Introduction. Currently, surgical complications in Crohn’s disease is still one of the most serious problems in pediatric surgery. An intensive development of video endoscopic surgery contributes to the active introduction of this technology in pediatric coloproctological practice. Crohn’s disease is still one of the most complex pathologies in pediatric gastroenterology, and surgical treatment of its complications is a disputable issue among pediatric surgeons. Up to now, there are no clear indications to surgery in the refractory form of Crohn’s disease, no standardized terms and types for surgical intervention, as well as no optimal variants of surgical access.Material and methods. A retrospective analysis of patients who had been treated surgically at departments of abdominal and emergency surgery in two pediatric hospitals in Moscow (Morozovskaya and Izmailovskaya ) was carried out. 39 children with Crohn’s disease, aged 4–17 year, were included in the study. All patients had standard clinical examination: clinical examination with anamnesis, laboratory and instrumental diagnostics.Results. The obtained results have shown that laparoscopic interventions have a number of advantages, such as less traumatic surgery, reduced exposure to anesthesia and shorter intestinal stimulation, less stay in ICU, shorter hospitalization as well as more rapid rehabilitation period.Conclusion. The performed assessment of outcomes after surgical treatment of children with complicated Crohn’s disease helped to develop indications for the selection of surgical technique in the ileocecal form. Thus, the obtained results improved outcomes in children with complicated Crohn’s disease because of the outlined indications for surgery and surgical tactics when minimally invasive techniques are more preferable.
Lymphangiomas are non-specific formations developing from the lymphatic vessels, occupying an intermediate position between the tumor and the developmental malformation. The most frequent localization of the pathology is the face and neck area (75%) and the axillary region (20%), less than 1% of cases are located in the mediastinum. According to the literature data, the only radical treatment is surgical, but there is a high prevalence rate of relapses (25%). This article is devoted to the analysis of the clinical case of the treatment of lymphangioma of the complex anatomical localization, reflecting the complexity of the diagnosis and radical relapse-free treatment of this pathology.
Hirschsprung disease (HD) is a congenital absence of nerve cells (ganglions) in a segment of the intestinal wall, leading to its obstruction. Diagnosis of BG in children is a labor-intensive process, on which surgical treatment tactics depend. The concentration of patients in large surgical centers with equipped diagnostic departments makes it possible to develop the most adequate examination plan while minimizing the risk of diagnostic errors. The aim of the study was to analyze methods for diagnosis of HD in children; a retrospective analysis of the records of patients hospitalized in three medical organizations in Moscow (n=201) in 2017–2019 was carried out. The first group – children with confirmed diagnosis (n=152), the second group – patients with suspicion of BG with unsatisfactory results of previous operative treatment, postoperative complications (n=49). Results: in the 1st group, irrigography was performed before hospitalization in 118 patients (77,6%). In the hospitals, irrigography was performed (repeated) for 109 (71,7%) children. 25 (16,4%) patients showed discrepancies in interpretation of the results. Thus, irrigography was applied to all patients. Intestine biopsy before hospitalization was performed in 79 patients (52%), in the hospitals – performed/repeated in 50 patients (32,9%). There were discrepancies in the interpretation of histological findings in 8 patients (18,6 per cent). Thus, in the diagnosis of HD in children, biopsies were used (before hospitalization and/or during hospitalization) in 89 patients (58,6%). Anorectal manometry was performed to 3 (2%) children. In the 2nd group a histological examination was performed (before and during hospitalization) in 41 patients (84%), anorectal manometry – in 15 patients (31%), irrigography – in all children. Correlation analysis did not reveal any relationship between the HD variant and manifestation symptoms (Spearman's correlation coefficient was –0,232 at p<0,05. Conclusion: all medical teams began examining children with suspected HD with irrigography. Various intestinal biopsies were performed in 58,6% of cases. Anorectal manometry is currently practically not used in the diagnosis of HD in children, although it is a promising non-invasive method with high sensitivity and specificity.
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