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AIM: to estimate the features of pseudomembranous colitis in patients with COVID-19, diagnostics, conservative treatment and surgery for complications.PATIENTS AND METHODS: a retrospective analysis of 396 patients with pseudomembranous colitis (PMC) in patients with new coronavirus infection was carried out for the period from March 2020 to November 2021. Among them there were 156 (39.3%) males, females — 240 (60.6%), moderate and severe forms of COVID-19 occurred in 97.48%.The diagnosis of PMC was established due to clinical picture, laboratory, instrumental methods (feces on Cl. difficile, colonoscopy, CT, US, laparoscopy).RESULTS: the PMC rate in COVID-19 was 1.17%. All patients received antibiotics, 2 or 3 antibiotics — 44.6%, glucocorticoids were received by all patients. At 82.8%, PMC developed during the peak of COVID-19. To clarify the PMC, CT was performed in 33.8% of patients, colonoscopy — 33.08%, laparoscopy — in 37.1% (to exclude bowel perforation, peritonitis). Conservative treatment was effective in 88.8%, 76 (19.1%) patients had indications for surgery (perforation, peritonitis, toxic megacolon). Most often, with peritonitis without clear intraoperative confirmation of perforation, laparoscopic lavage of the abdominal cavity was performed (60 patients — 78.9%, mortality — 15.0%), colon resection (n = 6 (7.9%), mortality — 66.6%), ileo- or colostomy (n = 8 (10.5%), mortality — 37.5%), colectomy (n = 2 (2.6%), mortality — 50.0%). The overall postoperative mortality rate was 22.4%, the incidence of surgical complications was 43.4%. In addition, in the postoperative period, pneumonia was in 76.3%, thrombosis and pulmonary embolism in 22.3% of patients. In general, the overall mortality in our patients with PMC was 11.4%, with conservative treatment — 8.8%.CONCLUSION: pseudomembranous colitis is a severe, life-threatening complication of COVID-19. In the overwhelming majority of patients, conservative therapy was effective, but almost 1/5 of patients developed indications for surgery, the latter being accompanied by high mortality and a high morbidity rate. Progress in the treatment of PMC, apparently, is associated with early diagnosis, intensive conservative therapy, and in the case of indications for surgery, their implementation before decompensation of the patient’s condition and the development of severe intra-abdominal complications and sepsis.

EDITORIAL COMMENT. Gripped aggressive foreign bodies (magnetic balls) in the gastrointestinal tract require emergency actions to clarify their localization and to remove them. The conservative approach with four-day observation described in the article should not be used.Introduction. Internal fistulas in foreign bodies of the digestive tract is a very rare complication.This publication is aimed to describe a rare case of fistula formation between the vermiform process and the ileum caused by magnetic foreign bodies.Clinical observation. As his parents said, a 2-year-old child swallowed magnetic balls; no clinical manifestations were noted. Plain radiography 3 days after the ingestion revealed foreign bodies (3) in the right lower quadrant of the abdomen. No foreign bodies were found on colonoscopy. Laparoscopy revealed a fistula between the appendix and the terminal ileum. The following steps were made: disconnection of fistula, appendectomy, suturing of fistula opening in the ileum.Conclusion. One of the complications after swallowing magnetic foreign bodies may be formation of internal intestinal fistulas. In our observation, the fistula was between the appendix and the ileum. No similar observations were found in literature.

Aim. To analyze the results of treatment of patients with ulcerative bleeding, to identify the main risk factors for rebleeding in patients with peptic ulcer bleeding. Methods. A retrospective analysis of the treatment results of 240 patients with acute peptic ulcer bleeding who were hospitalized in the Beloretsk Central District Hospital from 2008 to 2018 was carried out. Patients were divided into two groups: group 1 52 patients with rebleeding, group 2 188 patients in whom rebleeding did not occur. Results. Rebleeding in patients with peptic ulcer was observed in 21.7% of cases. The surgical rate was 22.9% and mortality 6.3%. Based on the obtained data, rebleeding should recognize as a risk factor for death [odds ratio (OR) 68.9; 95% confidence interval (CI) 8.8 to 539.7; p 0.001]. Surgical treatment for rebleeding had unsatisfactory results (postoperative mortality in group 1 26.8%, in group 2 0). Risk factors for rebleeding in peptic ulcer bleeding include localization of the ulcer on the lesser curvature of the stomach (OR=2.37; 95% CI=1.18 to 4.74) and the posterior wall of the duodenum (OR=3.84; 95% CI=1.69 to 8.73), as well as Forrest type IIA ulcer (OR=2.67; 95% CI=1.55 to 6.48). Forrest IIc and III ulcers reduce the risk of rebleeding (OR=0.24; 95% CI=0.10 to 0.56). It was found that a shock index, a decreased level of total protein and red blood cells, and an increasing level of urea have a statistically significant relationship with rebleeding in peptic ulcer bleeding. Conclusion. Rebleeding in patients with peptic ulcer is a serious complication of the disease that significantly increases mortality, and predicting the risk of rebleeding is one of the possible tools that can improve treatment outcomes and reduce mortality.

Aim. To analyze the results of treatment of patients with Mellory-Weiss syndrome (MWS) and describe a number of MWS cases, caused by exacerbation of the ulcer. To detect the characteristic features of the course of disease and possible variants of unfavorable outcome. Materials and methods. There were analyzed the results of treatment of 176 patients with MWS, who received hospital treatment from 2008 to 2018. Fifteen MWS cases, caused by ulcer exacerbation, were described. Statistical analysis was conducted; features of disease course were revealed. A clinical case of unfavorable variant of the disease course is presented. Results. The study included 176 patients. Mellory-Weiss syndrome, caused by ulcer, was registered in 15 of them (main group). The patients of the main group had pain syndrome, lower systolic arterial pressure, lower hemoglobin and erythrocyte amount at admission to hospital. The paper presents the variant of extremely unfavorable course of disease, when relapse of bleeding occurred not from laceration of the mucous membrane, but from the ulcer. Conclusions. According to our observations, ulcer is a relatively frequent cause of MWS development and takes the second place after alcohol etiology. Such patients have peculiar features of disease course, which require different approach to diagnosis and management.

Aim. To determine the ways to reduce postoperative morbidity and mortality in acute cholecystitis. Material and metods. Retrospective (2013–2014 years) and prospective non-randomized (2015–2016) analysis of outcomes in 804 patients with acute cholecystitis was performed. Analysis was carried out within two periods – before and after acceptance of national clinical recommendations “Acute cholecystitis” (2015). Protocols of diagnosis and treatment developed by our clinic were applied in the first period (2013–2014). 220 patients (group I) underwent surgery in the first period, 290 (group II) – in the second period. Results. There was significantly reduced incidence of conversions for laparoscopic and minimally invasive cholecystectomy from 4.09% to 2.41% (p < 0.05) (OR – 1.724; 95% CI 0.632–4.705). Incidence of extrahepatic bile ducts lesion, postoperative thrombotic, thromboembolic complications, cardiovascular complications (including myocardial infarction) were similar in both groups (p > 0.05) (for cardiovascular complications OR – 0.758, 95% CI 0.047–12.183). There was reduced length of hospital-stay from 11.5 ± 0.8 to 9 ± 0.5 days (p < 0.05). Slight augmentation of postoperative mortality in the second period (from 0.45% to 1.37%) was observed (p < 0.05) (OR – 3.063, 95% CI 0.340–27.599). Conclusion. Reduced number of conversions was predominantly caused by cholecystectomy in patients with milder gallbladder inflammation. It is explained by earlier surgery (within 24–48 h) when severe infiltration of surrounding tissues is absent. Preoperative prolonged medication (3–5 days) aggravates these processes, creates significant intraoperative technical difficulties and increases incidence of conversions.

It is a literature review for the use of continuous regional arterial infusion of protease inhibitors and antibacterial drugs in acute pancreatitis management. The technique of drug administration and the results of randomized clinical trial are described.

The article presents an analysis of modern methods of the measurement, including classical and original methods and devices developed by the authors. The results of examination and treatment were analyzed in 397 patients with acute obturation intestinal obstruction and acute destructive pancreatitis, who had the abdominal compartment syndrome from I to IV degree. The authors showed that on-time decompressive laparotomy allowed the decrease of lethality from 25% to 15-17,8%.

The article provides a review of foreign literature for 2020 on existing methods of drug treatment of coronavirus disease COVID-19. To date, in the treatment of COVID-19 in different countries, a little more than 10 drugs are used. The largest number of studies on the testing of these drugs is carried out by scientists from China, the USA, and European countries. It should be noted that among these drugs there is not a single new drug developed specifically for the treatment of COVID-19, the recommended and used drugs have previously been used to treat, as a rule, diseases of the viral etiology, less often another pathology. These suggestions are often based on analogy, the hypothesis of their supposed effectiveness for COVID-19. It can be assumed that a brake on the development of a drug specific for coronavirus disease is a poor knowledge of the pathogenesis of virus invasion in the body's adhesives and the development of complications. The review provides detailed literature data on drugs such as hydroxychloroquine / chloroquine, lopinavir/natinavir, remdesivir, ACE inhibitors and angiotensin converting enzyme receptor blockers, tissue plasminogen activator, as well as plasma transfusion transfusions.В статье представлен обзор иностранной литературы за 2020 г. по имеющимся методам медикаментозного лечения коронавирусной болезни COVID-19. К настоящему времени при лечении COVID-19 в мире используется чуть больше 10 препаратов, наибольшее число исследований по их апробации проводится учеными Китая, США, стран Европы. Однако нет ни одного нового лекарственного средства, разработанного специально для лечения COVID-19; рекомендуемые и используемые средства ранее применялись для лечения заболеваний вирусной этиологии, реже — другой патологии. Предложения чаще основываются на аналогии, гипотезе о предполагаемой эффективности препаратов и для COVID-19. Можно предположить, что основным фактором, препятствующим разработке специфического для коронавирусной болезни лекарственного средства, является слабое знание патогенеза инвазии вируса в клетки организма и развития осложнений. В обзоре подробно представлены данные литературы о таких препаратах, как гидроксихлорохин/хлорохин, лопинавир/натинавир, ремдесивир, ингибиторы АПФ и блокаторы рецепторов ангиотензинпревращающего фермента, активатор тканевого плазминогена, а также о процедуре переливания плазмы реконвалесцентов.

The review presents literature data on the peculiarities of laparoscopic procedures in case of new coronavirus infection COVID-19 The most important tasks in this case are to prevent hospital staff and patients from becoming infected Measures for minimization of contacts, operation of operating theatres, protection of medical personnel are described in detail Recommendations of surgeons-specialists from North America, China, Europe, who have considerable experience in performing laparoscopic operations under conditions of COVID-19 pandemic, are given В обзоре представлены данные литературы об особенностях выполнения лапароскопических процедур при новой коронавирусной инфекции COVID-19 Важнейшими задачами при этом являются предотвращение больничного инфицирования медицинского персонала и пациентов Подробно изложены мероприятия по минимизации контактов, работе операционных, защите медицинского персонала Приведены рекомендации хирургов-специалистов из Северной Америки, Китая, Европы, имеющих значительный опыт выполнения лапароскопических операций в условиях пандемии COVID-19

To present the algorithm of management of victims using modern technologies including CT, laparoscopy, angiography, intraabdominal pressure monitoring, etc.Treatment of 395 victims with traumatic retroperitoneal hemorrhage was analyzed.It was shown that the use of developed algorithm decreases mortality rate from 10.5 to 4.5% and postoperative complications incidence from 23 to 14.1% in reviewed patients.Цель - представить разработанный алгоритм ведения пострадавших с позиции современных технологий, таких как компьютерная томография, лапароскопия, ангиография, мониторирование интраабдоминального давления и др. Материал и методы. Проведен анализ результатов лечения 395 пострадавших с травматическими забрюшинными кровоизлияниями. Результаты. Показано, что применение разработанного алгоритма способствовало снижению летальности с 10,5 до 4,5% и частоты послеоперационных осложнений с 23 до 14,1% у рассматриваемой категории пострадавших.

To develop classification of surgical complications.The most common and recently proposed classifications of surgical complications (Clavien-Dindo, Occordion, R. Satava, et al., A. Kazaryan, et al.) were analyzed. Postoperative complications in 25 556 patients were retrospectively assessed. Incidence and severity of complications, methods of their correction, effect of complications on length of hospital-stay were analyzed.As a result of comprehensive analysis, new classification of surgical complications was proposed. 5 grades of complications were identified. Classification is based on anatomical features, type of complications (within surgical access, organ or cavity), correction depending on this type, severity of complications. Causal relationship of complication with type of repair and increased length of hospital-stay was considered.Classification proposed is anatomically justified, considers causal relationship of complications and their repair, as well as length of hospital-stay.Цель исследования - разработка классификации хирургических осложнений. Материал и методы. Проведен анализ наиболее распространенных и предложенных в последнее время классификаций хирургических осложнений (Clavien-Dindo, Occordion, R. Satava и соавт., А.М. Казарян и соавт.), ретроспективное продольное исследование осложнений у 25 556 оперированных больных. Рассмотрены частота осложнений в зависимости от степени тяжести, методы их коррекции, влияние осложнений на продолжительность стационарного лечения. Результаты. На основании критического анализа существующих классификаций и изучения частоты, тяжести хирургических осложнений, методов их лечения, удлинения сроков пребывания в стационаре предложена новая классификация хирургических осложнений. Выделены 5 степеней тяжести осложнений, в основу классификации положены анатомический принцип, тип (вид) осложнения (в области хирургического доступа, оперированного органа, полости), методы коррекции, зависимые от типа, тяжести осложнения: учтена причинно-следственная связь осложнения с методом устранения, а также с увеличением сроков лечения. Заключение. Предложенная классификация обоснована анатомически, учитывает причинно-следственную связь осложнения и метода его коррекции, а также изменения сроков лечения.

To study the results of simultaneous abdominal and retroperitoneal interventions.The article presents analysis of 856 simultaneous operations whose proportion was 3.49% of total number of operations. Most of them was performed via videolaparoscopic approach (697, 81.4%), open access and mini-laparotomy were used rarer (111, 12.9%) and 48 (6,7%) respectively). Severity of great number of interventions corresponded to degree I and II of D. Lochlein and R. Pichlmayer classification. Modern diagnostic methods including sonography, computed tomography, magnetic resonance imaging, angiography, endoscopy and laboratory data were used to define diagnosis.Simultaneous approach increases duration of surgery 30.3% on the average that is significant risk factor in case of surgery of severity degree III and videolaparoscopic interventions. Simultaneous surgery does not significantly increase ICU-stay and incidence of postoperative complications.Проанализированы результаты симультанных операций на органах брюшной полости, частота которых по отношению к общему числу всех хирургических вмешательств составила 3,49%. Большинство операций (697) выполнено видеолапароскопическим методом, из минилапаротомного (48) и открытого (111) доступов. Чаще производили сочетанные гинекологические (83,2%), абдоминальные хирургические (14,3%), реже урологические (0,8%) операции. Большинство сочетанных операций (89,8%) отнесено к I и II степени тяжести по классификации D. Lochlein и R. Pichlmayer. Сочетанные операции увеличивают продолжительность вмешательства в среднем на 30,3%, что является значимым фактором при операциях III степени тяжести и видеолапароскопических операциях. В то же время сочетанные операции не вызывали статистически достоверного увеличения срока проведения послеоперационной интенсивной терапии, а также летальности и частоты послеоперационных осложнений. Цель - изучение результатов симультанных операций у больных с заболеваниями органов брюшной полости и забрюшинного пространства. Материал и методы. В статье представлен анализ 856 симультанных оперативных вмешательств, доля которых к общему числу операций составила 3,49%. Большинство операций выполнено видеолапароскопическим способом (n=697, или 81,4%), реже из открытого (n=111, или 12,9%) и минилапаротомного (n=48, или 6,7%) доступа. Большая часть сочетанных операций отнесена к I и II степени тяжести по классификации D. Lochlein и R. Pichlmayer. При обследовании больных использованы современные методы лучевой (УЗИ, КТ, МРТ, ангиография), эндоскопической и лабораторной диагностики. Результаты. Выполнение симультанных операций увеличивает их продолжительность в среднем на 30,3%, что является значимым фактором при операциях III степени тяжести, видеолапароскопических операциях. Симультанные операции не вызывают статистически достоверного увеличения длительности пребывания больного в отделении интенсивной терапии и реанимации, а также - роста послеоперационных осложнений.

Ethiology, pathogenesis, treatment and prevention of reperfusion disorders in emergency abdominal surgery are highlighted in the article. The thorough analysis of reperfusional disorders' pathogenesis by the abdominal compartment syndrome was carried out.

Results of surgical treatment of 197 patients with acute colonic obstruction complicated by intraabdominal hypertension were analyzed. Monitoring of intraabdominal pressure was made in 101 patients at the pre- and postoperative periods. Compensated, sub- and decompensated forms of obstruction depending on the data of intraabdominal pressure were determined. The level and dynamics of the intraabdominal pressure are taken as criteria of severity of acute colonic obstruction, decision on the time and volume of surgical procedures. The medico-diagnostic algorithm of management of such patients is proposed. Lethality turned out to be decreased to 15.8% as compared with a control group (24%) due to the monitoring of intraabdominal pressure and improved surgical strategy.

The authors present results of examination and treatment of 698 patients with erosive-ulcerative lesions in the mucous membrane of the upper digestive tract that accounted for 39.49% of all subjects with gastrointestinal hemorrhage. These lesions were diagnosed in 73.8% of the patients in critical conditions. The leading role in their pathogenesis is played by ischemic-perfusion syndrome, gastric acid hypersecretion resulting in microcirculatory disorders, hypoxia, and activation of free radicals in gastric and duodenal mucosa. It is concluded that preventive and conservative therapy of the above lesions must be focused on the correction of ischemia and after-effects of reperfusion to achieve long-standing hypoacidic state (pH4) with the help of up-to-date antisecretory agents.

Treatment results of 405 patients with Mallory-Weiss syndrome, X-ray gastric investigation in patients with severe bloating reflex were analyzed. Experimental part of the study involved rats and pigs, modeling esophageal and gastric rupture. Cardioesophageal and gastric cardial rupture happen in case of simultaneous sudden intragastric and intraabdominal hypertension, following the rule of Laplace.

Retrospective analysis of treatment results was carried out in patients with acute bleedings from upper digestive tract according to efficacy evaluation of hemostatic methods. All methods of hemostasis were divided into 7 groups: resectional, local treatment of the bleeding source with or without vagotomy, angiosurgical, local surgical hemostasis, hemostasis along the length, endoscopic hemostasis and conservative modes. Indications for hemostatic methods were estimated depending on severity, intensity, character of the bleeding basing on the J. Forrest classification and severity of patient's condition (severity of blood loss). Prophylactic measures for prevention of recurrent bleedings after primary hemostasis are proposed. Differential approach to hemostasis in acute gastrointestinal bleedings allows achieving 96-97% efficacy.

Results of treatment of 345 patients with Mallory-Weiss syndrome were analyzed. Classification of the disease with a glance on stages and bleeding activity was given. Methods of hemostasis and indications for the surgical interference were discussed. The importance of consideration and respective treatment of the concomitant gastrointestinal diseases or alcohol intoxication was stressed.

Results of measurement and monitoring of intraabdominal pressure at 288 patients treated for different abdominal diseases and trauma were analyzed. In early postoperative period the increase intraabdominal pressure to 10-15 mm Hg (I degree) was revealed at 161 (56.0%) patients, from 16 to 25 mm Hg (II degree)--at 95 (33.0%), from 25 to 35 mm Hg (III degree)--at 23 (8.0%), more 35 mm Hg (IV degree)--at 8 (2.7%) patients. When intraabdominal pressure decreased on 4-5 mm per day the prognosis was positive at 257 (89.2%) operated patients. Critical type regarded as compartment syndrome (III-IV degree) was diagnosed at 31 (10.8%) patients. Relaparotomy was performed at 23 (8.0%) patients with III degree hypertension, the lethal outcome was at 6 (26.1%) cases. Relaparotomy at 8 (2.7%) patients with IV degree hypertension was late, and all the outcomes at these patients were lethal. General lethality at compartment syndrome was 45.2%. It is concluded that monitoring of intraabdominal hypertension should be mandatory diagnostic method, and critical parameters of abdominal hypertension--absolute indication to repeated laparotomy and decompression of abdominal cavity.

Autotransplantation of splenic tissue in two patients after total duodenopancreatectomy and splenectomy for trauma of the duodenum and pancreas has demonstrated positive results and stable compensation of insulin insufficiency in two cases. Experimental studies of autotransplantation of splenic tissue carried out on 20 cats and 100 rats with pancreatectomy- and alloxan-induced diabetes demonstrated good results too. This method may be regarded as the variant of repair therapy with stromal stem-cells of the spleen.