the disease.

MATERIALS AND METHODS: The results of the analysis of medical documentation of 38 patients with destructive pyelonephritis aged 3–204 months (median 93.5) who received inpatient treatment in 2015–2019 in three specialized clinics in Moscow are presented.

RESULTS: More than half of the patients (28 children) in the acute period of the disease received conservative therapy, including infusion and antibacterial, the escalation of which was carried out with the preservation or increase of manifestations of the systemic inflammatory response syndrome, as well as negative dynamics according to ultrasound or CT data. In the group of patients (n = 10), indications for surgical treatment were formulated – decapsulation of the kidney, opening of apostemas and abscessed foci, drainage of the paranephral space. During the examination in catamnesis, realized in 50%. It was found that in the majority (91%) of children treated conservatively, a statistically significant decrease in the volume of the kidney on the affected side was registered. These complications were not detected among the operated patients.

CONCLUSION: The pharmacy of choice for starting antibacterial therapy should be inhibitor-protected beta-lactams, carbapenems, if the etiological significance of staphylococcus is suspected, it is advisable to connect linezolid. In case of laboratory signs of hypercoagulation, it is necessary to connect anticoagulants. Surgical tactics can minimize the risk of complications associated with the purulent-destructive process, contributing to regenerative processes in the kidney parenchyma. The objectification of the results of the catamnestic examination is due to the performance of nephroscintigraphy.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(3):339-350
pages 339-350 views

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