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Introduction. Wilkie syndrome is a pathological manifestation caused by an abnormal disorder of the superior mesenteric artery arising from the abdominal part of the aorta. As a result, the distal part of the duodenum is compressed between the abdominal aorta, spine, and SMA, which creates a hindrance for the passage of himus in the duodenum, creating a mechanical obstruction.Aim: To draw the surgeons’ attention towards the possibility of developing a rare complication of decreased aorto-mesenteric angle and the distance, highlighting the challenges in diagnosis and treatment.Materials and methods. This article presents a clinical case of WS diagnosed in the surgical department of the BSMU clinic. We hereby discuss the case report of a 28-year-old patient diagnosed at the initial stage of WS. The patient had been suffering from the symptoms of WS since 2018 but wasn’t able to identify the disease, but when he came to the surgical department of BSMU clinic based on the results of abdominal CT-scan with combined contrast of the stomach and duodenum per os with water-soluble contrast and computer angiography of the mesenteric vessels, the diagnosis was confirmed. The patient was treated with the duodenojejunostomy (laparoscopic Strong’s operation).Results and discussion. Absence of timely diagnosis of this disease can lead to life-threatening complications, and early diagnostics is complicated by similarity of initial manifestations with other gastropancreaticoduodenal diseases. One of the most promising approach in the diagnosis of Wilkie syndrome is the use of abdominal CT-scan with combined contrasting of the stomach and duodenum per os with water-soluble contrast and computer angiography of vessels. In the present clinical case due to the given combination of methods we can assess functional state of the stomach and duodenum, clearly visualize not only the organs topography but also estimate the aorto-mesenteric angle and distance, which can further determine the type and tactics of initial stage treatment, which we decided to perform surgery (laparoscopic Strong’s operation). The postoperative period was without complications. The patient noted an improvement in the state and the relief of pain in the epigastrium and was discharged after 9 days of hospitalization in satisfactory condition.Conclusion. For diagnosis and treatment in time as well as prevention of possible complications, it is necessary to improve surgeons’ information about this pathology, which if diagnosed and treated late can lead to severe, life-threatening complications up to death. The diagnosis at the initial stages, specifically with the assistance of computer tomography with contrast, angiography, and treatment in a timely manner, can preserve life and prevent the possible outcomes of fatal complications.

Background. The study aimed to improve treatment outcomes in diabetic foot syndrome patients by use of invasive pressure monitoring during arterial radiological interventions.Materials and methods. A total of 36 patients with type 2 diabetes and purulent necrotic lesions of lower extremities have been treated at the surgery unit of Bashkir State Medical University Clinic during 2019—2020, with 12 persons forming the main cohort and receiving the measures complemented with the newly developed “X-ray endovascular intraoperative significance evaluation of lower limb arterial stenosis” technique (Patent RU 2737215 of 26.11.2020). The control cohort comprised 24 patients following pertinent standard treatment and recommendations in this pathology.Results and discussion. Immediate treatment outcomes were evaluated by person in the main and control cohorts. Longterm outcomes were observed at 6, 12 and 24 months since hospital discharge in 10 (83.3 %) patients of the main and 19 (79.2 %) — of the control cohort. In a 2-year run, the limb was kept in 8 (66.7 %) patients having the new revascularisation technique and in 10 (41.7 %) persons of the control cohort (p < 0.05).Conclusion. The use of endovascular radiology for limb revascularisation and intraoperative significance monitoring of lower limb arterial stenosis allow the volume determination of balloon angioplasty and statement of revascularisation completeness.

Background. Gallstone ileus is a rare complication of cholelithiasis accounting for 0.3–2.1% total acute intestinal obstructions. The recent years are witnessing a sharply elevated incidence of cholelithiasis and its entailed complications. The major diagnostic biases are the atypical clinical presentation, instrumental and laboratory evidence, and a relative paucity of surgical cases.Aim. Highlighting to surgeons the feasibility of this rare reluctantly diagnosed form of acute small bowel obstruction.Materials and methods. The article presents the clinical observations of gallstone-induced small intestinal obstruction collected at a surgery unit of the Bashkir State Medical University Clinic. Patients had surgeries for cholecystoduodenal fistula embolisation, gastro/enterotomy and lithoextraction followed by gastro/enterotomy wound suturing.Results and discussion. Patients had a benign postoperative period are were discharged in a satisfactory condition on day 7–10 after surgery for outpatient surveillance.Conclusion. Surgeons need to contemplate this pathology to ensure timely diagnosis and treatment, as well as avoid possible complications. Mostly important still is a timely gallbladder resection upon diagnosing cholelithiasis via laparoscopic cholecystectomy as a “gold standard” in treatment for this disease.

Background. Cystic pulmonary hypoplasia is a malformation of terminal bronchial tree as a cystic dilatation of various size at the level of subsegmental bronchi or bronchioles, which accounts for 60–80% of the overall malformation incidence.Materials and methods. We present a descriptive case of general clinical picture, diagnostic radiological examination and choosing a strategy for surgical diagnosis and treatment of cystic pulmonary hypoplasia. Patient K., 57 yo, was admitted to the Republican Clinical Tuberculosis Dispensary with fibroatelectasis of the right lung lower lobe and underlying subcompensated diabetes type II, inspected by a phthisiatrician, thoracic surgeon and referred for surgical treatment.Results and discussion. A careful history inspection and X­ray data in most cases suffice to successfully diagnose the congenital type of cystic pulmonary defects. Treatment in such patients is personalised, with preference towards surgical intervention. A correct diagnosis is usually conditioned by a detailed and careful examination of the lung morbid morphology during surgery.Conclusion. Modern instrumental methods, with multispiral computed tomography in particular, are key to correctly diagnose a malformation. Relevant case reports are of interest and importance to advance research into causative factors of the disease.

Determining the exact sizes of anatomical structures play a very important today in laparoscopic surgery. This makes it possible to make a correct selection of gauges of instruments needed, prosthetic materials, and to make decisions regarding the further strategy of the surgical procedure. The device developed at the clinic has proven itself in everyday clinical practices. It is currently used in laparoscopic operations for hiatal hernias, choledoch measurements in patients with choledocholithiasis, stomach stump size measurements during the resection in patients with morbid obesity. The presented clinical case serves to confirm that obtaining objective data in video endoscopic surgery makes it possible to choose the optimal treatment strategy.

Introduction. Aneurysms of visceral arteries in the abdominal cavity are very rare. Often aneurysms of branches of the abdominal aorta are an incidental finding as patients seldom present obvious clinical signs or pathological changes in the organ supplied by the artery involved. The incidence of aneurysms of branches connecting the celiac trunk and the upper mesenteric artery amounts to 3.5% of all the cases of aneurysms of abdominal aorta arteries, mostly the gastroduodenal artery. This paper presents a case of minimally invasive treatment of gastroduodenal artery pseudoaneurysm at the BSMU Clinic.Materials and methods. Patient K, a 47-year-old female, was admitted for emergency treatment at the Bashkir State Medical University Clinic in May 2019. The patient’s complaints included feeling weak, black stool for seven days prior, faintness and epigastric pain.Results and discussions. Instrumental examination and angiography data demonstrated that the size of the pseudoaneurysm has increased 2.5 times and reached 65×45 mm; the clinical picture led to the conclusion that the aneurysm was ready to rupture and that there was an immediate need to stop the blood flow to the gastroduodenal artery pseudoaneurysm.Conclusion. The range of currently available image-guided surgical procedures makes it possible to perform adequate embolization of pathological structures such as artery aneurysms.

Introduction. Our first experience in embolization of prostatic arteries at patients with benign prostatic hyperplasia had comprised patients with the symptoms of chronic urinary retention.Material and methods. The average age of patients (n=3) was 61.0±4 years. Among medical indications to embolization there were dysuria significantly degrading the patients’ life quality and their unwillingness to proceed to transurethral resection. Before the embolization of the prostatic artery, it is necessary to identify the place of its departure and its anastomosis by computed tomography. Successful operation was effectuated without microcatheter guides in 3 cases and with the application of microcatheter guides in 3 cases. For the purposes of embolization there were used spherical embolus HydroPearl sized 400 nm. No complications were reported neither in the operational nor in the post-operational periods.Results. All patients admitted a decrease in dysuria as well as the improvement in life quality already in 7–15 days after the endovascular invasion. Control ultrasound dopplerography was performed 3 months after intervention. Two patients with embolization showed decrease of prostate volume by 26%, and one patient — by 35%.Conclusions. Embolization of the prostatic arteries is a promising low-traumatic and safe method for treating patients with benign prostatic hyperplasia. It is necessary to further study its long-term results, to develop an optimized methodology — fast, simple and cheap, but not at the expense of efficiency and safety.

Artery aneurysms of pool celiac trunk and superior mesenteric artery are not often in clinical practice. Often, the first clinical manifestation of the aneurysm is a hemorrhagic shock which proceed from its rupture. The risk of aneurysm rupture doesn’t depend on their size, ranging from 3% to 10%. But the mortality from aneurysm rupture can be reaches 36%. As we know well that the aneurysm ruptures has a high rate of mortality, treatment as symptomatic as asymptomatic aneurysms are essential. The authors of the article represent the demonstration of successful endovascular treatment of aneurysms splenic artery and posttraumatic aneurysm of common hepatic artery using modern embolization materials. In the first case performed embolization of lumen aneurysm by embolization coil with next installation in the lumen of the artery stent graft, in the second case – the feeding artery was embolized by microemboles. Nowadays, the medical instruments for X – ray surgical interventions allow you to perform a complete embolization of pathological structures such as aneurysms of the main arteries of the celiac trunk. Thanks to low level of interventions endovascular therapies can be related to the method of choice in the treatment of many surgical diseases in compulsory with the open methods of operation.