The article presents the main stages of the development of ideas about a fairly rare pathology in clinical practice the syndrome of compression of the ventral trunk. Until the mid-nineteenth century, reports of the clinical picture of chronic abdominal ischemia were more descriptive. Serial pathoanatomic studies, comparison of anatomical features revealed at autopsy with clinical manifestations accompanying these changes, contributed to the isolation of chronic ischemic disease of the digestive system in a separate nosological form. The discovery of angiography contributed to the significant development of vascular surgery and the isolation of the ventral trunk compression syndrome as an independent disease, since it allowed for a lifetime comparison of the detected changes in blood vessels with the clinical manifestations of the disease. The term ventral trunk compression syndrome was first introduced by P. Harjola when describing a case of abdominal pain in a patient with compression of the ventral trunk by the neuroganglionic tissue of the ventral plexus. Later, J. Dunbar confirmed the Association of clinical manifestations of chronic abdominal pain with compression of the ventral trunk by the median arched ligament of the diaphragm. In English-language literature, the disease was named Dunbar syndrome. The effectiveness of eliminating the symptoms of this disease by surgical dissection of compression structures has been proven. Further study of this problem developed in parallel with the development of surgery in General in accordance with the emergence and introduction of new surgical technologies. The purpose of numerous studies was to study the etiopathogenetic mechanisms of the occurrence of a variety of clinical manifestations of this syndrome and improve the results of its treatment by improving known surgical techniques and introducing new ones.
A Peroral Endoscopic Myotomy was performed on the patient with the persistent dysphagia despite preceding Heller myotomy combined with partial fundoplication, relaparotomy, fundoplication wrap reconstruction, gastrostomy and left-sided thoracoscopy with the drainage of the thoracic abscess. The use of intraoperative High-Resolution Manometry during Endoscopic Peroral Myotomy helped to reveal the reasons for the failure of previous treatment and to address the dysphagia.
Celiac trunk compression syndrome is a symptom complex arising from compression of the celiac trunk by the median arcuate ligament, crura of diaphragm or ganglion tissue of the celiac plexus. The main clinical manifestations of this pathological condition are abdominal pain syndrome, indigestion and weight loss. The disease is detected in 0.4–1 % of people in the population, more often in young people. The pathophysiological mechanisms of the development of celiac trunk compression syndrome remain not fully understood, but the key reason for its development is ischemia of the digestive system. The main instrumental methods for diagnosing compression of the celiac trunk are ultrasound duplex scanning of the abdominal aorta and visceral arteries and spiral computed angiography. The only effective treatment for celiac trunk compression syndrome is surgery. Currently, both classical techniques and various minimally invasive technologies are used to decompress the celiac trunk. The advantages of open access include good visual and manual control of anatomical structures, the possibility of eliminating complications, changing the tactics of surgical intervention, if necessary, performing vascular reconstruction. The advantage of minimally invasive surgical technologies is minimal trauma to the abdominal wall tissues, minor postoperative pain syndrome, early rehabilitation, a low risk of developing cusp, wound infection and hernial defects. Regardless of the methodology, surgical treatment can achieve a positive effect in 75–90 % of patients with celiac trunk compression syndrome. These are the modern concepts of epidemiology, pathogenesis, clinical manifestations, diagnosis and methods of treatment of this pathological condition.
To develop the optimum medical-diagnostic algorithm, allowing to lower the lethality and frequency of complications at patients with acute cholangitis and biliary sepsis. To define interrelation and to reveal distinctions between acute cholangitis and biliary sepsis. Patients with acute cholangitis and biliary sepsis of various severity and etiology; cases history. Development of the given problem will allow to lower lethality at purulent cholangitis and biliary sepsis.
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