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Rectal duplications are rare congenital anomalies that represent 1%–6% of alimentary tract duplications. We report a case of a woman in her 50s who presented to our hospital with perianal pain and urinary retention. She had a history of imperforate anus repaired after birth and dynamic graciloplasty performed during her adulthood for faecal incontinence. Abdominal CT scan showed a fluid collection extending from the electrostimulator, placed in a subcutaneous pocket in the abdomen, to the rectouterine pouch. Infection related to the electrostimulator was assumed and, after a course of antibiotics without patient improvement, the electrostimulator was removed. The symptoms and the pelvic fluid collection persisted, and diagnostic laparoscopy was performed. Diagnosis of rectal duplication cyst was made intraoperatively, and the cyst was completely resected. Patient fully recovered after surgery. This is a rare case of a rectal duplication cyst presenting during adulthood and associated with imperforate anus.

Cystic hydatid disease or cystic echinococcosis (CE) is a globally endemic zoonosis caused by the larval cyst stage of the tapeworm Echinococcus granulosus. Concomitant presence of CE and hepatocellular carcinoma (HCC) is a rare clinical scenario. A 70-year-old male patient presented with acute abdominal pain to the surgical outpatient department. On evaluation, a cystic lesion with solid components and free fluid in the abdomen was observed, which led to multiple differentials in the working diagnosis. A CT showed the mass to have a delayed enhancement. Surgical exploration revealed a partially ruptured hydatid cyst with daughter cysts in the abdominal cavity and a solid-component mass lesion. We proceeded with a right partial hepatectomy. Pathological evaluation revealed a pale mass lesion with a large collapsed cyst. HCC with unusual dense fibrillar fibrosis and cystic interface with normal parenchyma was observed. This case connects the multimodal assessment of radiology, surgery and pathology.

Negative pressure wound therapy (NPWT) is commonly used in open abdomen management, where there may be a simultaneous need for prevention of abdominal hypertension, tamponade of hemorrhage, and continuous fascial tension. The regional pressure dynamics of vacuum dressings are poorly understood.Three duroc swine underwent mid-line laparotomy and application of vacuum open abdomen dressing, with and without sponge packing. Twenty-five catheters were placed throughout the abdomen to capture and record pressures in each quadrant as the vacuum system was ranged between (-75 mmHg to -200 mmHg pressure). Vital signs and ventilator pressures were measured and recorded concomitantly.No variations in ventilatory pressures or vital signs were observed with any setting. NPWT changed pressure in seven of seventy-five catheters (9%), five of which were related to abdominal packing. When data were grouped into abdominal wall, perihepatic, perisplenic, and deep abdominal regions, there was no significant change in abdominal pressure when packing was absent. With packing, only the abdominal wall region showed a pressure change, reaching a maximum of 20% of the set vacuum pressure.NPWT does only little to change the intraabdominal pressure, except in superficial locations in packed abdomens and does not appear to cause hemodynamic changes in a porcine open abdomen model. While NPWT may play an important role in fluid scavenging and fascial tensioning, there are likely to be few benefits or drawbacks specifically related to negative abdominal pressure in the deep abdomen.

Background/Purpose Decompressive laparotomy and open abdomen for abdominal compartment syndrome have been historically avoided during Extracorporeal Membrane Oxygenation (ECMO) due to seemingly elevated risks of bleeding and infection. Our goal was to evaluate a cohort of pediatric respiratory ECMO patients who underwent decompressive laparotomy with open abdomen at a single institution and to compare these patients to ECMO patients without open abdomen. Methods We reviewed all pediatric respiratory ECMO (30 days-18 years) patients treated with decompressive laparotomy with open abdomen at Riley Hospital for Children (1/2000-12/2019) and compared these patients to concurrent respiratory ECMO patients with closed abdomen. We excluded patients with surgical cardiac disease. We assessed demographics, ECMO data, and outcomes and defined significance as p=0.05. Results 6 of 81 ECMO patients were treated with decompressive laparotomy and open abdomen. Open and closed abdomen groups had similar age (p=0.223) and weight (0.286) at cannulation, but the open abdomen group had a higher reliance on vasoactive medications (Vasoactive Inotropic Score, p=0.040). Open abdomen group survival was similar to closed abdomen patients (66.7%, vs 62.7%, p=1). Open abdomen patients had lower incidence of ECMO complications (33.3% vs 83.6%, p=0.014), but the groups had similar bleeding complications (p=0.412) and PRBC transfusion volume (p=0.941). Conclusion/Impact Pediatric ECMO patients with open abdomen after decompressive laparotomy had similar survival, blood products administered, and complications as those with a closed abdomen. An open abdomen is not a contra-indication to ECMO support in pediatric respiratory patients and should be considered in select patients.

Peritoneal adhesion formation is a challenging postoperative complication. We aim to evaluate the effect of orally administered sirolimus, prednisolone, and their combination to prevent this entity.Eighty female albino underwent intraperitoneal injection of 3 mL of 10% sterile talc solution to induce peritoneal adhesion, and were subsequently and randomly divided into four groups (each n = 20); including a control group; 1 mg/kg oral prednisolone daily in the morning; 0.1 mg/kg oral sirolimus daily; and a combination group which received both drugs, with the same dosage. On the 29th day, abdominal cavities were explored, and classification was done based on Nair classification.All rats were healthy on the 29th day, in which exploration was performed. The rats in the control group had extensive intra-abdominal adhesions, while 17 (85%) rats in the control group had substantial adhesion; however, the prednisolone, sirolimus, and combination group had lesser adhesion formation. Also, 14 (70%) rats of prednisolone group, 13 (65%) of sirolimus group, and 16 (80%) of combination group had insubstantial adhesion. The decrease in the grade of peritoneal adhesion bands was highly significant in the combination group (P 0.001).The combination of sirolimus and prednisolone was effective for preventing peritoneal adhesions in rats.

BACKGROUND A correlation between atypical recurrences and minimally-invasive surgery has been suggested in case of urothelial cancer; however, very few data are available on the role of pneumo peritoneum in terms of gas flow and intra-abdominal pressure. The objective of the study is to analyze the impact of CO2 pneumoperitoneum variation on an inert material as surrogate of neoplastic cells. MATERIAL AND METHODS We designed an experimental model mimicking pneumoperitoneum in three settings: sealed flow (no leakage), pulsatile flow (alternating efflux and influx) and continuous flow (AirSeal® insufflator). Each experiment was characterized by a pre-determined gas flow and pressure, trocar distance and position from the particles. Hounsfield density (HD) variation in the areas of interest was measured as index of graphite powder dispersion. A Linear regression model was employed to measure the correlation between modifiable variables and HD. RESULTS HD was lower in the pulsatile compared to both the sealed and continuous flows (p 0.05). CONCLUSIONS Flow and pressure setting, in-flow trocar distance and contiguity from the tumor, and pneumoperitoneum stability may be all crucial component in minimally invasive surgery. In vivo, these variables should be considered as potential risk factors for tumor cells spread within the abdominal cavity.

Purpose The aim of this experimental study was to test the method of prevention of postoperative complications, especially infectious, in partial dehiscence following stapler anastomosis in rectal surgeries. Methods The method includes the application of a hyaluronic acid-based gel in combination with triclosan, which has antibacterial properties. The gel was applied to the space around the rectum with an artificial, precisely defined dehiscence so that the dehiscence was separated from the rest of pelvis and the peritoneal cavity to avoid the spread of infection. The study included 30 female pigs. The rectosigmoid colon was mobilized and transected completely. Anastomosis was constructed with circular staplers. A perforator was then used to create precisely defined artificial dehiscence. Subsequently the lesser pelvis was filled with hyaluronic gel such that the site of artificial dehiscence was covered completely. Results All animals survived for 14 days until the second-look revision with no signs of failure in the anastomosis healing, local inflammation, and sepsis or postoperative complications, such as chills, refusal of liquid or feed, abdominal distension, and bowel obstruction. Conclusion Hyaluronic acid applied as a precursor solution around the rectal anastomosis fills the lesser pelvis perfectly. It prevents the leakage of intestinal contents in the lesser pelvis. Triclosan as an antibacterial substance prevents the spread of inflammation in the pelvis or even in the abdominal cavity.

Application of molecular testing in clinical practice has led to significant advances in the classification of soft tissue sarcomas. Despite remarkable progress, there are still challenging cases that remain unclassified. In this study, we present an unusual spindle cell sarcoma arising in the abdominal cavity of a 37-year-old female. An extensive panel of immunostains was nonspecific for a line of differentiation and the tumor was subjected to targeted RNA sequencing for further classification. The findings showed a novel WWTR1::AFF2 fusion, which was further confirmed by break-apart FISH analysis for WWTR1 gene rearrangement. The tumor was attached to the wall of sigmoid colon and showed a highly cellular proliferation of plump spindle to epithelioid cells arranged in intersecting fascicles. Areas of extensive endometriosis were identified adjacent to the tumor. The immunoprofile was significant for reactivity with desmin, calponin, WT-1, ER, and PR, while negative for CD10, SMA, caldesmon, pan-keratin, ALK, CD117, and S100. The patient is alive and well after 11 months of follow-up. The exact histogenesis of this sarcoma remains unclear, however, the presence of adjacent endometriosis and coexpression of WT1/ER/PR raises the possibility of an unusual endometrioid stromal sarcoma, occurring outside the GYN tract. Additional cases are needed to establish the recurrent potential of this fusion event and to better define its pathogenesis and clinical behavior.

Mesenteric lymphatic malformations result from abnormal proliferation of disorganized mesenteric lymphatic channels. Sclerotherapy is often preferred over surgery as it is less invasive and has lower post-procedure morbidity. Sclerotherapy has been described as durable and effective with a low complication rate. We describe a serious complication from sclerotherapy of a lymphatic malformation extending from the mesentery through the bowel wall, highlighting the spectrum of this pathology and the need for multidisciplinary management of complex cases.

Introduction: Perineal hernia (PH), also termed pelvic floor hernia, is a protrusion of intraabdominal viscera into the perineum through a defect in the pelvic floor. Aim: The study was conducted to evaluate the cases of perineal hernia resulting as a complication of abdominoperineal resection (APR) of rectal cancer. Material and methods: 30 cases from 24 articles published in reputable peer reviewed journals were evaluated for eight variables including [I] patient age, [II] gender, [III] time since APR, [IV] clinical presentation, [V] approach to repair, [VI] type of repair, [VII] presence/absence of pelvic adhesions [VIII] complications. Results: There was a total of 30 cases (18 males and 12 females) with a mean age of 71.5 years. The time of onset of symptoms ranged from 6 days to 12 years. Perineal lump with pain was the chief presenting feature followed by intestinal obstruction. Different approaches were adopted to repair by various methods. Conclusions: Perineal hernia as a complication of abdominoperineal resection is reported increasingly nowadays, as the approach to management of rectal cancer has gradually got shifted from open to minimally invasive in recent years. There is a need to spread awareness about this condition, so that it is actively looked for, during the postoperative follow-up. Management is surgical repair; the approach and type of repair should be individualized.

Introduction: Acute abdomen is one of the most common surgical emergencies faced by a surgeon. Monitoring Intra-Abdominal Pressure (IAP) in patients with acute abdomen referred for exploratory laparotomy may help guide the need for early intervention. Aim: This study was performed to determine whether preoperative IAP had any significant association with organ failure as assessed using SOFA score. Furthermore, effect of IAP on patient outcome in terms of hospital stay, mortality was also evaluated. Materials and methods: 60 patients above 18 years of age presenting with acute abdomen requiring exploratory laparotomy were included in this prospective observational study from November 2013 until March 2015. IAP and SOFA scores were calculated at the time of admission. The outcome of patients was assessed in terms of hospital stay, morbidity and mortality. The correlation between IAP and SOFA scores was also assessed to determine the risk of organ failure. The inferences were drawn with the use of SPSS v22.0 statistical software. ANOVA, Chi-square and Student’s t-test were used in the analysis. Results: There was a positive correlation between SOFA score and IAP; and this correlation was found to be statistically significant with Pearson’s correlation coefficient being 0.6247 and significance levels being Conclusions: IAP should be routinely measured in patients with acute abdomen requiring exploratory laparotomy. Patients with preoperatively raised IAP should be referred for emergency surgery as soon as possible for better outcome.

Background: Trauma patients undergoing damage control surgery (DCS) have a propensity for complicated abdominal closures and intra-abdominal complications. Studies show that management of open abdomens with direct peritoneal resuscitation (DPR) reduces intra-abdominal complications and accelerates abdominal closure. This novel study compares intra-abdominal complication rates and the effect of DPR initiation in patients who received DPR and those who did not. Patients and Methods: A retrospective chart review was performed on 120 patients who underwent DCS. Fifty patients were identified as DCS with DPR, and matched to 70 controls by gender, race, age, body mass index (BMI), past medical history, mechanism of trauma, and injury severity score. Results: The two groups of patients, those without DPR (-DPR) and those with DPR (+DPR), were similar in their characteristics. The +DPR group was more likely to have a mesh closure than the -DPR (14% and 3%; p = 0.022). The +DPR group took longer to have a final closure (3.5 ± 2.6 days vs. 2.5 ± 1.8; p = 0.020). Infection complications and mechanical failure of the closure technique were similar among the two groups. Timing of DPR initiation had no effect on closure type but did statistically increase the number of days to closure (initiation at first operation 2.8 ± 1.8 days vs. initiation at subsequent operations 6.0 ± 3.3 days; p ≤ 0.001). Conclusions: The use of DPR did not result in different outcomes in trauma patients. Therefore, traditional resuscitative measures for DCS may not be inferior to DCS with DPR. When choosing to use DPR, initiating it at the first operation could reduce the number of days to closure.

У статті описано випадок застосування основних принципів бриджинг-терапії в пацієнта з попередньою заміною аортального клапана, у якого виникла необхідність проведення ургентного хірургічного втручання з приводу гострого гангренозного калькульозного холециститу, ускладненого холедохолітіазом, гнійним холангітом, підпечінковим абсцесом із дренуванням у черевну порожнину на фоні змішаної жовтяниці та постійного прийому пероральних антикоагулянтів.

We describe a novel EWSR1-HOXB13-fusion in a fibroblastic tumor from the abdominal wall of a 29-year-old woman. This tumor caused intermittent intense pain and had grown to approximately 5 cm in size over two years. The tumor was located beneath subfascial section of the abdominal wall and was invading the abdominal cavity and pressing on the liver. The tumor was well-circumscribed and consisted of intersected fascicles of monomorphic spindle-shaped cells with uniform ovoid nuclei lacking nuclear pleomorphism or mitotic activity. This tumor was immunohistochemically negative for pan-cytokeratin AE1/AE3, desmin, SMA, S100, myogenin, MyoD1, CD34, melanosome, SOX10, STAT6, SS18-SSX, and ERG. H3K27me3 was retained. RNA sequencing revealed a unique EWSR1-HOXB13-fusion, and strong, diffuse nuclear immunostaining for HOXB13 was observed. No local recurrence or evident distant metastasis were observed over eight months without chemotherapy, implying that the behavior of this tumor is not yet known.

Extralobar pulmonary sequestration is generally located in the left thoracic cavity and is often identified prenatally or in infants. We experienced a rare case of multiple extralobar pulmonary sequestrations in the thoracic and abdominal cavities, incidentally detected in a 60-year-old woman by cancer screening. The patient underwent surgery by thoracoscopic and laparoscopic approaches simultaneously, and extralobar sequestration was histologically confirmed in each lesion. Preoperative diagnosis was difficult because of unusual multiple localization and an undetectable aberrant artery on imaging examinations.

The current study aimed to compare between open and tow portals laparoscopic techniques for colopexy in dogs. Twenty healthy adult mongrel male dogs were divided equally into two groups: open colopexy (OC) group (n=10) and laparoscopic colopexy (LC) group (n=10). Open colopexy was performed through laparotomy while laparoscopic colopexy was performed using two port technique and transabdominal fixation of the colon. WBCs, serum CRP, ultrasongraphic, laparoscopic second look and histopathological examinations were conducted. Results declared significant increase in leukocytic counts and serum CRP in OC as compared to LC group. Moreover, ultrasonography showed intensive hyperechogenisty between the descending colon and the left abdominal wall. Laparoscopic second look revealed the adhesion between the descending colon and the left abdominal wall in both groups and the omental adhesions with the spleen and the left abdominal wall in OC group. Histopathological examination revealed that granulation tissue, inflammatory cells and tissue degeneration in OC technique were more pronounced than that in LC technique. In conclusion, LC is more recommendable than OC for its non-invasive technique, offered the advantages of direct visualization of the abdominal cavity and reduced incidence of complications.

Relatively little is known about allantois and urachal development in early humans. Serial sagittal histological sections from eight human embryos and fetuses were examined to determine allantois development. At gestational age 6-7 weeks, the primitive allantois consists of an enlarged tube located between the umbilical cord and abdominal cavity, whereas the urachus is not yet developed. At 8 weeks, the allantois gradually withdraws from the distal to the proximal end of the umbilical cord, and both the proximal allantois and the rectum (hindgut) start to develop into the cloaca. At 10 weeks, the allantois was located mostly in the abdominal cavity. The urachus forms from the distal end of the allantois and develops into a closed fibrous cord between the base of the urinary bladder and the umbilicus. The urogenital sinus forms from the proximal end of the allantois.

Background The prognostic importance of sterilized lymph nodes (SLN) remains unclear in patients with esophageal squamous cell carcinomas (ESCC) treated by neoadjuvant chemoradiotherapy (nCRT). This study aimed to determine whether SLN predicted disease-free survival (DFS) in ESCC. Methods We enrolled 246 eligible patients who were divided into SLN (+) and SLN (-) group according to the presence or absence of fibrosis, necrosis, calcifications and/or foreign body giant cell reactions in the negative lymph nodes specimens. The prognostic value of SLN was determined using univariate and multivariate analyses. The prognostic strength of counting SLN as positive lymph nodes was evaluated using the difference of Akaike information criterion (ΔAIC). Results A total of 61 SLN were identified in 38 (15.4%) patients. There was no significant difference in baseline characteristics between SLN (+) and SLN (-) group. The most frequently detected SLN in the thoracic cavity and abdominal cavity were those along bilateral recurrent laryngeal nerve (21/38,55.3%) and left gastric artery (13/24,60.9%), respectively. The univariate and multivariate analyses showed SLN was an independent prognostic factor for worse DFS in the whole cohort (HR = 2.05, 95%CI = 1.08–3.90, P = 0.029). The SLN (+) group additionally correlated with worse 5-year DFS than SLN (-) group in the ypT0, ypN0 and pCR subgroups. Counting SLN as positive lymph nodes showed better prognostic strength than ignoring them. Conclusion SLN was of prognostic significance for worse DFS in patients with ESCC, particularly in patients with good response to nCRT.

Computed tomography (CT) can both locate and identify foreign bodies as well as pinpoint complications to help direct treatment. Retained foreign bodies in the abdomen and pelvis can lead to perforation, obstruction, intussusception, fistula formation, and abdominal abscess formation. This article reviews the imaging appearance of incidentally found common foreign bodies and the role of CT in identifying unsuspected foreign bodies.

Gliomatosis peritonei (GP) is a rare clinical condition characterized by presence of mature glial cells in the peritoneum. Growing teratoma syndrome (GTS) is described as an uncommon phenomenon that could be related to the incidence of non-seminomatous germ cell tumors. We report a case of a patient treated for immature ovarian teratoma, in whom both GP and GTS were observed, an association to date scarcely described in literature. A 15-year-old girl presented to the emergency department with severe pain in her lower abdomen and right lumbar region. Upon admission, concentration of α-fetoprotein (AFP) was 1500 ng/mL and β−human chorionic gonadotropin (β-hCG) less than 2 ng/mL. A computed tomography (CT) scan of the abdominal cavity and pelvis confirmed the presence of an anomalous mass in the abdominal cavity and pelvis. Initial surgery was performed. Histopathology revealed the presence of immature teratoma with epithelial elements. Normalization of AFP was achieved within 8 weeks. Five months after surgery, a progressive increase in AFP was noted. Magnetic resonance imaging (MRI) and CT scans of the pelvis minor showed local relapse. Evaluation of the remission after 2 blocks of preoperative chemotherapy revealed the presence of a large tumor mass in the pelvis minor, despite normalization of the AFP concentration. After opening the abdominal walls, numerous abnormal white nodules were observed in the peritoneum. Histopathology revealed the presence of mature glial tissue (gliomatosis peritonei). The remaining tumor mass was removed, and histopathology confirmed existence of mature teratoma (growing teratoma syndrome). Postoperative chemotherapy was continued. To date, the patient remains under clinical and laboratory remission. Concomitant incidence of GP and GTS, although rare, should always be taken into consideration in pediatric patients with diagnosis of either condition.

Acute cholecystitis is a common condition, with varying presentations and complications, and is frequently treated in the emergency department. This case report illustrates hemorrhagic cholecystitis (HC) as a rare complication of cholecystitis. A 74-year-old woman presented to our emergency department with intermittent abdominal discomfort and continued vomiting after any oral ingestion as well as watery diarrhea. Patient history included mitral valve replacement and a daily dose of warfarin. Emergent cross-sectional abdominopelvic computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large mass that occupied most of the right abdominal cavity. An exploratory laparotomy revealed a necrotizing and hemorrhagic enlarged gallbladder with cholelithiasis. This enlargement appeared adherent and fistulizing into the cecum, without signs of bowel perforation. The postoperative period was uneventful, and the patient recovered well. Owing to its non-specific presentation, imaging studies are essential in establishing a diagnosis for HC. Although CT has not been advocated as a primary imaging examination for acute right upper quadrant pain, it is a valuable tool for assessing HC, along with MRI.

Background : Growing teratoma syndrome is defined as conversion of a metastatic immature tumor to a mature tumor after adjuvant chemotherapy and remains an area of investigation because of its unclear pathogenesis. Because of its risk of malignant transformation, the primary treatment strategy for pediatric patients is surgical resection. Case : In this report we present a case of a pediatric patient with recurrent growing teratoma syndrome who was treated with chemotherapy, debulking procedures, and cryoablation for the growing nodules throughout her abdominal cavity. The patient has had a good clinical outcome without recurrent malignant tumor. Summary and Conclusion : These masses do not always regress with chemotherapy and complete surgical excision or ablation should be attempted when possible.

Study Objective Coronavirus disease 2019 (COVID-19) infection poses significant risks during surgical interventions. We investigated the intraperitoneal presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients who are COVID-19 positive. Design A prospective group study. Setting Department of Obstetrics and Gynecology designated for patients with COVID-19, Central Clinical Hospital of the Ministry of Interior, Warsaw. Patients Overall, 65 pregnant women with COVID-19 infection underwent cesarian section. The diagnosis was confirmed either by positive antigen test or by positive reverse transcriptase-polymerase chain reaction assay performed within no more than 13 days before the operation. Interventions On the day of the operation, a nasopharyngeal swab was taken, and peritoneal fluid was collected at the beginning of the operation. Both the nasopharyngeal swab and peritoneal fluid samples were tested for SARS-CoV-2. Measurements and Main Results A total of 65 pregnant women with COVID-19 infection were enrolled in the study. The SARS-CoV-2 ribonucleic acid test by nasopharyngeal swab produced positive results in 34 patients. In this group as well as in 31 nonconfirmed patients, all peritoneal fluid samples tested negative for SARS-CoV-2 ribonucleic acid. Conclusion These results suggest a low risk of COVID-19 transmission from the peritoneal cavity at the time of laparoscopy or laparotomy.

In this article, an unusual case of a 27-year-old woman, who presented with abdominal pain for the previous 2 days, is presented. Ultrasonography revealed a perforated uterus and a straw in the abdominal cavity. A foreign body in the abdominal cavity was diagnosed and removed by laparoscopic surgery, and antibiotics were administered. The patient reported no discomfort during follow-up for 1 month. This report highlights the rare case of a foreign body crossing the uterus into the abdominal cavity. The only possible action was immediate surgery to remove the foreign body from the abdominal cavity.

Background. The National Science and Technology Development Agency (NSTDA) in Thailand researched and prototyped digital radiography systems under the brand name BodiiRay aiming for sustainable development and affordability of medical imaging technology. The image restoration and enhancement were implemented for the systems. Purpose. The image quality of the systems was evaluated using images from phantoms and from healthy volunteers. Methods. The survey phantom images from BodiiRay and other two commercial systems using the exposure settings for the chest, the abdomen, and the extremity were evaluated by three experience observers in terms of the high-contrast image resolution, the low-contrast image detectability, and the grayscale differentiation. The volunteer images of the chests, the abdomens, and the extremities from BodiiRay were evaluated by three specialized radiologists based on visual grading on 5-point scaled questionnaires for the anatomy visibility, the image quality satisfaction, and the diagnosis confidence in using the images. Results. BodiiRay phantom results were similar to those from the commercial systems. The overall performance averaged across the exposure settings showed that BodiiRay was slightly better than Fujifilm FDR Go in the low-contrast detectability ( p = 0.033 ) and in the grayscale differentiation ( p = 0.004 ). It was also slightly better than Siemens YSIO Max in the high-contrast resolution ( p = 0.018 ). The images of chest, pelvis, and hand phantoms illustrated comparable visual quality. For volunteer images, the percentage of the images scored ≥4 ranged from 61% to 99%, 23% to 92%, and 96% to 99% for the chest, abdomen, and extremity images, respectively. The average score ranged from 3.63 to 4.46, 3.18 to 4.21, and 4.41 to 4.51 for the chest, abdomen, and extremity images, respectively. Conclusion. The phantom image results showed the comparability of these systems. The clinical evaluation showed BodiiRay images provided sufficient image qualities for digital radiography of these body parts.

The aim of the study is to conduct a comparative analysis of the effectiveness of endovidiosurgical diagnosis techniques to detect gastrointestinal and intra-abdominal bleeding, which may occur after abdominal operations. Materials and methods. The main group included patients (n=408), whose condition was controlled by the endovideosurgical techniques. The control group included patients (n=102) who were controlled by using conventional surgical methods to correct bleeding that may occurred after similar surgical interventions. Gastrointestinal bleeding was observed in 323 patients, and intra-abdominal bleeding was observed in 85 patients. In all cases, endoscopic haemostasis was performed by clipping (n=57), submucosal infiltration (n=32), electrocoagulation (n=29), argon-plasma coagulation (n=74), and combined techniques (n=54). Results and discussion. 408 patients with clinical signs of bleeding in the early postoperative period were examined by endoscopic techniques. Patients with alarming clinical and laboratory findings underwent ultrasound examination, which revealed the presence of free fluid in one or more parts of the abdominal cavity. Laparoscopy was performed in the first hours of the postoperative period in 17 cases (n=17); on the first day of the postoperative period (n=36), on the second day (n=19), on the third (n=8), on the fifth (n=3), and on the sixth day (n=2). Complications were excluded in 7 (16.0%) patients, despite a decrease in blood pressure and haemoglobin levels. The volume of blood found in the abdominal cavity, including clots, ranged from 30 ml to 2000 ml. Signs of ongoing bleeding (the predominance of a large amount of liquid blood with a small number of clots) were found in 49 (57.6%) cases, and signs of arrested bleeding (the presence of a large number of clots with a small amount of liquid blood) was detected in 29 (34.1%) cases. Haemostasis was provided by electrocoagulation (n=35), clipping (n=15), suturing (n=12) and tamponade from a mini-laporatomic incision (n=9). Gastrointestinal bleeding was observed in 323 patients, and intra-abdominal bleeding in 85 patients. In 8.4% (n=27) of cases, the suspicious cases of postoperative complication were excluded by endoscopic examinations. In 91.6% (n=296) of clinical cases, early postoperative bleeding or signs of unstable haemostasis with the risk of repeated bleeding were confirmed. In cases of alarming clinical and laboratory findings indicating intra-abdominal bleeding, diagnostic laparoscopy enables to exclude complications in 16.0% of patients, despite a decrease in blood pressure and haemoglobin levels.

In human foetus, the mesenteries that carry vascular and neural supply to the alimentary tube play an important role in its development and anatomical location within the abdominal cavity. The mesenteric attachments of the small bowel, transverse colon and sigmoid allow them to be intraperitoneally mobile structures. In contrast, the ascending and descending colon lose their mesenteries by fusion with the parietal peritoneum and become fixed in retroperitoneal position along the posterolateral walls of the abdomen. In about 2%-4% of individuals, this process is disrupted, causing a complete or partial retention of their congenital mesocolon. The ascending or descending colon will then remain intraperitoneally mobile, affecting the normal visceral anatomy and causing potential complications. This article reviews the spectrum of radiological manifestations and clinical consequences of these anomalies.

To study the cardiac and visceral signs of connective tissue dysplasia in children with juvenile rheumatoid arthritis, a comprehensive ultrasound examination of the abdominal cavity organs and echocardiography examination were conducted according to the standard protocol in 52 children aged from 5 to 16 years with the diagnosis of juvenile rheumatoid arthritis. The reference group consisted of 26 patients with autonomic dysfunction (vegetative-vascular dystonia). The incidence of such visceral dysplasia types as duodenogastric reflux, gastroesophageal reflux, and gallbladder malformations among children with juvenile rheumatoid arthritis was shown higher than in the reference group. The main cardiac sign of connective tissue dysplasia in patients with juvenile rheumatoid arthritis are an excessive chord of the left ventricle.

Background The THUNDERBEAT is a multi-functional energy device which delivers both ultrasonic and bipolar energy, but there are no randomized trials which can provide more rigorous evaluation of the clinical performance of THUNDERBEAT compared to other energy-based devices in colorectal surgery. The aim of this study was to compare the clinical performance of THUNDERBEAT energy device to Maryland LigaSure in patients undergoing left laparoscopic colectomy. Methods Prospective randomized trial with two groups: Group 1 THUNDERBEAT and Group 2 LigaSure in a single university hospital. 60 Subjects, male and female, of age 18 years and above undergoing left colectomy for cancer or diverticulitis were included. The primary outcome was dissection time to specimen removal (DTSR) measured in minutes from the start of colon mobilization to specimen removal from the abdominal cavity. Versatility (composite of five variables) was measured by a score system from 1 to 5 (1 being worst and 5 the best), and adjusted/weighted by coefficient of importance with distribution of the importance as follow: hemostasis 0.275, sealing 0.275, cutting 0.2, dissection 0.15, and tissue manipulation 0.1. Other variables were: dryness of surgical field, intraoperative and postoperative complications, and mortality. Follow-up time was 30 days. Results 60 Patients completed surgery, 31 in Group 1 and 29 in Group 2. There was no difference in the DTSR between the groups, 91 min vs. 77 min (p = 0.214). THUNDERBEAT showed significantly higher score in dissecting and tissue manipulation in segment 3 (omental dissection), and in overall versatility score (p = 0.007) as well as versatility score in Segment 2 (retroperitoneal dissection p = 0.040) and Segment 3 (p = 0.040). No other differences were noted between the groups. Conclusions Both energy devices can be employed effectively and safely in dividing soft tissue and sealing mesenteric blood vessels during laparoscopic left colon surgery, with THUNDERBEAT demonstrating some advantages over LigaSure during omental dissection and tissue manipulation. ClinicalTrial.gov # NCT02628093.

We studied the dynamics of morphological changes in the operated segment of the uterine horn of Sprague-Dawley rats during the first 2 weeks of the wound-healing process after a full-thickness surgical incision with regard to the estrous cycle phase. Morphometric parameters of injured uterine right horn were compared with those in the intact left horn of the same animal as a control of changes determined by the hormonal background. It was found that the uterine epithelium in the focus of injury was restored as soon as on day 2 after surgery under the influence of estrous cycle hormones. By day 4, the wound space was completely filled with the endometrial tissue on the side of the uterine lumen and coved by the attached adipose tissue of the mesentery on the side of the abdominal cavity. The thickness of the uterine wall and the uterine lumen differed most strongly between the operated and intact uterine horns during the first 3 days and on day 6 after surgery. The size of the healing area increased during the first three days and reached the peak value by day 3, but then decreased to minimum by day 6.

Abdominal wall hernia is a protrusion of the abdominal contents through an abnormal ring or hole in the abdominal cavity of the body. A mixed breed female cat, 3 years old, weighing 2.5 kg, complaining of a lump in the left lateral abdominal area accompanied by a ring with a mass that can be pushed in. Based on the history, the protrusion is approximately 3 weeks and is thought to be caused by trauma. The results of a complete blood count showed normal results. Accompanied by the results of the x-ray examination, the patient was diagnosed with a traumatic hernia of the abdominal wall with a faustal prognosis. Case management involves repositioning the content into the abdominal cavity and suturing the hernia ring. Postoperative therapy was given injection cefotaxime antibiotics followed by amoxicilline (20 mg / kg BW; q 12h; for 5 days), anti-pain mefenamic acid (for 5 days), and Vitamin B, C (until patient healed).

Surface anatomy is fundamental to clinical and surgical practices. As the surface anatomy varies with age, the purpose of this study is to provide age-standardized surface markings for the abdomen in children. A total of 155 abdominal computed tomography scans of healthy children aged 0-18 years were categorized into six groups, and the surface anatomy of the major vascular structures, solid viscera, and anatomical planes in the abdomen was analyzed. The vertebral levels of the celiac trunk, superior mesenteric artery, and hepatic portal vein formation were higher in the youngest age group, whereas the levels of the inferior mesenteric artery, formation of the inferior vena cava, and renal arteries did not differ with age. The right kidney lay between T12 and L3 and the left at T11-L3; however, both kidneys were in lower positions in younger children. The spleen was most commonly located between the 8th and 11th ribs except in toddlers. In all age groups, the hepatic portal vein formation was within the transpyloric plane and the aortic bifurcation was above the supracristal plane. In vivo reassessment of the surface anatomy enables the substantial variability of surface landmarks to be highlighted. This study demonstrates that taking account of age-related variations will increase the accuracy and therefore the clinical relevance of surface anatomy.

espanolLa peritonitis secundaria es una patologia extremadamente delicada con una alta tasa de mortalidad, debido a las complicaciones que esta pude generar. Su tratamiento esta combinado entre antimicrobianos y el quirurgico, mediante la tecnica de laparoscopia en donde se debe contener el foco de infeccion, mediante la reseccion del organo afectado y drenaje del area purulenta. Se presenta caso clinico de paciente femenino de 17 anos de edad, que ingresa a centro de salud por presentar cuadro clinico de aproximadamente de 19 dias de evolucion, caracterizado por dolor abomino pelvico muy intenso de tipo colico, se acompanaba de nauseas y vomitos de tipo bilioso en varias ocasiones; refiere familiar ausencia de deposiciones una semana previa a su ingreso hospitalario en clinica San Francisco, donde es intervenida quirurgicamente, debido a apendicitis incidental y dolicomega sigma, diagnosticandose choque septico por peritonitis secundaria. En el presente caso de estudio, se observa el desarrollo de una apendicitis, que derivo en un abdomen agudo, desencadenandose una peritonitis secundaria. En el presente caso de estudio, se observa como el desarrollo de una apendicitis previa, derivo en un abdomen agudo, esencadenandose una peritonitis secundaria. En este contexto algunos de los sintomas de dolor abdominal concuerdan con la literatura, en el aspecto del dolor abdominal localizado o focalizado que en este particular la paciente refiere con nauseas y vomitos, no se presenta o describe alguna perforacion de la cavidad abdominal, por ello se puede clasificar como un abdomen agudo de tipo inflamatorio (peritonitico). A consecuencia de ello el paciente debe ser intubado e ingresado a UCI y se le realiza una relaparotomia para explorar y corregir los danos causados por la peritonitis en este contexto, con protocolo de antimicrobianos, sin embargo el paciente continua con una condicion critica, bajo sedacion, en constante monitoreo de su evolucion. EnglishSecondary peritonitis is an extremely delicate pathology with a high mortality rate, due to the complications that it can generate. Its treatment is combined between antimicrobial and surgical, through the laparoscopic technique where the focus of infection must be contained, through resection of the affected organ and drainage of the purulent area. A clinical case of a 17-year-old female patient is presented, who is admitted to the health center due to a clinical picture of approximately 19 days of evolution, characterized by very intense pelvic pain of the colic type, accompanied by nausea and vomiting of the bilious on several occasions; She refers to her family's absence of stools a week prior to her admission at the San Francisco clinic, where she undergoes surgery due to incidental appendicitis and dolicho mega sigma, diagnosing septic shock due to secondary peritonitis. In the present case study, it is observed how the development of a previous appendicitis led to an acute abdomen, triggering secondary peritonitis. In this context, some of the symptoms of abdominal pain agree with the literature, in the aspect of localized or focused abdominal pain that in this particular the patient refers with nausea and vomiting, no perforation of the abdominal cavity is presented or described, therefore It can be classified as an acute abdomen of an inflammatory type (peritonitic). As a result, the patient must be intubated and admitted to the ICU and a relaparotomy is performed to explore and correct the damage caused by peritonitis in this context, with an antimicrobial protocol, however the patient continues with a critical condition, under sedation, constantly monitoring its evolution

Most studies reporting the outcomes of laparoscopic ovarian prolapsed hernia operations with large sample sizes are based on intracorporeal closure, while studies on extraperitoneal closure have limited sample sizes. We proactively used the single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) technique and obtained favorable outcomes, which we report in this paper. We retrospectively reviewed patients who had undergone laparoscopic surgery for inguinal hernia at our institution. They were retrospectively classified into two groups based on the pre- or intraoperative diagnosis of hernia with a prolapsed ovary, namely the prolapse group and the non-prolapse group, respectively. The data were statistically analyzed and p

BACKGROUND: Extrathoracic lung sequestration is a rare variant of a developmental malformation that can be diagnosed prenatally and should be included in the differential diagnosis of abdominal tumor-like formations. CASES REPORT: From 1996 to 2020, 70 children with confirmed lung sequestration were treated at the Children's City Hospital No. 1 in St. Petersburg. Of these, 29 had intralobar sequestration, and 41 had extralobar sequestration. Four of these patients were diagnosed with a rare extrathoracic (intraabdominal) form. All four were born full-term without clinical manifestations of the defect. Ultrasound examination of all children revealed a solid formation up to 3 cm in diameter, located in the upper left quadrant of the abdominal cavity or retroperitoneal space in the projection of the left adrenal gland. Due to the location of the formation and the inability to visualize the aberrant arterial vessel during ultrasound examination, the first two patients were differentially diagnosed with an adrenal tumor (neuroblastoma). The cancer markers were negative, and adrenal cortex hormones were normal. The children underwent multispiral computed tomography-angiography to clarify the diagnosis. In both cases, the diagnosis of intraabdominal extrapulmonary sequestration with a feeding arterial vessel extending from the thoracic aorta was confirmed. Two children, previously treated in the last two years, were diagnosed by the ultrasound examination results that enabled the visualization of an aberrant arterial vessel feeding the sequester. Indications for surgical treatment have been set. The parents of one child refused treatment. Three children underwent sequestration removal (two by laparoscopic access, one had a laparotomy). Histologically, extrathoracic sequestration in combination with cystoadenomatosis was confirmed. The postoperative period proceeded without complications. RESULTS: Long-term treatment results were observed in all operated patients for a period of four to 10 years. The assessment was performed based on complaints and ultrasound data. All patients matured and developed according to their ages. CONCLUSIONS: Extrathoracic lung sequestration is a rare type of defect that is subject to surgical treatment. This pathology should be included on the spectrum of differential diagnosis of tumorous formations of the abdominal cavity and retroperitoneal space in newborns. The main methods for postnatal diagnosis of the defect are ultrasound and multispiral computed tomography-angiography.

This review is devoted to the relevance of the problem and the assessment of potential surgical indications, surgical methods and clinical results in the intestinal autotransplantation. Radical resection of theneoplasmisperformed. Currently, the main indications for performing intestinal autotransplantation are considered neoplasms of the pancreas, mesenteric and retroperitoneal space with the involvement of the superior mesenteric vessels in the process. Preliminary results demonstrate that radical resection can be effective in carefully selected patients. Although perioperative morbidity and mortality are relatively high, the literature describes some cases with long patient survival, especially when performing radical resection of a benign tumor or a tumor of potentiallow malignant. However, early tumor recurrence remains a serious problem in patients with a high-grade tumor, especially with pancreatic ductal adenocarcinoma (PDAC). It should be noted that when using intestinal autotransplantation, it is possible to perform a radical resection of the organ in patients with separate neoplasms in the abdominal cavity and the involvement of the main mesenteric vessels in the process. However, this aggressive method is associated with significant operational risk and should be only performed in specialized centers. The additional combination therapies have to be developed to optimize the clinical outcome and prolong the survival of patients with pancreatic cancer.

Primary (hematogenic) peritonitis caused by non-tuberculosis mycobacteria is extremely rare in the clinical practice. The main number of reported episodes of primary intraabdominal infection is associated with M. tuberculosis and the development of granulomatous inflammation of the peritoneum visually similar to carcinomatosis. The vast majority of reports of peritonitis associated with non-tuberculosis mycobacteria are interlinked with chronic peritoneal dialysis or foreign bodies of the abdominal cavity, when an infection is carried out by the contact through a dialysis catheter, prosthesis or a gastric banding device. The article describes a clinical case of peritonitis and splenitis caused by M. avium with hematogenic spread of infection from the primary pulmonary focus in a young patient with immunosuppression. Diagnosis of such peritonitis at the preoperative stage is extremely difficult due to the similarity of symptoms with atypical appendicitis or infected ascites. The intraoperative picture also did not allow us to assume a mycobacterial etiology of the process, and the absence of a focal point of peritonitis made it necessary to thoroughly understand the situation. Only a peritoneal biopsy and a complete laboratory examination of exudate allowed us to verify the diagnosis, to understand the pathogenetic mechanisms of the disease and to start a timely etiotropic therapy.

Purpose of the study. Revealing the features of the formation of damage to the structure of the chest and abdominal organs in pedestrians during their collisions with moving cars. Materials and methods. A forensic medical examination of 215 corpses of persons killed in collisions with moving cars was carried out. Among the dead there were 173 men and 42 women. The victims were between 14 and 75 years old. Research results and their discussion. It was found that among pedestrians who died in collisions with cars, injuries of two or more parts of the body with fractures of the limb bones (55.8%) and с ombined injury (CI) of the head, chest, abdomen (23.3%) prevail. In the composition of CI, damage to the structure of the chest and organs of the chest cavity was noted in 85.6% of cases. Rib fractures were detected in 57.7% of cases; fractures in the midclavicular and axillary lines predominated in localization. Damage to the structure of organs and tissues of the abdominal cavity in the composition of the abdominal CI in pedestrians was -71.0%. At the same time, 80.8% of the dead pedestrians show signs of injury to organs and tissues with pronounced hemorrhages in the suspension apparatuses, walls and parenchyma of organs. In 23.2% of cases, along with hemorrhages, there is a violation of the anatomical integrity of organs, mainly the liver and spleen. The outlined nature of damage to the structure of the chest, organs of the chest and abdominal cavity made it possible to establish the possibility of their formation in the 3rd phase of car injury - the fall of the injured on the road surface. Traumatic (pleuropulmonary), hemorrhagic shock and hemorrhagic pneumothorax were the main causes of injuries at the prehospital stage.

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is increasingly used to manage gastric cancer peritoneal metastasis (GCPM). This study analyzed a prospective database of GCPM patients treated with cisplatin and doxorubicin PIPAC (PIPAC-C/D). The outcome criteria were adverse events, pathologic response [peritoneal regression grading score (PRGS)], and overall survival (OS). The PIPAC-C/D procedure was scheduled for 144 patients with a median age of 57 years (range 22–88 years). Access to the abdominal cavity for the first PIPAC failed in 11 patients (7.7 %). A total of 296 procedures were performed for 131 patients. Of the 144 patients, 52 (36.1%) underwent one PIPAC, 32 (22.2%) underwent two PIPACs, 24 (16.7%) underwent three PIPACs, and 21 (14.6%) underwent four or more PIPACs. The overall morbidity/mortality was grade 1 for 22 patients (15.3%), grade 2 for 32 patients (22.2%), grade 3 for 7 patients (4.9%), grade 4 for no patients (0%), and grade 5 for 2 patients (1.4%). Of the 37 patients who had three or more PIPACs eligible for histopathologic response analysis, 27 (73%) had major or complete regression (PRGS 1/2). A median OS of 11 months (range 0–61 months) for the total study population and 16 months (range 2–61 months) for the patients with three or more PIPACs was observed. For 10 patients (7%) who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, the median OS was 15 months (minimum, 4 months; maximum, 27 months). Multivariate analysis showed three or more PIPACs to be an independent prognostic factor for improved OS (hazard ratio, 0.36; p

Purpose: To evaluate contrast-enhanced magnetic resonance imaging (CE‑MRI) and diffusion-weighted (DWI) in the detection and differential diagnosis of recurrent of retroperitoneal liposarcomas with postoperative changes.Material and methods: The retrospective study included of 23 patients previously operated on for retroperitoneal inorganic liposarcomas. All patients underwent MRI of the abdominal cavity and pelvis with intravenous contrast with further assessment of the size, shape, structure and characteristics of the accumulation of contrast agent in the detected formation.Results: Morphological verification were performed in 17 patients (74 %), in 6 cases (26 %) patients were left for dynamic control for 1–3 years. Local relapses were detected in 16 patients (67 %), postoperative changes — in 7 (33 %) patients, of which in 2 cases deformation of adipose tissue and fibrotic changes in the area of surgery was determined, in 3 patients granulomas were revealed, and in two patients — volvulus of the greater omentum and lymphocele. The sensitivity of MRI with intravenous contrast enhancement was 68.7 %, specificity 71.4 % and accuracy 69.6 %. The addition of DWI to the standard MRI protocol in patients with suspected recurrence of retroperitoneal liposarcoma to increase the sensitivity of the method in the differential diagnosis of recurrent drugs from postoperative changes to 93.7 % (15 out of 16), specificity up to 100 % (7 out of 7) and accuracy up to 95.6 % (22 out of 23).Conclusion: The joint use of MRI with intravenous contrast and DW‑MRI increases the information content in the detection and differential diagnosis of small-sized recurrent tumors in dedifferentiated and myxoid types of liposarcomas with postoperative changes.

The inverted ovariosalpingohysterectomy (OSH) technique involves initial uterine removal, followed by ovarian disinsertion. The objective of this study was to compare the inverted technique with the traditional technique, characterized by initial removal of the ovaries followed by uterine resection, for evaluating the performance of the inverted OSH technique in cats. For this, 24 healthy, female cats, aged between 7 months and 5 years, with a body condition score of up to 6 points (9-point scale), divided into two equal groups: the traditional technique (TT) and the inverted technique (IT). Procedures were performed by the same veterinarians (surgeon and their assistant) as well as semi-quantitative analysis of the techniques (questionnaire related to the ease of uterine and ovarian manipulation as well as of intestinal and urinary vesicle manipulation) and descriptive qualitative analysis (technical report with the opinion of surgeons and an external evaluator). In addition, the total surgical time and positive pain response were evaluated, indicated by the changes in vital parameters observed by the anesthesiologist during surgery. Inverted technique it promoted greater ovarian exposure, allowing uterine cranial flexion to perform the ligatures, thus facilitating their manipulation, hemostasis, and section of the pedicle. Free the uterus from its ligaments to the abdominal cavity allowed greater mobilization of the conjoint. Both techniques required short operation time (average time of 16’± 1.321’ in the IT group and 15’± 0.525’ in the TT group). The presence of algetic stimulus was similar in the techniques, three animals in each group suffered analgesic rescue.

Accurate assessment of disease extent is required to select the best primary treatment for advanced epithelial ovarian cancer patients. Estimation of tumour burden is challenging and it is usually performed by means of a surgical procedure. Imaging techniques and tumour markers can help to estimate tumour burden non-invasively. 2-[18F]FDG PET/CT allows the evaluation of the whole-body disease. This study aimed to correlate HE4 and CA125 serum concentrations with tumour burden evaluated by volumetric 2-[18F]FDG PET/CT parameters in advanced high-grade epithelial ovarian cancer. We included 66 patients who underwent 2-[18F]FDG PET/CT and serum tumour markers determination before primary treatment. Volumes of interest were delimited in every pathological uptake. Whole-body metabolic tumour volume (wb_MTV) and total lesion glycolysis (wb_TLG) were calculated summing up every VOI’s MTV value. SUVmax thresholds were set at 40% (MTV40 and TLG40) and 50% (MTV50 and TLG50). In addition, four VOI subgroups were defined: peritoneal carcinomatosis, retroperitoneal nodes, supradiaphragmatic nodes, and distant metastases. MTV and TLG were calculated for each group by adding up the corresponding MTV values. TLG was calculated likewise. wb_MTV and wb_TLG were found to be significantly correlated with serum CA125 and HE4 concentrations. The strongest correlation was observed between HE4 and wb_MTV40 (r = 0.62, p

BACKGROUND Shoulder pain is among the early postlaparoscopic symptoms related to carbon dioxide used for pneumoperitoneum, which remains in the abdominal cavity. Therefore, incentive spirometry (IS) is a novel technique to alleviate this pain following laparoscopic cholecystectomy (LC). The present study was designed to investigate if the use of IS after LC would relieve shoulder tip pain, and determine the amount of postoperative opioid analgesics utilized. MATERIALS AND METHODS This randomized clinical trial was conducted on patients who were clinically diagnosed with cholecystitis, and underwent LC. Accordingly, group I patients (n=42) received IS (including 10 deep breaths with a spirometer in sitting or semisitting positions) in full consciousness every 2 hours starting at 2 hours after surgery, but group II patients (n=42) did not have respiratory physiotherapy. The postoperative shoulder pain after the surgery was further evaluated by a numerical rating scale (NRS). RESULTS At 4, 8, 12, 24, and 48 hours following LC, the NRS pain scores significantly reduced in group I compared with group II. In addition, the results of the repeated measures analysis of variance indicated significantly lower NRS pain scores within the first 48 hours after LC in group I compared with group II. Consequently, the study findings showed a significantly higher percentage of cases in group II, requiring postoperative analgesics, in comparison with group I. CONCLUSIONS IS decreased the severity of shoulder tip pain after LC with no complications. Thus, IS may be considered as a viable alternative to other laparoscopic interventions. However, still further studies are necessary to evaluate its efficacy compared with other techniques.

Забрюшинный (ретроперитонеальный) фиброз (РПФ) — редкое заболевание, характеризующееся разрастанием воспалительной и фиброзной ткани в забрюшинном пространстве. Обычно эти разрастания локализуются вокруг инфраренальной части брюшной аорты и подвздошных артерий, часто покрывая мочеточники или другие органы брюшной полости. Идиопатические заболевания составляют 70 % случаев. РПФ может быть ассоциирован с иммуноглобулином G4 (IgG4), что является причиной двух третей случаев идиопатического РПФ. Вторичный РПФ может развиться вследствие инфекций, злокачественных новообразований, приема лекарственных препаратов, забрюшинного кровотечения или других заболеваний. Описан клинический случай идиопатического РПФ, вероятно, ассоциированного с IgG4, у пациента, прошедшего симптоматическое оперативное лечение в урологической клинике и продолжившего лечение у ревматолога патогенетической терапией (метилпреднизолон и мофетила микофенолат) со значительным улучшением. Для ревматологов данная патология представляет безусловный клинический интерес, поскольку, с одной стороны, в основе данных изменений лежат процессы, аналогичные таковым при системных заболеваниях соединительной ткани, а с другой стороны — это редкая патология, встречаемость РПФ составляет от 0,1 до 1,3 случая на 100 000 человек в год. Однако чаще такие пациенты сразу попадают на прием к врачам смежных специальностей (урологам, нефрологам, хирургам, сосудистым хирургам), что подчеркивает важность разбора такого клинического случая.

Мета дослідження — покращити результати лікування дітей з інфільтратами черевної порожнини за рахунок удосконалення діагностичних заходів, хірургічних технологій і післяопераційної реабілітації. Матеріали та методи. За 22 роки в Чернігівській області виконано 27 325 операцій на органах черевної порожнини в дітей, із них у 19 842 (72,6 %) — із причини різних форм апендикулярного відростка. Ускладнення у вигляді інфільтратів та абсцесів черевної порожнини встановлено у 285 (100,0 %) хворих дітей, з яких інфільтрати діагностовано в 78 (27,4 %) та абсцеси — у 207 (72,6 %). Хворі розподілені на дві підгрупи: групу дослідження (I; 2005–2015 рр.) — 29 дітей (37,2 %) і групу порівняння (II; 1994–2004 рр.) — 49 (62,8 %). Первинні інфільтрати черевної порожнини (ПІЧП) установлено в 51 хворого (65,4 %), з яких у I групі — у 27 (34,6 %), у II — у 24 (30,8 %). Вторинні інфільтрати черевної порожнини (ВІЧП) встановлено у 27 хворих (34,6 %), з яких у I групі — у 2 (2,6 %), у II — у 25 (32,0 %). Усім хворим проводилися загальноклінічне, лабораторне, а в групі дослідження — ультразвукове дослідження черевної порожнини з кольоровим допплерівським картуванням та комп’ютерна томографія органів черевної порожнини. Результати. Проведені дослідження показали, що термін госпіталізації дітей із первинними інфільтратами в I групі становив 11,75 ± 0,23 доби, а в II — 13 ± 1 доба, із вторинними інфільтратами — 13,65 ± 1,65 доби, серед дітей у I групі — 19 ± 9 діб, у II — 12,52 ± 1,71 доби. Клінічна картини у хворих із ПІЧП була такою: лихоманка — у 86,3 % випадків, симптоми дисфункції шлунково-кишкового тракту — у 41,1 %, нудота — у 29,4 %, біль у животі — у 62,4 %. Дані симптоми вказували на атиповість перебігу захворювання, що спричинило помилки на діагностичному етапі. Причинами несвоєчасної діагностики ПІЧП були: самолікування — у 43,1 % випадків, пізнє звернення за медичною допомогою — у 37,2 %, несвоєчасна амбулаторна діагностика — у 19,6 %. Променеві методи дослідження (оглядова рентгенографія черевної порожнини та комп’ютерна томографія): у II групі в 6 дітей (11,7 %) проти 18 (35,3 %) — у I. Клінічна картина з ВІЧП: лихоманка — у 100,0 % дітей, нудота — у 63 %, блювання — у 37 %, здуття черевної порожнини — у 55,6 % дітей, що була більш специфічною для ранніх післяопераційних інфільтратів — у 10 хворих (37 %). При об’єктивному обстеженні визначалися біль у животі — у 81,4 % дітей, симптоми подразнення очеревини — у 96,3 %, симптом «пухлини, що пальпується» — у 63 %. Променеві методи дослідження: у II групі в 5 дітей (18,5 %) проти 2 (100 %) — у I. З метою покращання результатів лікування нами була розроблена шкала бальної оцінки. Пацієнтам, які згідно з діагностичною шкалою мали 26–36 балів, було показане консервативне лікування. У хворих, які мали 37–45 балів, застосовували хірургічне лікування недуги через місцевий доступ. У хворих, які мали 46–72 бали, застосовували хірургічне лікування недуги через серединну лапаротомію. У 7 (9 %) хворих із ПІЧП при обстеженні згідно з діагностичною шкалою було встановлено 26–36 балів — показане консервативне лікування, з яких у І групі — у 3 (3,9 %), у ІІ — у 4 (5,1 %). У 35 дітей (44,9 %) було 37–45 балів — застосовували хірургічне лікування через місцевий доступ, з яких у І групі — у 18 (23,1 %), у ІІ — у 17 (21,8 %). У 9 дітей (11,5 %) було 46–72 бали, у них застосовували хірургічне лікування через серединну лапаротомію, з яких у І групі — у 6 (7,6 %), у ІІ — у 3 (3,9 %). Таким чином, у 44 хворих із ПІЧП проведено оперативне лікування. У 26 (33,4 %) хворих із ВІЧП згідно з діагностичною шкалою було встановлено 26–36 балів та показано консервативне лікування, з яких у І групі — у 2 (2,6 %), у ІІ — у 24 (30,8 %). В 1 дитини (1,2 %; хворий із ІІ групи) було встановлено 37–45 балів, застосовували хірургічне лікування з місцевого доступу. Висновки. Установлено, що клінічний перебіг інфільтратів черевної порожнини у хворих у 12,5–18,9 % випадків характеризується атиповою клінічною симптоматикою, що здебільшого призводить до запізнілого звернення до дитячого хірургічного стаціонару. Впровадження шкали бальної оцінки недуги черевної порожнини дозволило досягти покращання результатів лікування як у близькому, так і віддаленому періодах. У дослідженнях встановлено, що найбільш вразливими до розвитку інфільтратів черевної порожнини є діти віком від 7 до 12 років, які мають атипову локалізацію апендикулярного відростка в 62,3 % спостережень.

Background. Escherichiosis remains one of the most common intestinal infections, especially among young children. Indigestion of essential nutrients, transient fermentopathy, imbalance of the symbiotic flora, which develop in escherichiosis in combination with general intoxication and water-electrolyte disturbances, can lead to unfavorable outcomes. One of the factors influencing the course of escherichiosis can be Epstein-Barr virus (EBV) infection in the child. Purpose of the research — improvement of treatment of children with escherichiosis and EBV infection in different periods of the disease. Materials and methods. We examined 74 children aged 2–3 years, who were treated at the Regional Children’s Clinical Infectious Diseases Hospital in Kharkiv with a diagnosis of moderate-to-severe escherichiosis. A group of 36 children was selected, who received conventional therapy with early gradual restoration of nutrition according to the existing protocol, and the restoration of the qualitative and quantitative composition of food was carried out as soon as possible (first group). The second group was represented by 38 children, who received two-day prolonged gradual restoration of the diet: more gradual increasing the volume of food at each feeding and reducing the number of feedings per day. Children of the second group received drugs containing Lactobacillus, milk thistle extract and B vitamins (once daily with meals) from the first day. Ultrasound examination of the abdominal cavity was performed in all children. Results. Analysis of the main clinical, laboratory and instrumental parameters of patients in both groups during their stay in the hospital and one month after the discharge from the hospital revealed that in children of the second group, in whom rational diet therapy was applied, there was a reduction in the duration of bowel dysfunction, abdominal syndrome, flatulence; the parameters of the coprological test and the echosonoscopy of the hepatic parenchyma were normalized more quickly. Patients on the optimal diet regained their weight in a shorter period. The proposed methods of improving the therapy made it possible to prevent exacerbation of escherichiosis in children of the second group at the early convalescence stages. Conclusions. Early detection of EBV infection in children with escherichiosis, correction of therapy enable early restoration of physiological processes in the intestine and bile system, normalization of digestion and absorption of nutrients, and generally has a positive effect on the course of the underlying disease.

Purpose. To identify and evaluate the effectiveness of sonographic signs of intestinal ischemia in patients with strangulated small bowel obstruction.Materials and methods. For the period 2017–2019, 115 patients with SIO were treated at the N.V. Sklifosovsky Federal Research Institute of Emergency Medicine. There were 64 women (55.6%) and 51 men (44.4%). The mean age was 62 ± 15 years. In all patients, the diagnosis was verified intraoperatively. All patients underwent ultrasound examination of the abdominal cavity in B-mode with the assessment of blood flow of the intestinal wall in the mode of CDI. Patients were divided on the basis of intraoperative data into 2 groups. The first group: 63 (54.8%) patients with signs of ischemia of the strangulated loop of the intestine. The second group consisted of 21 (18.1%) patients in whom intestinal necrosis was detected. The comparison group included 31 (26.7%) patients with adhesive small bowel obstruction without intestinal strangulation.Results. The most informative signs of ischemia of the strangulated intestine of the loop are infiltrative changes of its mesentery. In the second and third groups 9 (14.3%) and 12 (57.1%) participants, respectively, showed severity of intestinal ischemia, compared with 1 participant (3.2%) in the first group. The next informative criterion is the thickening of more than 0.4 cm and edema of the intestinal wall. In the second and third groups 30 (47.6%) and 14 (66.6%), in the comparison group 4 (12.9%), akinesis of the strangulated loop and paresis of the entire small intestine also directly correlated with intestinal ischemia. The absence of differentiation of intestinal wall layers occurs in (23.8%), the absence of blood flow in the intestinal wall in the CDI mode (19%), gas inclusions in the intestinal wall (4.3%).Conclusion. The assessment of sonographic symptoms allows to diagnose the presence of ischemic changes in the intestinal wall and perform surgery before the development of necrosis in the early period. In cases of late admission of the patient to the hospital, with the onset of intestinal necrosis and the associated erased clinical picture, ultrasound allows to establish indications for surgery before the development of peritonitis.

Background Primary omental tumors are uncommon, and omental fibromas account for 2% of these tumors. Due to the low incidence of omental fibromas and the limited relevant literature, it is challenging for clinicians to make an accurate diagnosis of this condition, especially before surgery. Case summary A 30-year-old man was admitted to the hospital because of a left epididymal mass with vague discomfort for more than 1 mo. A physical examination was performed, and the findings showed that the epididymal mass may have entered the abdominal cavity. Pelvic computed tomography was performed in our hospital and revealed a left inguinal hernia with a mass in the hernial contents, and no masses were found in the left epididymis. A traditional inguinal hernia incision was made. Intraoperative hernia contents were found to be of the greater omentum, and a 2.5 cm-diameter mass was found at the distal end of the greater omentum. The scrotum and epididymis did not exhibit other masses. Then, the mass of the greater omentum was excised. Intraoperative frozen pathological examination suggested a spindle cell tumor. The postoperative pathological examination suggested that the mass was an omental angiofibroma. Postoperatively, the patient recovered well and was discharged. Outpatient re-examinations were performed at 1 mo and half a year after the operation and showed no obvious abnormalities. Conclusion Due to the low morbidity rate associated with and latent nature of omental tumors, these tumors are difficult to diagnose preoperatively; thorough medical history taking, detailed physical examinations, and necessary imaging auxiliary examinations can help clinicians diagnose and treat these cases.