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.
Nonfunctioning neuroendocrine tumors (NFET) account for up to 33% of the neuroendocrine tumors of the pancreas, ranging from 1 to20 cmin diameter and showing a higher malignancy rate, up to 90%. The clinical presentation of nonfunctioning neuroendocrine tumors is nonspecific. These tumors, in fact, are predominantly characterized by an expansive growth pattern; therefore, they are clinically silent until adjacent viscera and structures are involved. This makes it difficult to diagnose NFET at an early stage. Correct diagnosis is typically delayed by several years. About 15% of pancreatic NFET are cystic and difficult to differentiation from other cystic pancreatic lesions. In such cases, the important role played by hypervascular rim in the arterial phase image. Literature review and case report оf diagnostics and treatment of Neuroendocrine Tumor with cystic transformation are presented in the article.
Aim. To analyse the dynamics of morbidity and mortality from diseases of the digestive system, as well as the quality of medical care for gastroenterological patients in the Krasnodar Krai.Materials and methods. The analysis was carried out according to C 51 “Distribution of deaths by gender, age groups and causes of death” form of the Territorial Authority of the Federal State Statistics Service for the Krasnodar Krai for the period from 2006 to 2018, as well as on the basis of the “Demography” block database of the Parus software of the healthcare management system of the Krasnodar Krai for 6 months of 2019. 1341 medical records of patients receiving outpatient medical care and the medical records of people who had died from digestive diseases in 2017-2019 were reviewed.Results. Digestive diseases (DD) occupy the fourth place (7.1 %) in the structure of the general morbidity of the population in the Krasnodar Krai. Over the study period (13 years), the structure of mortality from DD has not changed significantly among the region’s population. About 70% of the causes of death from DD among people of working age account for liver diseases. The pathology of the pancreas takes the second place (13.5 %). The peptic ulcer of the stomach, duodenum and “other diseases of the digestive system” (8.8 % and 7.7 %, respectively) are represented in almost equal shares. In the etiological structure of liver cirrhosis, viral (39 %) and alcoholic (36 %) liver diseases are leading. The frequency of viral liver lesions tends to decrease, while the proportion of liver cirrhosis in the outcome of non-alcoholic fatty liver disease (NAFLD) progressively increase, having reached 7 % in 2017–2018. In the group of patients with inflammatory diseases of the pancreas, men prevail (66.9 %), often those abusing alcohol. The third leading cause of mortality from DD in the Krasnodar Territory is pathological conditions that occurred in the upper gastrointestinal tract (acute stomach ulcer, duodenal ulcer with bleeding, perforation) in older age groups taking antiplatelet agents and non-steroidal anti-inflammatory drugs (71.8 %). Conclusions. The main causes of death among the population of the Krasnodar Krai from diseases of the digestive system at a young age are alcohol consumption with unhealthy consequences. At the same time, people of older age groups die from a lack of prevention of ulceration and inadequate eradication of Helicobacter pylori in patients taking non-steroidal anti-inflammatory drugs and antiplatelet agents.
Background. Pancreatic pseudocysts stand among current challenges in modern medicine. Their treatment uses variant instrumental techniques and implies a multispecialty approach. Trials in surgery and gastroenterology have aimed to identify an optimal strategy to tackle pancreatic pseudocysts for reducing complications and the recurrence rate, suggesting ultrasound-guided percutaneous, laparoscopic and flexible endoscopic drainage as promising treatment choices.Objectives. A summarising review of diagnostic and therapeutic methods for pancreatic pseudocyst treatment and comparison of ultrasound-guided percutaneous vs. surgical and endoscopic drainage techniques.Methods. The review examines the classification, epidemiology and methods for diagnosis and treatment of pancreatic pseudocysts. Only comparative full-text studies published within 2014–2021, as well as selected impactive publications within 2002–2013, have been included. The eLibrary, Elsevier and PubMed resources were queried for the article or journal title fields against the keywords (separate or combined) “pancreatic pseudocyst” [псевдокиста поджелудочной железы], “pseudocyst drainage” [дренирование псевдокисты], “surgical drainage” [хирургическое дренирование], “endoscopic drainage” [эндоскопическое дренирование], cystogastrostomy [цистогастростомия], gastrojejunostomy [гастроеюностомия], “duodenal-cystic anastomosis” [цистодуоденоанастомоз], “transpapillary drainage” [транспапиллярное дренирование], “transmural drainage and esophagogastroduodenoscopy” [трансмуральное дренирование и эзофагогастродуоденоскопия]. Records have been selected for topic-related scientific value.Results. The review systematically surveys 68 scientific papers in the focus area and summarises the most common surgical methods for pancreatic pseudocyst treatment. Based on the main principle, the methods are classified into three categories, ultrasound-guided percutaneous drainage, surgical drainage and flexible endoscopic drainage. The major classifications and treatment techniques are highlighted for their advantages and disadvantages.Conclusion. There exist no generally adopted strategy for pancreatic pseudocyst treatment in current clinical practice and no evidence on a particular method application in a large patient cohort. The publication survey identifies the techniques of percutaneous, surgical and endoscopic drainage with ultrasound control as highly effective overall among other surgical treatments.
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