Purpose: to report a case of a giant stomach trichobezoar successfully treated with a laparoscopic technique. Methods. A 14-year-old girl with signs of partial upper gastrointestinal obstruction was admitted to the hospital. Stomach trichobezoar was found during an endoscopic examination. The child was discharged following conservative therapy, as her parents gave no consent to surgery. In 2 months, she was admitted to the hospital again for planned surgery. Result. Gastrotomy was performed laparoscopically. Giant bezoar was removed from the stomach, placed in an endosac and then removed from the abdominal cavity through a Pfannenstiel incision. No postoperative general or wound complications were found. The patient recovered and was discharged. Conclusion. Treatment of stomach trichobezoars should be surgical. The method depends on a certain case. We believe that laparoscopy is more useful as compared to open surgeries and recommend it in uncomplicated forms of stomach trichobezoars.
The authors aim to consider a clinical case of treatment of a newborn baby with gastroschisis by staged immersion of intestinal loops and anterior abdominal wall plasty. A defect of the anterior abdominal wall was detected by ultrasound scan at 15 weeks gestation of a baby born at 33 weeks gestation (the Apgar score is 6–7, weight is 2,000 g). The child had a surgery 5 hours after the birth. After revision of the retained organs a pronounced visceral and abdominal disproportion was found. It was decided in favor of two-stage procedure of gastroschisis. A silicon bag with an elastic fixing ring hermetically placed under the abdominal wall was used during silo placement. It is an alternative to original bags for silo placement. At day 9 after the surgery (immersion of intestinal loops) the plasty of the anterior abdominal wall was done. As a result, the patient recovered and was transferred from the neonatal resuscitation department when he was 36 days old. By describing the advantages of the technique, the authors suggest it should replace other types of silo replacement which are widely used in our country.
Цель. Демонстрация клинического случая гидрометрокольпоса у новорождённого и краткий обзор литературы по данной теме. Материал. Нашим пациентом являлась новорождённая девочка, родившаяся от второй беременности матери, осложнённой течением анемии и острой респираторной инфекцией в первом и третьем триместрах соответственно. При антенатальном обследовании на 32 неделе гестации было установлено наличие у ребёнка врождённого порока развития: кисты правого яичника. Роды срочные, на 39 неделе -плановая операция кесарева сечения после рубца на матке. На момент рождения состояние ребёнка было расценено как удовлетворительное, ОША -7-8 балов. При первичном осмотре было обнаружено патологическое пролабирование из половой щели образования мягкоэластичной консистенции, без местной гиперемии и гипертермии, флюктуирующее при пальпации. По результатам эхографии было установлено объёмное образование в полости малого таза больших размеров, c чёткими границами, двусторонний уретерогидронефроз. Патология была расценена как киста яичника, сдавливающая тазовые отделы обоих мочеточников, приводя к вторичному уретерогидронефрозу. Гинекологом была проведена пункция образования, получено жидкостное содержимое, выставлен диагноз: врождённая киста яичника? Киста гарднерова хода? Результаты. После ухудшения состояния и повторного появления симптоматики на 7-е сутки жизни больная была консультирована детским хирургом. У ребёнка была диагностирована неперфорированная девственная плева, которая и являлась причиной развития гидрометрокольпоса. Больной была проведена крестообразная гименотомия, приведшая к разрешению состояния. Девочка была выписана в удовлетворительном состоянии. Заключение. Из-за трудностей дифференциальной диагностики гидрометрокольпос в периоде новорожденности нередко приводит к диагностическим и лечебным ошибкам.Ключевые слова: гидрометрокольпос, неперфорированный гимен, врождённый порок развития Шидаков И. Х., Калниязов Б. М.
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.
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