ОПЫÒ ЛЕЧЕНИЯ БЕРЕМЕННЫХ С «ОСÒРЫМ ЖИÂОÒОМ»Материалы и методы. Анализ результатов лечения 183 беременных с острыми хирургиче скими заболевани-ями в условиях двух многопрофильных стациона ров г. Красно дара. Наибо лее часто встречаемыми ургентными хирургиче скими заболевани ями у беременных являются ост рый аппендицит, желчнокамен ная бо лезнь и ее ослож-нения, острый панкреатит, острая кишеч ная непроходи мость.Результаты. Диагностика заболеваний, учитывая контингент боль ных, весьма затрудни тельна и нередко про-должается длительное время, суще ственно ухуд шая прогноз как для ма тери, так и для плода. Использование УЗИ брюш ной поло сти всем пациенткам позволяет уточнить диа гноз и скорректировать так тику лече ния. При сомне нии в диагнозе необходимо выполнять диагностиче скую видеолапароско пию.Заключение. Использование малоинвазивных технологий в лече ние беремен ных позволяют умень шить часто-ту хирургиче ских и связан ных с ними перинаталь ных осложнений, способ ствую т пролонгированию беременно сти и снижению показателей материн ской и перинаталь ной смертно сти. ABSTRACT Aim. To summarize the current experience of diagnosis and treatment of pregnant women with acute abdomen. Materials and methods. Analysis of treatment results of 183 pregnant women with acute abdomen in the conditions of two multidisciplinary hospitals in Krasnodar. The most common urgent surgical diseases in pregnant women are acute appendicitis, cholecystitis and its complications, acute pancreatitis, acute intestinal obstruction.Results. Diagnosis of diseases, providing the contingent of patients, is quite difficult, and often takes a long time, significantly worsening the prognosis for both the mother and the fetus. The ultrasound examination of the abdominal cavity in all patients makes it possible to clarify the diagnosis and adjust the treatment tactics. When doubting the diagnosis, it is necessary to perform diagnostic laparoscopy.Conclusion. The use of minimally invasive technologies in the treatment of pregnant women can reduce the frequency of surgical and associated perinatal complications, promote the prolongation of pregnancy, and reduce maternal and perinatal mortality.

Aim. This study was conducted to assess the possibility of ultrasound elastometry using the shear wave method in the preoperative assessment of the stiffness condition of the  pancreatic parenchyma in order to predict the risk of complications and the choice of the method for the formation of pancreatoenteroanastomosis in pancreatoduodenal resection.Materials and methods. The study was performed in 10 patients operated in the volume of pancreatoduodenal resection. All patients  underwent preoperative ultrasound pancreatic elastometry with  transcutaneous shear wave access method. The results were  compared with the intraoperative data obtained by the visual  examination and palpation. Depending on the average "stiffness"  indicators of the parenchyma in comparison with the intraoperative  data, one of two ways of forming the pancreatic intestinal  anastomosis was preferred: either end-to-side or  pancreatoenteroanastomosis with a wide atraumatic peritonization of the pancreas stump cutoff by the jejunum according to the original technique.Results. The inconsistency of class A pancreatoenteroanastomosis was noted in 2 (20%) patients, it was transient, asymptomatic, did  not require additional medical interventions and did not extend the  duration of the postoperative period. There were no inconsistencies  of classes B and C, pancreonecrosis of the stump, repeated surgical  interventions, and lethal outcomes.Conclusion. Ultrasound pancreatic elastometry with the shear wave method can be used in the preoperative assessment of the  "stiffness" of the parenchyma in order to predict the risk of the  complications and the choice of the method for the pancreatoenteroanastomosis formation.

A clinical case demonstrates the potential of transabdominal ultrasound of the large intestine in diagnosis and follow-up in a patient with ulcerative colitis. It is shown that transabdominal ultrasound examination performed in seroscan mode (B-mode) with the use of Doppler color mapping allows to monitor the degree of resolution of inflammation in the mucosa of the large bowel, as well as to evaluate the effectiveness of conservative approach.

Background. Colorectal obturation is a fairly rare complication in patients with colorectal polyposis. Case descriptions of colonic obturation with underlying familial adenomatous colorectal polyposis have not been reported to date in national and foreign literature.Clinical Case Description. Patient G., female, 31 yo, was emergently admitted to a surgical unit with a preliminary diagnosis: acute intestinal obstruction, complaints of abdominal pain, nausea, vomiting, stool and gas outlet blockage, marked general weakness. Clinical and biochemical blood tests without peculiarities. Signs of intestinal obstruction in abdominal ultrasonic and X-ray examination. Obstructive right hemicolectomy performed as emergent surgery. Diagnosis: transverse colonic C-r T3NoMo, stage II, clinical group 2. Patient had routine fibrocolonoscopy in six months; polyps were revealed in all operated colon portions. APC genetic test was positive, total colectomy was decided with single-barrel ileostomy excretion on anterior abdominal wall. Definitive diagnosis: transverse colonic C-r T3NoMo, stage II, developed with underlying familial adenomatous colorectal polyposis, clinical group 2.Conclusion. Diagnosis of familial adenomatous colorectal polyposis with acute intestinal obturation is challenging due to forced urgent surgical intervention and lack of time for a detailed deeper examination in avoidance of baleful consequences. The case reported demonstrates that clinical manifestations of familial adenomatous colorectal polyposis extend beyond the routine complaints of abdominal bloating, stool blockage and rectal bleeding towards a formidable complication of acute colonic obturation of polypoid genesis.