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Duodenal duplication cyst (DDC) is a rare form of intestinal malformation (2-12% of all gastrointestinal duplications). There are many difficulties in diagnosis and management of DDC. We present a case of successful endoscopic transluminal treatment of DDC in a 30-year-old female. She complained of epigastric pain, nausea and vomiting, weight loss of 5 kg over the past 3 months. Laparoscopic cholecystectomy for gallstone disease was performed 18 months prior to admission. Examination revealed a cyst 52×60?35 mm in descending part of duodenum. There was a calculus inside the cyst. Transluminal endoscopic cyst fenestration was performed. Histological examination confirmed DDC. According to control duodenoscopy data, cyst was collapsed. The patient remains asymptomatic three months after surgery. DDC is a rare disease of gastrointestinal tract, which should be differentiated first with choledochocele Todani type III and intraluminal duodenal diverticulum. Endoscopic treatment may be an adequate alternative to traditional interventions in some cases.Дупликационная киста (ДК) двенадцатиперстной кишки (ДПК) является редким вариантом кишечной мальформации (2—12% всех ДК желудочной-кишечного тракта). Диагностика и определение тактики лечения ДК ДПК существенно затруднена. Представляем случай эндоскопического лечения ДК ДПК у взрослой женщины с клинической картиной дуоденальной непроходимости.Клиническое наблюдение. Женщина 30 лет обратилась с жалобами на дискомфорт в эпигастральной области, тошноту и рвоту после еды, похудение на 5 кг за последние 3 мес. Из анамнеза известно, что за 18 мес до обращения пациентке выполнили лапароскопическую холецистэктомию по поводу желчнокаменной болезни. В ходе обследования выявлено кистозное образование нисходящей части ДПК размером 52×60×35 мм, в полости которого обнаружены конкремент и суживающее ее просвет образование. Выполнена операция — эндоскопическая фенестрация кистозной полости в просвет ДПК с гистологическим исследованием. Патологоанатомическая картина соответствовала ДК ДПК. При контрольной дуоденоскопии отмечена киста в спавшемся состоянии. Через 3 мес после операции жалобы у пациентки отсутствуют.ДК ДПК представляет собой редкое заболевание желудочно-кишечного тракта, дифференцировать которое в первую очередь следует с кистой холедоха 3-го типа по Todani и внутрипросветным дивертикулом ДПК. Эндоскопическое лечение, выполненное нами в данном наблюдении, в некоторых случаях может являться адекватной альтернативной традиционным вмешательствам.

The article presents the outcome in patient with duodenal congenital abnormality caused by defective intrauterine rotation of the intestinal tube with premature turn of back intestine.Представлен результат лечения пациентки с врожденной аномалией двенадцатиперстной кишки, причиной которой является дефектная внутриутробная ротация кишечной трубки с преждевременным поворотом задней кишки.

To compare treatment of intestinal malrotation in newborns and infants using laparoscopy and laparotomy.For the period from January 2004 to December 2013 34 Ladd's procedures were performed. Children were divided into 2 groups by 17 patients: laparoscopic (group I) and open treatment (group II).Both groups had similar demographic and other preoperative parameters. There were significant differences in duration of operation between both groups (61 vs. 70 minutes). Nutrition was initiated earlier after mini-invasive treatment (1.5 days vs. 3 days) and the time need for full enteral nutrition was also less (4.2 days vs. 6.9 days). Hospital-stay was shorter in group I (7.7 vs. 10.2 days). Number of early postoperative complications was similar in groups. Incidence of remote complications was higher in laparotomy group but the differences were not significant.Our results showed that endoscopic correction of congenital anomalies of intestinal rotation provides better postoperative results than open surgery and can be widely used in young children.Введение. Мы сообщаем результаты сравнения лечения мальротации кишечника у новорожденных и младенцев с использованием лапароскопии и лапаротомии. Материал и методы. В период между январем 2004 г. и декабрем 2013 г. было выполнено 34 операции Ледда. В исследовании сообщаются данные детей, которые подвергнуты лапароскопической (17 пациентов - 1-я группа) и стандартной (17 больных - 2-я группа) операции. Результаты. Группы имели одинаковые демографические и другие предоперационные параметры. Были обнаружены значимые различия в длительности операции между лапароскопическими и открытыми операциями (61 мин против 70 мин). Пациенты начинали раньше питание после миниинвазивного способа лечения (1,5 сут против 3 сут) и имели меньшее время перехода на полное энтеральное питание (4,2 сут против 6,9 сут). Продолжительность пребывания в стационаре была меньше в 1-й группе (7,7 сут против 10,2). Количество ранних послеоперационных осложнений не отличалось в группах. Число поздних осложнений было больше в группе лапаротомии, однако различия не были достоверны. Заключение. Исследование демонстрирует, что эндохирургическая коррекция врожденных аномалий вращения кишечника дает лучшие послеоперационные результаты, чем открытая хирургия, и может быть широко использована у маленьких детей.

The sterno-costal hernia of Morgagni is a congenital vice in which is represented unfinished fusion of the transverse septum and the muscular diaphragmal wall. The malrotation syndrome is an embryonic vice as well, with various degree of incomplete and even reverse rotation of the gut, because of disturbed or unfinished development of the midgut. The described case presents a 37 years old female without anamnesis of any previous complains, who was pointed to the clinic after a X-ray photograph because of breathless and asteno-adynamic syndrome. After a precise CT investigation performance was found the presence of the above described anomalities, as well as ectopy of the right kidney and the right liver part. An operative treatment was performed with correction of the hernia and the bowel malrotation. The patient was followed up to the 12th month post-operatively. After a review of the literature in the discussion we inspect the diagnostics and the definition of the right surgical tactics and operative approach in this case with combined malformative pathology.

Intestinal malrotation is defined as a group of anomalies in the rotation and fixation of the small intestines and the colon during the embryological development. It can affect the duodenojejunal segment, the cecocolic segment or both. Its most common complication is the midgut volvulus. It is considered to be a childhood pathology, as it usually affects newborns and infants, but with the advent of modern imaging modalities in everyday practice, it is discovered in adults more often. This places it in the group of rare, but important causes for acute and chronic abdominal complaints in children and adults. When it is asymptomatic, it is hard to predict if and in whom complications will occur, which imposes the need to know its variants and diagnostic techniques to prove it. Extremely often the malrotation is associated with other inborn malformations and congenital cardiovascular defects. We report 6 cases of intestinal malrotation, diagnosed in the Medical Imaging Department of Tokuda Hospital Sofia between 2011 and 2014, in order to revise the condition's potential risks and to mark the role of the different imaging modalities in the diagnostic process.

53 patients with dolichocolon and chronic cologenic constipations were operated on. Results of comprehensive preoperative check-up, as well as results of surgical treatment were assessed. 88,7% of patients demonstrated good and satisfactory results. Active surgical tactics in respect of these patients, such as wider use of total colectomy and ileorectostomy is suggested.

Tendencies in neonatal surgery research are presented. Based on 187 cases, indications to preventive intestinal stomas creation in the newborns and also time of their closure are regarded. Surgical correction of malformation or treatment of acute process in the abdominal organs with intestinal stoma closing is finished to month 2-3 of childs life. The developed differential-diagnostic criteria of functional and organic lesion of ureteropelvic and ureterovesicular segments based on diuretic sonography permitted one to reveal early age pathology of urinary system and to correct it with surgical methods. The developed algorithm of diagnosis and treatment of newborns with eruct syndrome permits one to determine indications to surgery in 10% infants with gastroesophageal reflux.