Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care

BACKGROUND: Conservative treatment options developed and tested over several decades prevent splenectomy, which leads to post-splenectomy hyposplenism associated with immunodeficiency and hematologic disorders. This article reviews 22 years of conservative management of traumatic splenic rupture, emphasizing the important role of organ preservation and minimizing surgical intervention.

AIMS: The aim was to summarize 22 years of experience in the management of children with traumatic splenic rupture.

MATERIALS AND METHODS: This observational single-center prospective study was conducted from March 2002 to March 2024 at the Ivano-Matreninskaya City Children’s Clinical Hospital in Irkutsk. The medical records of 95 children with traumatic splenic rupture were evaluated. Conservative treatment was received by 83 (87.4%) patients and surgical treatment was received by 12 (12.6%) patients. The age of the affected children was 12 [8; 14] years, with 3.3 times more boys observed (73 vs. 22). For analysis, patients were divided into two groups: comparison group (n = 62; 65.3%) in the early treatment period (March 2002 to August 2012); main group (n = 33; 34.7%) in the late treatment period (September 2012 to March 2024). All children were followed for complications related to spleen injury. Comprehensive follow-up of patients after discharge ranged from 6 months to 15 years.

RESULTS: Of the 95 patients, 2 (2.1%) underwent splenorrhaphy, 3 (3.1%) underwent laparoscopic exploration of the spleen, and 7 (7.4%) underwent splenectomy. Surgical treatment required prolonged combined antibacterial therapy for 13 [10; 16] days. If the spleen was removed after discharge from the hospital, patients were prescribed preventive vaccinations. A discriminant analysis was used to identify cumulative factors that influence the choice of surgical treatment in children with splenic rupture. Combined factors included low systolic blood pressure of 95 (70; 118) mm Hg (p = 0.002); tachycardia with heart rate of 105 [100; 120] beats per minute (p = 0.019); increased shock index of 1.1 [0.9; 1.57] (p = 0.001); blood loss at admission of 13% [6.3; 19] of the circulating blood volume (p = 0.001); maximum degree of blood loss of 2 [1; 3] (p = 0.001). When comparing the groups by duration of treatment, a statistically significant difference was found in the number of days spent in the Surgery Department: the duration of hospital stay was 12 [8; 14] days in the comparison group and 7 (7; 9) days in the main group (p = 0.001). Patients did not differ in terms of blood loss and hemodynamics. Recently, however, the number of surgeries for splenic rupture has decreased 2.6 times, from 16.1% to 6.1%. When evaluating immediate outcomes after splenectomy, it was found that 71.4% (n = 5) of the children had thrombocytosis on day 3–6 after surgery. After spleen removal, all children had an elevated ESR of 25 [23; 39] mm/h for 2 weeks. Long-term results showed that 57.1% of patients had frequent infectious diseases. No symptoms of hyposplenism were observed with conservative management.

CONCLUSIONS: Conservative management of children with traumatic splenic rupture is safe and clinically effective. Non-surgical management can be used in 93.9% of cases. Based on the results obtained, the active use of conservative treatment options for traumatic splenic rupture in children is recommended as the preferred option, with an individualized approach to patient monitoring.

BACKGROUND: Cerebral palsy is a severe disorder of the nervous and musculoskeletal systems. Equinus foot deformity is the most commonly diagnosed deformity. Surgical treatment is required in 12%–70% of patients. Existing surgical treatments are complicated by loss of improvement, relapse, and recurrent deformity in 6.7%–41.0% of cases.

AIM: The aim of the study was to determine the optimal surgical treatment algorithm for preschool and early school-aged patients with cerebral palsy.

MATERIALS AND METHODS: A clinical study included 102 children with cerebral palsy aged 3–10 years. Two groups of children were formed: group 1 for 3–6-year-old patients, group 2 for 7–10-year-old patients. The follow-up period was from 2014 to 2023. Equinus foot deformity was the main symptom in children. The GMFCS, Ashwort, and Boyd–Graham scales were used to assess patients. The severity of the foot deformity was evaluated by the author’s method (Invention Patent of the Russian Federation No. 2712951). Grade I deformity was reported in patients who required a force of 5–7 kg/cm² to move the foot to a 90° angle, grade II deformity was reported with a force of 8–10 kg/cm², and grade III deformity was reported with a force of more than 10 kg/cm². All children underwent surgery: selective myotomy of the gastrocnemius muscle of the lower leg in 65 (63.7%) patients (Intervention Patent of the Russian Federation No. 2332180) and partial achillotomy in 37 (36.3%) patients (Intervention Patent of the Russian Federation No. 2819283).

RESULTS: Spastic diplegia was diagnosed in 59 (57.8%) patients and hemiplegia was diagnosed in 43 (42.2%) patients. Grade I, II, and III equinus foot deformities were diagnosed in 29, 36, and 37 patients, respectively. Selective myotomy was performed in 37 children in group 1 and in 28 children in group 2. Partial achillotomy was performed in 18 and 19 patients in both groups, respectively. Selective myotomy was performed in 63.7% of children in both groups with grades I and II equinus foot deformity, and partial achillotomy was performed in 36.3% of children with cerebral palsy with grade III equinus foot deformity. Treatment results are considered satisfactory in 95.1% of cases.

CONCLUSIONS: The surgical treatment algorithm is effective in children 3–10 years of age with intact intelligence and independent mobility. For patients with cerebral palsy with grade I and II equinus foot deformities, selective myotomy of the gastrocnemius muscle is recommended, whereas for patients with grade III deformity, partial achillotomy is recommended.

BACKGROUND: The term primary acquired cryptorchidism is generally used to describe the absence of a testicle in the scrotum in a boy with a previously documented descended testicle.

AIM: The aim of the study was to demonstrate the potential for unprovoked migration of a normally located testicle back to the groin region based on big data analysis.

MATERIALS AND METHODS: A retrospective analysis of 42,749 electronic outpatient records of boys aged 0–18 years who were followed up at the Children’s City Clinics of Stavropol in 2018–2022 with a diagnosis of undescended testicle was performed.

RESULTS: Between 2018 and 2022, 158 patients diagnosed with undescended testicles were followed up by pediatric surgeons, pediatric urologists/andrologists, and pediatric endocrinologists at pediatric clinics in the city. Of these, 14 patients (8.8%) were identified with testicles previously documented as being in the scrotum.

CONCLUSIONS: The study showed potential for spontaneous movement of the testicle from the scrotum to the groin area as the child grows. However, further research, including multicenter studies, is needed.

BACKGROUND: The Bacillus Calmette-Guérin (BCG) vaccine has been in use around the world for the prevention of tuberculosis since 1921. Unfortunately, this vaccine is associated with the risk of various complications. Post-BCG osteitis is one of the most serious complications. Our observations show that the sternum is the most common site.

AIM: The aim of the paper is to increase the medical community’s awareness and knowledge of such a rare but serious disease as post-BCG osteitis. This paper may be of interest to various specialists, as most patients do not seek primary medical care from a surgeon.

MATERIALS AND METHODS: In 2009–2023 in Surgery Department No. 2 of the Irkutsk regional children’s clinical hospital, 8 children with post-BCG sternal osteitis were treated, which is 29.63% of all cases of post-BCG osteitis of various sites. Six patients were male and two were female. The mean age of patients was 9.12 months (range: 5 to 14 months). Prior to surgical treatment, one child was diagnosed with a fistula that formed an extensive wound surface on the anterior chest wall. All children underwent multispiral computed tomography of the chest as the main preoperative diagnostic modality. As an additional diagnostic modality, ultrasound of the soft tissues overlying a tumor-like formation on the anterior surface of the chest wall was performed.

RESULTS: In 7 out of 8 cases, the diagnosis was based on a set of clinical and epidemiological criteria. Histology and cytology of surgical specimens were performed to confirm the diagnosis. In one case, the diagnosis was fully confirmed by molecular genetic methods. Radical necrectomy was the main surgical treatment option. Based on histological and cytological data, children with confirmed post-BCG osteitis were referred to a tuberculosis clinic for specific chemotherapy. The surgeon’s follow-up examinations showed no recurrence of the disease.

CONCLUSIONS: Post-BCG osteitis is one of the rarest and most serious complications of tuberculosis vaccination. Early radical surgery and specific treatment result in 100% complete recovery of children.

In recent years, the incidence of magnetic ingestion in children has been rapidly increasing in many countries of the world. It is especially dangerous to swallow multiple magnets because they can be attracted to each other and damage the walls of the stomach and intestines. Swallowing magnets is most common in children between the ages of 6 months and 4 years, and much less common in teenagers. Case description. A 13-year-old boy presented to an emergency department complaining of abdominal pain. Multiple vomiting was noted the day before the visit. The bowel movements were regular. The patient was admitted to the hospital with suspected acute appendicitis. Clinical examination and abdominal ultrasound ruled out this diagnosis. Due to the unclear cause of the abdominal pain, a plain abdominal X-ray was performed, which revealed multiple metallic dense bodies in the projection of the cecum. Further questioning revealed that the patient had swallowed several dozen magnetic spheres 2 weeks prior to the visit. Diagnostic laparoscopy was performed and revealed an infiltrate consisting of a portion of the ileum and greater omentum in close proximity to the head of the cecum. When dividing the infiltrate, the wall of the cecal head was found to perforate. The decision was made to convert the access. By transverse mini-laparotomy in the right iliac region, the abdomen was opened, the cecum was exposed with a defect through which part of the foreign bodies was removed. There were 18 magnetic beads. The remaining beads migrated into the colon. Intraoperative radiographs showed foreign bodies as a single conglomerate in the ascending colon projection. The intestinal defect was sutured and the omentum lesion was resected. The progress of the magnets was monitored by stool examination and radiography. A follow-up X-ray on day 3 showed that the beads remained in the projection of the hepatic angle of the colon. A colonoscopy was performed and 15 magnetic beads were removed. Recovery of the patient. Children of any age can swallow magnets. To clarify the diagnosis of abdominal pain syndrome of unknown etiology in children, it is necessary to ask parents and children about possible contact with magnets and perform plain abdominal radiography. The surgical treatment strategy using laparoscopy and intraluminal endoscopy depends on the location of the magnetic foreign bodies and the presence of intra-abdominal complications.

The paper examines the background to the creation and contents of the first Russian manual on pediatric surgery, as well as key moments in the biography and work of Dmitry E. Gorokhov. The introduction briefly outlines the history of the creation of the first manuals in surgery, obstetrics, and pediatrics in Russia. Data on the first foreign guidelines related to pediatric surgery are also presented. The first section of the article reveals the contents of the Russian manual on pediatric surgery, compiled on the basis of long-term reports of the Surgical Department of the Moscow Sofia Hospital and articles by Dmitry E. Gorokhov. It contains the author’s prefaces to each of the three parts and reviews on the author’s published books from medical publications. The structure of Dmitry E. Gorokhov’s manual differs from similar modern books guided by the nosology principle. Based on his personal experience, the author describes the treatment of children with pathologies for which they were admitted to the department or surgery in other hospitals. The manual contains many clinical cases presented with detail rarely seen in our time. The second section of the article characterizes Dmitry E. Gorokhov’s personality, his professional biography and public activities, based on research of archival documents conducted by his grand-nephew, Professor Vitaly Gorokhov. It demonstrates the breadth and diversity of Gorokhov’s scientific interests, his successful combination of practice and research activities with teaching. Dmitry E. Gorokhov authored 215 papers, 60 of which are focused on pediatric surgery, while the rest discuss the problems of rural medicine, gynecology, general surgery, and the combat against infant mortality. He taught a course on pediatric surgery to students at the Sofia Hospital and to doctors at refresher courses at the Moscow University. Dmitry E. Gorokhov was a member of more than 20 commissions under various medical communities. His most fruitful work was as chairman of the commission to combat infant mortality. Published in 1910–1916, the manual by Dmitry E. Gorokhov is currently a bibliographic rarity, so in 2019 it was published in a reprint version, accessible to a wide range of readers. Considering the importance of Dmitry E. Gorokhov’s work for the development of Pediatric Surgery as a specialty, the Russian Association of Pediatric Surgeons launched a fundraising campaign to erect a beautiful monument at the Vagankovo Cemetery, unveiled during the Congress of Pediatric Surgeons of Russia on October 22, 2013.

The paper describes professional activities and achievements of pediatric surgeon Svetlana A. Karavaeva, celebrating her milestone birthday.

The paper presents information about the life of the pediatric surgeon Professor Evgeniy S. Bocharnikov.