Abdominal Cavity Research Articles

Development of a novel fluorescent gauze using indocyanine green

Gauzes are used in various ways, including wiping blood, compressing organs, and as markers during surgery. However, losing gauze during surgery can lead to pieces being left inside the body, causing time-consuming searches and unnecessary radiation exposure. To address this, we developed a fluorescent gauze using indocyanine green (ICG), which fluoresces under near-infrared (NIR) light. This study aimed to evaluate the fluorescence intensity (FI) of the gauze and confirm its fluorescence in a porcine abdominal cavity. We dissolved 25 mg of ICG in 10 ml of glycerol, ethanol, distilled water, and 5% bovine serum albumin, then diluted each solution 5- to 106-fold with distilled water. The gauze was dyed using these solutions. A rigid laparoscope observed the fluorescent gauze in a dark room under NIR light, and FI was measured. The gauze treated with a 100-fold dilution of each ICG dyestuff showed the strongest fluorescence. This gauze was then placed in a pig’s abdominal cavity and observed under NIR light, demonstrating that the fluorescence could penetrate two or three layers of the mesentery. Our fluorescent gauze, confirmed both ex vivo and in vivo, should be manufactured for clinical use and further validated for its utility.

First experience of laparoscopic colon resection with primary anastomosis for combat-related thoracoabdominal trauma with through-and-through colon injury

Aim: to demonstrate the possibilities and advantages of laparoscopic surgery in combat-related abdominal penetrating trauma with colon injury. Materials and methods. This case report presents the first experience of laparoscopic colon resection with primary anastomosis for combat-related thoracoabdominal trauma with through-and-through colon injury. A 47-year-old serviceman sustained an explosive penetrating thoracoabdominal injury (dropping explosives from a drone) operated 10 hours after. Initial management at Role 2 included chest tube drainage, surgical debridement, and wound sealing of the chest. CT: penetrating gunshot wound with internal and external damage to the lower lobe of the left lung, perforation of the diaphragm on the left, and transverse colon perforation with a retained metal fragment, pneumoperitoneum, drained hemopneumothorax, and a gunshot fracture of the posterior third of the 5th left rib. Exploratory laparoscopy revealed no free fluid in the abdominal cavity. Surgery: the diaphragmatic perforation was sutured with a 3-0 V-loc barbed suture, the segment of the transverse colon was resected using two Endo-GIA 60 linear staplers according to the severity of injury (AAST Grade 3) and non-viable edges of colon wound. To ensure mobility, a side-to-side antiperistaltic anastomosis was performed using an Endo-GIA 60 stapler (blue cartridge). The anastomosis site was reinforced with a single-layer 3-0 V-loc suture. The procedure was completed with abdominal drainage and port site closure. Results. Postoperative recovery was without complications. The abdominal drain was removed on the 2nd day, and the pleural drain on the 5th day after the control CT scan. Follow-up after 1.5 month – returned to military service. Our case demonstrates that laparoscopic surgery can be a useful option for combat-related colon injuries when tissue damage is minimal and the patient’s condition is stable. The absence of massive hemoperitoneum and contamination confirms the feasibility of primary repair or anastomosis. Conclusions. Laparoscopic surgery for combat-related penetrating abdominal trauma with colon injuries is feasible and safe in stable patients. If there are no multiple colon injuries or significant contamination, primary repair or stapled anastomosis is a suitable option.

Laparoscopic access in treatment of reproductive system diseases in women with multiple adhesions

Introduction. Recent progress in abdominal surgery and operative gynecology has led to a significant increase in the number of patients with postoperative abdominal adhesions. The incidence of adhesions after abdominal surgery reaches 67–95%, a serious health problem. In their presence, any following operations may be associated with an increased risk of intra- and postoperative complications.Objective. To study the possibility of laparoscopic access and its outcome in the surgical treatment of women with reproductive system diseases concomitant with pronounced abdominal and pelvic adhesions.Materials and methods. A retrospective analysis of 265 patient medical records was performed. The general group included 91 women who had undergone surgery for diseases of the reproductive system in the setting of pronounced abdominal and pelvic adhesions. The second group (control) comprised 174 patients who had undergone surgery for diseases of the reproductive system and had no adhesions. The average age of the patients in the general and control groups was 47.1 ± 12.8 and 46.5 ± 8.1 years, respectively. The preoperative examination included ultrasonography and dynamic magnetic resonance imaging (MRI) of the abdominal cavity and lesser pelvis. For laparoscopic surgery, a STORZ high-resolution video system (Germany) and a BOWA power plant (Germany), including high-frequency (HF) electric, laser, and argon plasma energy, were used. Statistical data processing was carried out using the Statistica 13 and MS Office Excel software. The result was considered statistically significant at p < 0.05.Results. The conducted comparative analysis demonstrated the possibility of using laparoscopic access for the treatment of women with reproductive system pathologies in combination with pronounced abdominal and pelvic adhesions. The duration of surgery, the volume of blood loss, the severity of pain, the duration of hospitalization, and convalescence had no statistically significant differences between the general (n = 91) and control groups (n = 174). The absence of differences in the frequency of intra- and postoperative complications proves laparoscopic access to be safe in the setting of severe adhesions. The safety is ensured by preoperative patient preparation and examination, use of necessary modern equipment and tools, surgical skills and experience.Conclusions. The use of laparoscopic access for performing surgical treatment of patients with reproductive system diseases in combination with pronounced adhesions can be considered as the preferred and safe treatment method.

Sarcomatous Transformations Causing Early Recurrence in Malignant Mixed Germ Cell Tumor: From case to analysis

Aim: Our aim is to analyze the malignant mixed germ cell tumors of the ovary that recur due to sarcomatous transformation in the literature, with a case report. Materials and Methods: An electronic database search was conducted from January 1980 to January 2023 using PubMed/MEDLINE. We evaluated the 10 cases included in these articles together with our own case. Patient age (years), first surgery type, tumor types, adjuvant therapy type, recurrence time, recurrent tumor types, and recurrence site were analyzed. Results: We evaluated 11 cases, including our own. The mean age of the 11 patients was 27.36±16.39 years. Nine patients (81.8%) had rhabdomyosarcoma differentiated areas in primary pathology. Ten patients (90.1%) received adjuvant chemotherapy. The mean recurrence time was 10±8.94 months, ranging from 2 to 24 months. Reported areas of recurrence included retroperitoneal, peritoneal, pelvic, scapula, aortic bifurcation, abdominal cavity, and mediastinal area. Discussion: We compiled ten cases in the literature with rhabdomyosarcoma transformation, including our case. Although the prognosis of GCT depends on the clinical stage and location, the presence of a sarcomatous area in GCT is a factor indicating a more aggressive behavior. Diagnostic imaging, including PET-CT scans, can be used for staging recurrent lesions and demonstrating local lymphatic metastasis or lung metastasis, which may indicate sarcomatous differentiation. Conclusion: In patients with sarcomatous differentiation, the choice of chemotherapy may vary according to this component. It is important to determine the presence of the sarcomatous component in malignant germ cell tumors with detailed pathological examination. Close follow-up with radiological means is crucial to detect early recurrence and distant metastases as a result of sarcomatous transformation, as in our case.

Abdominal bleeding secondary to isolated mesenteric injury following blunt abdominal trauma: A case report.

Isolated mesenteric injury often results from traffic accidents causing blunt abdominal trauma, exhibit nonspecific symptoms and signs. Most mesenteric injuries occur concurrently with injuries to other organs, such as the liver and spleen. As a result, the incidence of isolated mesenteric injury is very low and often misdiagnosed. A 49-year-old male patient presented with abdominal pain following a traffic accident more than 5 hours before admission. Upon admission, his blood pressure was normal but dropped sharply in a short time and presented with shock. Anemia, abrasions in the upper abdomen, cold skin on the dorsum of the foot, rebound pain, muscle tension, and noncoagulation of abdominal blood were all observed during the physical examination. Emergency plain and contrast-enhanced abdominal computed tomography (CT), and mesenteric artery CT angiography revealed a large volume of blood accumulated in the abdomen, pelvis, and jejunal mesentery. The jejunal wall and mesentery were edematous, with mesenteric distortion, and some branches of the inner jejunal artery were not clearly visualized. We found no evidence of liver or splenic rupture. Mesenteric injury of the jejunum caused acute hemorrhagic anemia and hemorrhagic shock. An emergency laparotomy was performed. An emergency laparotomy showed 3 hematomas close to the perforation site, 2 fully split tears in the jejunal mesentery, bleeding from partially exposed veins, a significant amount of blood and clots in the abdominal cavity, and serosal damage at the jejunal mesentery's root. The patient recovered well after we performed abdominal cavity drainage and jejunal mesenteric hemostasis and repair. Isolated mesenteric injuries are very rare in clinical practice, and their clinical symptoms and signs are nonspecific, which makes them prone to misdiagnosis and oversight. When a patient satisfies the 4 requirements listed below: abdominal hemorrhage or hematoma; a history of abdominal trauma; no damage to high-risk organs like the liver or spleen; the CT-detected signs of mesenteric injury. Abdominal paracentesis or laparoscopy should be conducted to confirm the diagnosis and initiate further treatment.

Acute intestinal obstruction, difficulties in diagnosis in starged hernias of the opturate forana and surgical tactics

Relevance. Hernias of the obturator canal are extremely rare in surgical practice. This type occurs in 0.07% to 1% of all known hernias, in which the contents of the pelvic or abdominal organs penetrate through the obturator foramen. The hernias in question occur predominantly in elderly women of low nutrition with a large history of childbirth. This is explained by the peculiarities of the anatomical structure of the female pelvis: its pronounced slope, the larger size of the obturator foramen, the more vertical position of the obturator canal compared to the male, and the weakness of the pelvic floor muscles. Diagnosing an obturator hernia is very difficult. Being difficult to diagnose cases, strangulated hernias of the obturator canal are detected at the treatment stage and are accompanied by high mortality. Mortality for these manifestations ranges from 12% to 70%, with postoperative measurements in 11.6% of cases. These statistics provide the majority of observations provided by reputable Japanese colleagues [3]. Conclusions. Hernias of the obturator foramen, due to their rare occurrence and lack of clear clinical manifestations, are difficult diagnostic cases. Knowledge of the symptoms characteristic of this pathology, the use of computed tomography of the abdominal cavity and pelvis with contrast enhancement is extremely important, influencing the adoption of a reliably correct, quick decision for surgical intervention, largely determining the outcome of the disease. Specific diagnostics for determining obturator foramen hernia are not covered in clinical recommendations. Due to the fact that this clinical pathology is quite complex for a surgeon to quickly determine, it is detected at the stage of complications and is accompanied by high mortality. The leading clinical picture for a strangulated hernia of the obturator foramen is signs of intestinal obstruction. Correctly and timely preoperative diagnosis is crucial for the surgeon to decide on tactics. In the case of a clinical picture of intestinal obstruction, one should act on the basis of national clinical recommendations, not forgetting to manually check the location of the hernia, which will significantly reduce the time for diagnostic searches and reduce postoperative mortality in case of a strangulated hernia of the obturator foramen.

Pheochromocytomas and Paragangliomas-Current Management.

Pheochromocytomas and paragangliomas (PPGLs) are infrequent neuroendocrine hypervascular neoplasms arising within different sites of the paraganglion system. They are divided into sympathetic (including pheochromocytomas and extraadrenal paragangliomas) and parasympathetic extraadrenal tumors. These tumors are usually not malignant and grow slowly; about 90% of them are found in the adrenal paraganglia (pheochromocytomas). Extraadrenal tumors are most frequently located in the abdominal cavity (85%), followed by the thoracic cavity (12%), and head and neck (3%). About 25% of PPGLs are related to germline mutations, which are risk factors for multifocal and metastatic disease. In PPGL diagnostics, laboratory, biochemical, and imaging (anatomical and functional) examinations are used. Surgery is the standard management choice for locoregional disease. For patients who are not candidates for surgery and who have stable, not-growing, or slow-growing tumors, active observation or other less invasive techniques (i.e., stereotactic surgery, hypofractionated stereotactic radiotherapy) are considered. In metastatic disease, systemic therapies (tyrosine kinase inhibitors [TKIs], mTORC1 inhibitor everolimus, immunotherapy, cold somatostatin analogs [biotherapy], and radioligand therapy) are used. The prognosis for PPGLs is quite good, and the 5-year survival rate is >90%. The goal of this paper is to review knowledge on the etiopathogenesis, current diagnostics, and therapy for PPGL patients. Our paper is particularly focused on the current management of PPGLs.

Pentalogy of Cantrell: A challenge in prenatal diagnosis. A case report in Bolivia

Introduction. Pentalogy of Cantrell is a rare congenital anomaly with an incidence of less than one in 100,000 pregnancies. It is characterized by a defect in the abdominal wall at the level of the supraumbilical midline, the lower segment of the sternum, the anterior diaphragm, the diaphragmatic pericardium, and cardiac abnormalities such as ectopia cordis. Few cases of this entity have been reported in the literature in Bolivia. It is a constellation of congenital defects that pose a unique challenge, hence the importance of diagnosis in the prenatal stage. Clinical Case and Discussion. An 18-year-old pregnant woman came to our hospital, was consulted by Gynecology and Obstetrics, and an ultrasound was performed which revealed a defect in the anterior abdominal wall with viscera outside the fetal cavity (liver, heart, stomach and intestinal loops, 24.3 weeks of pregnancy and multiple fetal malformations. A discussion of the case was held with specialists in Gynecology and Obstetrics, Pediatrics, Genetics, Family Physician, Imaging and Psychology. Taking into account the poor prognosis and the complexity of the anomalies, the patient was told that this could represent a threat and risk for her. At the request of the parents and with prior informed consent, the patient was admitted to the gynecology service, prepared and admitted to the operating room for cesarean section. A female product was obtained, with multiple malformations, a large defect in the anterior thoracoabdominal wall from the navel to the upper third of the body of the sternum, omphalocele. Part of the heart outside the thoracic cavity, presence of a uterine cavity, and a large thoracic cavity. of defects in the diaphragm, liver and intestinal loops outside the abdominal cavity. Conclusions. The case highlights the importance of early prenatal diagnosis, even in settings with limited resources. Despite the lack of access to more complex studies, the appropriate use of ultrasound, combined with the expertise of the operator, allowed this complex congenital malformation to be identified at an early stage. The timely identification of these conditions not only facilitates multidisciplinary counseling for the pregnant woman and her family, but also opens the possibility of making informed decisions, including the option of terminating the pregnancy before the period of viability, if the parents so consider. In severe cases, such as ours, where the prognosis is generally unfavorable, an early diagnosis can better prepare families emotionally and psychologically, as well as allowing them to consider all possible options with due ethical and medical guidance.

Frailty index and its role in emergency surgery of acute abdominal diseases in elderly patients

The study involved patients over the age of 62 years with acute diseases of the abdominal cavity, who underwent surgical treatment. The patients were divided into two groups based on the Edmonton fragility index. Complications were classified according to the Clavien-Dindo system. The immediate and long-term results of surgical treatment were evaluated. Complications in the immediate postoperative period of the 2nd and 3rd degrees of severity were significantly greater in patients with a high fragility index, and complications of the 1st degree were more common in patients without fragility. In the group with a high fragility index, unsatisfied long-term results were observed, including an increased risk of re-hospitalization and a decrease in functional status. Fragility assessment plays a key role in improving postoperative outcomes in elderly patients with acute abdominal diseases.

A syndrome of non-palpable testis: history and current state of art. Literature Review

By to the domestic and foreign literature, non-palpable testes are found in 20% of cases among children with cryptorchidism. Approximately 50% of them are located in the abdominal cavity and 50% are atrophied or vanished ones. Purpose: To systematize data of the scientific literature on the syndrome of non-palpable testes in children. For the review, original articles found in the scientific source engines, such as eLibrary, PubMed, and Scopus, were used. Most often, literature sources divide non-palpable testes into three types: intra-abdominal, extra-abdominal, and non-viable. Extra-abdominal gonads are often of the normal volume, unlike intra-abdominal gonads which are mostly hypoplastic. Testicular ectopia is one of the variants of non-palpable testes when a testis cannot be detected on the usual migration path from the abdominal cavity. In children with cryptorchidism, testicular ectopia is observed only in 5% of cases, thus making it a rare case which poses certain challenges in diagnostics. There are many controversial issues regarding diagnostic methods and treatment strategies for different types of non-palpable testes in children. Most researchers recommend to use additional visualization options such as ultrasound, computed tomography, magnetic resonance imaging, and laparoscopy to confirm the presence or absence of the gonad. However, a definitive diagnosis is not always possible when based solely on ultrasound findings, as this method has limited sensitivity and specificity in detecting non-palpable gonads. The current publications state that an intra-abdominal testis can be visualized during diagnostic laparoscopy in 49% of case in boys with the non-palpable testicular syndrome and with no gonad found at ultrasound examination. Management of non-palpable testes in children, especially with high intra-abdominal gonad location, remains a highly relevant issue and requires further researches and observations.

Robot-assisted appendectomy in a child — a case report

BACKGROUND: Acute appendicitis is the most common surgical pathology requiring emergency intervention in children worldwide. The gold standard in the treatment of the disease is laparoscopic appendectomy. At the same time, advances in technology increasingly incline specialists to the introduction of robotic systems in surgical practice. This fact once again confirms the importance of research aimed at determining the feasibility of using robot-assisted appendectomy in emergency surgery in children. CLINICAL CASE DESCRIPTION: The authors made a retrospective review of the medical history of a child with acute appendicitis. A 11-year-old boy was admitted to the Irkutsk State Regional Children's Clinical Hospital with abdominal pain in the right iliac region. At the time of admission, disease duration was 20 hours. For surgery, the Versius robot manufactured by CMR company (UK) was used. Robot-assisted appendectomy followed the same principles as those used in open or laparoscopic approaches: (1) appendix exposure, (2) mesoappendix bipolar coagulation, (3) appendix removal using an endoscopic mechanical stapler. The total surgical time was 30 minutes, out of which the robot installation time was 10 minutes and the main console time was 20 minutes. The entire procedure was performed completely intracorporally and without conversion to laparoscopic or open surgery. There were no any intraoperative problems and complications. The surgery was successful. Patient’s enteral feeding started on the same day after the surgery. He was discharged from the hospital on Day 3 day after the surgery. Ultrasound of the abdominal cavity, performed 1 month later, did not reveal any signs of abnormalities observed at this age. The patient did not complain of any digestive problems during the entire observation period for 3 months after the surgery. CONCLUSION: Robotic appendectomy has its advantages and disadvantages in the treatment of acute appendicitis. Robotics provides faster postoperative recovery of patients, but requires longer time for surgery; besides, it is an expensive surgical intervention. However, over time the robot-assisted appendectomy may become a cost-effective one that will be successfully used by all surgeons, as it happened with laparoscopic appendectomy several decades ago.

Acute appendicitis complicated by peritonitis in a premature newborn: a clinical observation

BACKGROUND: Acute appendicitis in premature newborns (AAPI) is very rare case and is described as isolated observations. AAPI symptoms and clinical picture are similar to those of other acute abdominal diseases in premature newborns. Its diagnosis before surgery is one of the complex problems of neonatal surgery. This pathology is detected accidentally during surgery for other diseases. CLINICAL CASE DESCRIPTION: We present a rare clinical case of acute appendicitis complicated by peritonitis in a premature newborn aged 11 days, weighing 1200 g. After a clinical and radiological examination diagnosis of necrotic enterocolitis (NEC) and perforation of a hollow organ was put. Laparocentesis and drainage of the abdominal cavity were performed. After patient’s state stabilization three days later gangrenous perforated appendicitis was diagnosed during laparotomy 3 days later, and appendectomy was performed. Recovery complied with that of the surgical pathology. On day 13th, the patient was transferred to the department of pathology of premature babies for nursing. The child, being in satisfactory condition, was discharged home at the age of 1 month weighing 2250 g. CONCLUSION: Laparocentesis and drainage of the abdominal cavity with subsequent laparotomy and appendectomy improves outcomes in AAPI patient.

Early diagnosis of damage to internal organs in thoracoabdominal injuries

Background. Thoracoabdominal wounds in combat occupy a key place and often become the cause of mortality. Early pre-hospital diagnosis plays an important role in triage according to the degree of severity of injuries, further selection of research methods and treatment strategy. Objective: to evaluate the possibilities of ultrasonography using the FAST protocol in the early diagnosis of damage to internal organs in thoracoabdominal injuries. Materials and methods. The results of ultrasonography using the FAST protocol were analyzed in the diagnosis of gunshot thoracoabdominal injuries in 57 victims. Diagnosis was carried out using linear and convex sensors in the frequency range of 5–10 and 2–5 MHz on the Ultima Radmir device. Results. According to computed tomography scans, 113 thoracoabdominal injuries were found in 57 wounded patients. On ultrasound, signs of damage to the thoracoabdominal organs were detected in 96 (84.9 %) patients using the FAST protocol: free gas in the abdominal cavity — in 13 (11.5 %), free fluid — in 29 (25.7 %), pericardial effusion — in 12 (10.6 %), free fluid in the pleural sinus — in 19 (16.8 %), pneumothorax — in 25 (22.1 %) cases, respectively. Conclusions. Ultrasonography using the FAST protocol allows you to detect signs of damage to internal organs in thoracoabdominal injuries. When detecting free gas and liquid, the sensitivity of ultrasound using the FAST protocol was 91.4 %, specificity — 75.0 %, accuracy — 90.3 %, positive predictive value — 98.0 %, negative predictive value — 49.0 %.

Clinical characteristics of mammary gland neoplasms in cats

Mammary tumors are one of the most common neoplasms in both cats and dogs, but the degree of malignancy of such neoplasms is higher in cats. Mammary neoplasms (MN) are recorded in cats of different ages and breeds. Today, domestic science does not pay enough attention to the study of MN neoplasias in cats according to clinical and morphological criteria, since incomplete research on sick animals is performed. Single domestic studies, partially, sometimes contradictory, reflect the current state of incomplete diagnostics of the incidence of neoplasia in cats, in particular according to the TNM classification criteria. It should be understood that sick animals with cancer need to undergo a wide range of studies, including preoperative examination, laboratory and additional methods, as well as morphological assessment of neoplasms according to the TNM classification. The purpose of the research was to establish the frequency of spread of cancer diseases in cats in the city of Lviv and the suburban area of the regional center, to find out the nosological structure of mammary tumors depending on breed, age and reproductive status, as well as to study the clinical and morphological characteristics of various forms of neoplasia according to the international clinical TNM classification. The object of the research were cats with mammary tumors (n = 144) of different breeds, aged from 1 to 18 years, who were admitted (in the period from 2019 to 2024) to the clinic of the Department of Surgery, the Vet Center of the Stepan Gzhytskyi National University of Veterinary Medicine and Biotechnologies Lviv and Veterinary Medicine and veterinary clinics of the city of Lviv (“Vetplus”, “Sonovet”, “Vetclinic of Dr. Markevych”). According to the results of the studies, the largest number of cats with cancer was occupied by mammary gland tumors (47.4 %), the second and third places were occupied by tumors of the head and abdominal organs, which accounted for 16.1 % and 15.1 %, respectively. Most often, cats were diagnosed with mammary gland adenocarcinoma (95.1 %), which indicates a clear predominance of malignant neoplasms, and only 4.9 % of neoplasms were benign, in particular proliferative mastopathy, intraductal papilloma, and adenoma. It was found that the cranial (36.8 %) and caudal (38.5 %) abdominal glands were most often affected, while the left and right mammary glands were affected with almost the same frequency. 24 animals (16.7 %) were found with stage I tumor process, respectively 53 (36.8 %) with stage II, 50 (34.7 %) with stage III, and 17 (11.8 %) with stage IV tumor development. The use of additional research methods, such as general and biochemical blood tests, ultrasound examination of the abdominal cavity, and radiography of the chest cavity, is important for establishing the clinical condition of the animal and making a final diagnosis.

Liquid-bodied antibiofilm robot with switchable viscoelastic response for biofilm eradication on complex surface topographies.

Recalcitrant biofilm infections pose a great challenge to human health. Micro- and nanorobots have been used to eliminate biofilm infections in hard-to-reach regions inside the body. However, applying antibiofilm robots under physiological conditions is limited by the conflicting demands of accessibility and driving force. Here, we introduce a liquid-bodied antibiofilm robot constructed by a dynamically cross-linked magnetic hydrogel. Leveraging the viscoelastic response of the robot enables it to adapt to complex surface topographies such as medical meshes and stents. Upon actuation, the robot can mechanically destroy the biofilm matrix, chemically deactivate bacterial cells, and collect disrupted biofilm debris. The robot's antibiofilm performance is studied in vitro and demonstrated on a medical mesh and a biliary stent. Tracking and navigation under endoscopy and x-ray imaging in an ex vivo porcine bile duct are demonstrated. Last, in vivo antibiofilm treatment is conducted by indwelling infected stents into mice's abdominal cavity and clearing the biofilm infection using the proposed robot.

Employing hydrogen stable isotope analysis for traceability of invasive pine wood nematode vector insects.

Bursaphelenchus xylophilus, the pathogen responsible for pine wilt disease, significantly threatens pine forests globally, with rapid infection leading to tree mortality within 40 days. This disease spreads efficiently through vector beetles, with Monochamus alternatus and Monochamus saltuarius serving as the primary vectors and Monochamus galloprovincialis being considered a potential vector in China. Molecular traceability and stable isotope traceability are both important techniques for insect tracing, each with its own advantages and limitations. Molecular traceability, such as DNA-based methods, offers high specificity and accuracy in identifying insect species, but it may require more complex procedures and higher costs due to the need for advanced equipment and skilled personnel. Stable isotope tracing, however, provides conservative and high-precision signatures, and is label-free, making it suitable for tracing the origins and pathways of insects in complex environments. Using the method of degreasing, the fat of the sample epidermis was removed, only the bone part was left, and the abdominal cavity was emptied to prevent the food from affecting the determination of hydrogen isotope. The present study aimed to trace the geographic origins of these vector insects in China using hydrogen stable isotope ratios, providing a novel tool for disease management. Data processing and modeling were conducted using R and Origin software, yielding the equation y = 0.9822x + 19.1765. Statistical tests confirmed the model's significance and fit. Results indicate a significant positive correlation of temperature and precipitation with atmospheric hydrogen isotopic composition. Our findings demonstrate the model's applicability in tracking the spread of pine wilt vectors, offering a promising approach to forest pathogen management. If the sample isotope test value is brought into the model and marked in the partition diagram, it can be proved that the model can effectively identify the source information of the sample. © 2025 Society of Chemical Industry.

Endoscopic Negative Pressure Therapy for Post-Sleeve Gastrectomy Proximal Staple-Line Leaks: A Single-Center Experience of 40 Patients.

Post-sleeve gastrectomy (SG) proximal staple-line leak is a rare yet serious complication. Endoscopic negative pressure therapy (ENPT) has emerged as a safe technique, showing promising results in treating anastomotic leakages in the upper and lower gastrointestinal tract, often in conjunction with surgical interventions. A standardized treatment algorithm has not been established. This study aimed to assess the safety and efficacy of ENPT in the multidisciplinary management of proximal staple-line leaks after SG. This is an observational study of 40 post-SG proximal staple-line leak cases treated with an ENPT-based approach. Revisional surgery was performed in addition to ENPT in critically ill patients or nondiagnostic imaging results. Success was defined as the healing of the defect and paraluminal cavity with no further need for surgical or endoscopic intervention following ENPT. Thirty-three patients were successfully treated with ENPT (82.5% success rate). Additional surgical interventions were performed in 37 patients, with re-laparoscopy, lavage, and drain of the abdominal cavity being the most frequently performed procedures. The mean duration of treatment was 25.6 days, with an average of 6.4 endoscopic interventions per patient. ENPT is a safe and effective technique for treating proximal staple-line leaks following SG. Its application should be considered alongside other endoscopic and surgical approaches.

ПЕРЕКРУТ ДОЛЕЙ ПЕЧЕНИ У КОШЕК

The aim of the study is to describe a clinical case of torsion of the right medial lobe of the liver in a cat and to characterize the echographic markers of this pathology. The object of the study was a British Longhair cat, aged 2 years 6 months, admitted to the Pirogov Veterinary Center in Stavropol. Ultrasound was performed on a SIUI Apogee 1100 Omni scanner (Shantou Institute of Ultrasonic Instruments Co., Ltd., Guangdong, China) according to the generally accepted technique using a multi-frequency linear sensor with a frequency of 7.5–12 MHz. The cause of torsion of the liver lobe, as in a number of other des-cribed cases, has not been established. The clinical manifestation and laboratory blood test results for torsion of the liver lobe are described. This is the first clinical case in which the final diagnosis in cats was made using ultrasound. Echographic markers of complete torsion of the liver lobe include an increase in the size of the affected lobe, its heterogeneity, the presence of symmetrical thinning of the lobe, increased echogenicity of adipose tissue along the periphery of the torsed lobe, disturbances of lobar blood flow du-ring Dopplerography in the form of the presence of blood flow before the torsion area and the absence of it after the torsion area, the presence of free fluid in the abdominal cavity with a finely dispersed diffuse homogeneous suspension corresponding to hemoabdomen, as well as the presence of an ultrasound pattern of "swirl" resulting from twisting of the liver parenchyma around its axis. The combination of the described echographic manifestations of torsion of the liver lobe will allow visual diagnostics specialists to obtain the necessary information to establish the correct diagnosis, saving time, which is especially important in this urgent pathology.

WIDESPREAD PERITONITIS IN PENETRATING GUNSHOT WOUNDS OF THE ABDOMEN WITH DAMAGE TO INTERNAL ORGANS

Gunshot wounds to the abdomen are one of the most complex sections of military field surgery. The natural reaction of the body to this type of injury is the development and progressive course of widespread gunshot peritonitis. Multi-stage surgical sanitation and adequate drainage of the abdominal cavity using VAC systems are the main controlled technologies that determine the outcome of treatment of patients with this severe complication.Aim. To evaluate the effectiveness of programmed relaparotomies with staged sanation and the use of vacuum-assisted (VAL) and vacuum-instillation laparostomy (VIL) techniques in the treatment of widespread peritonitis in penetrating gunshot wounds of the abdomen with damage to internal organs.Materials and methods. A comparative analysis of the treatment results was performed for 118 patients with gunshot injuries to abdominal organs complicated by widespread peritonitis, who underwent multi-stage surgical treatment using various types of VAC therapy for drainage of the abdominal cavity.Results. The first relaparotomy according to the program was performed in 75.7% of patients after 24 hours, in 24.3% – after 36-48 hours. The number and interval between subsequent repeated sanitations were determined individually. Each stage included revision, sanitation of the abdominal cavity by multiple lavage with antiseptic solutions and installation of VAC systems. An analysis of 213 cultures from the abdominal cavity was performed. In 82.2% of the wounded, intra-abdominal complications (prolonged necrosis of the intestinal segment, perforation of acute ulcers, failure of intestinal sutures and previously applied anastomoses, adhesive intestinal obstruction, developing limited purulent leaks and necrosis, the presence of foreign bodies of gunshot origin) were effectively eliminated during programmed relaparotomies. The use of abdominal cavity drainage techniques using VAC systems (VIL, VAL) ensured faster decontamination during the treatment of gunshot peritonitis, which made it possible to reduce the number of program sanitizations and decrease the risk of complications by 32%. There were no fatal outcomes.Conclusion. The method of laparostomy with programmed sanation of the abdominal cavity, supplemented by the installation of a drainage VAC system (VAL, VIL) – made it possible to reduce the number of relaparotomies performed by increasing the time intervals, promptly eliminate complications of the wound process and even more effectively treat gunshot peritonitis.

DIFFICULTIES AND THE POSSIBILITY OF INTRAOPERATIVE ARREST OF EROSIVE BLEEDING FROM A POSTNECROTIC PANCREATIC CYST

Arrosive bleeding of pancreatonecrosis is a rare, however, life-threatening condition due to the lack of a clear arteriographic localization of the source. Most bleeding occurs against the background of infected pancreatic necrosis, as well as pseudocysts of the pancreas, which are formed due to the destruction of the ductal system. The most common causes of hemorrhagic complications of pancreatic necrosis are pseudoaneurysms of vessels involved in the blood supply of the pancreas, with their breakthrough into the free abdominal cavity, retroperitoneal space, into the lumen of the gastrointestinal tract, as well as arrosias of pancreatic vessels involved in the infiltrative inflammatory process. The literature describes isolated cases of endovascular embolization in the treatment of arrosive parapancreatic bleeding in the presence of a round-the-clock angiographic service in a surgical hospital on duty. Today there is no specific management tactics in clinical practice for patients with erosive bleeding from pancreatic cysts, which underlines the urgency of the problem. The observation of intraoperative arrest of arrosive parapancreatic bleeding in a surgical hospital on duty, devoid of round-the-clock angiographic service, is demonstrated. It highlights the difficulties in surgically identifying the source of bleeding and possible solutions.