Acute Surgical Pathology Research Articles

Difficulties in differential diagnosis of preeclampsia and acute surgical pathology

Aim: to determine the prevalence of preeclampsia and HELLP syndrome among patients hospitalized in surgical departments with complaints of pain in the epigastrium, right hypochondrium and/or nausea and vomiting. Material and methods. An analysis was carried out of visits from pregnant women over 20 weeks to the surgical department in 2023 and 42 cases of hospitalization of pregnant patients with suspected acute surgical pathology hospitalized in surgical departments No. 6 and No. 7 of the Samara City Clinical Hospital No. 1 named after. N.I. Pirogov." The following parameters were assessed: age, gestational age, complaints at the time of admission, general blood test data, urine, biochemical blood parameters (ALT, AST, total protein, creatinine, urea, total bilirubin, LDH, amylase, alkaline phosphatase, CRP), the presence of protein in urine, the state of the hemostatic system, the condition of the fetus according to ultrasound, ultrasound, CTG, the presence of obstetric and gynecological pathology and somatic diseases. Results. Patients with acute appendicitis (7 out of 42 pregnant women) were excluded from the study. Of the remaining 35 patients, the diagnosis of severe preeclampsia, HELLP syndrome was made in 3 cases (8.6%), in 2 cases gestational hypertension or protineria (5.7%) - the main group. Cholelithiasis, acute cholecystitis - in 2 cases (5.7%), in other cases the diagnosis of acute pancreatitis was made - 28 patients (80.0%). The work provides a comparison of clinical and laboratory parameters of patients in two groups - with obstetric and surgical pathology. An clinical case of a combination of severe PE with the development of HELLP-syndrome and cholecystitis is also presented. Conclusions. Based on numerous literature data and the results of our work, we can confidently say that the differential diagnosis between obstetric complications such as PE and HELLP syndrome and acute surgical pathology still remains a pressing interdisciplinary problem. Severe forms of PE can take the form of acute pancreatitis, acute cholecystitis, or exacerbation of chronic diseases of the abdominal cavity and retroperitoneal space. According to the results of our observation, this phenomenon occurred in 15% of patients hospitalized in surgical departments.

Algorithm for Managing Patients Hospitalized in the Surgical Wards Due to COVID-19-Related Acute Abdominal Pathology

AIM OF THE STUDY. Was to improve the outcomes of treatment of patients with COVID-19-related acute abdominal pathology by developing and implementing an algorithm for the diagnosis and treatment of those patients.MATERIAL AND METHODS. The study involved 200 patients who were randomized into two groups. This research was retrospective, based on the analysis of the medical histories of patients hospitalized with clinical manifestations of acute abdominal pathology that developed against the background of COVID-19. All medical histories in emergency departments and centers of the Republic of Uzbekistan were analyzed in the period from the beginning of the declaration of the pandemic (March 2020) to July 2022 inclusive.RESULTS. In the context of an infectious disease pandemic (COVID–19 as an example), it is very important to develop an algorithm for managing patients with acute surgical pathology. This algorithm should include a diagnostic component with the purpose of timely diagnosis of acute surgical pathology and hospitalization in the surgical department. The next step is to identify patients with a high risk of perioperative complications and adverse outcomes. The final component of the algorithm is the correction of possible risk factors for adverse outcomes.CONCLUSION. The duration of hospitalization of patients who underwent surgery for acute abdominal pathology was significantly longer during the pandemic compared to that of in the post-pandemic period (10.35±7.01 vs. 5.83±3.85 days, p<0.001), which may be due to both changes in the structure of the pathology and a larger number of complicated forms. The application of the developed algorithm will optimize the management of patients with COVID-19-related acute surgical pathology, guarantee rapid decision-making while minimizing the risk of infection, reduce the risk of complications and adverse outcomes.

ОСЛОЖНЕННОЕ ТЕЧЕНИЕ БОЛЕЗНИ КРОНА ПРИ БЕРЕМЕННОСТИ

Crohn's disease is an inflammatory bowel disease of unknown etiology. This pathology more often affects young people, so it can occur during pregnancy and complicate its course. A case of intestinal obstruction caused by Crohn's disease during pregnancy was presented. Clinical manifestations are described; data from additional research methods and the results of morphological studies are presented. Particular emphasis is made on management of patients with acute surgical pathology during pregnancy. A brief review of the literature on this issue is presented. In the described case, the cause of intestinal obstruction was Crohn's disease, first diagnosed only during pregnancy. Complications of Crohn's disease are an indication for surgical intervention and not a reason for changing obstetric tactics: in most cases, pregnancy should be prolonged using specific therapy.

Free radical fragmentation and oxidation in the polar part of lysophospholipids: Results of the study of blood serum of healthy donors and patients with acute surgical pathology

The interaction of reactive oxygen species with cell membrane lipids is usually considered in the context of lipid peroxidation in the nonpolar component of the membrane. In this work, for the first time, data were obtained indicating that damage to human cell membranes can occur in the polar part of lysophospholipids at the interface with the aqueous environment due to free radical fragmentation (FRF) processes. FRF products, namely 1-hexadecanoyloxyacetone (PAc) and 1-octadecanoyloxyacetone (SAc), were identified in human serum, and a GC-MS method was developed to quantify PAc and SAc.The content of FRF products in serum samples of 52 healthy donors was found to be in the range of 1.98–4.75 μmol/L. A linear regression equation, CPAc&SAc (μmol/L) = 0.51 + 0.064 × years, was derived to describe the relationship between age and content of FRF products. In 70 patients with acute surgical pathology in comparison with the control group of healthy donors, two distinct clusters with different concentration levels of FRF products were revealed. The first cluster: groups of 43 patients with various localized inflammatory-destructive lesions of hollow organ walls and bacterial translocation (septic inflammation) of abdominal cavity organs. These patients showed a 1.5–1.9-fold (p = 0.012) decrease in the total concentration of PAc and SAc in serum. In the second cluster: groups of 27 patients with ischemia-reperfusion tissue damage (aseptic inflammation), – a statistically significant increase in the concentration of FRF products was observed: in 2.2–4.0 times (p = 0.0001).The obtained data allow us to further understand the role of free-radical processes in the damage of lipid molecules. FRF products can potentially be used as markers of the degree of free-radical damage of hydroxyl containing phospholipids.

Optimal content for a surgical curriculum for general practice in Rwanda: A Delphi study.

In Rwanda, a nationwide shortage of surgeons necessitates general practitioners (GPs) perform many common procedures and minor surgeries. However, GPs only receive a 1-year internship to prepare them to provide this care. We performed a Delphi survey of practicing GPs to assess essential content for a surgical curriculum for Rwandan interns to better prepare them for general practice. We invited 56 practicing GPs to participate in a two-round anonymous electronic survey in February 2023. The first round assessed demographics and solicited free-text responses to gather knowledge and procedural content suggestions for the curriculum. The second round refined these responses into key content areas. Thirty-one GPs responded to both rounds of the Delphi survey. They provided insight into the most commonly performed procedures, most important technical skills, and the top areas of surgical knowledge necessary for general practice. They expressed a need for more exposure to a variety of surgical pathologies and interventions across multiple specialties, highlighting the value of foundational skills in trauma, obstetrics and gynecology, and orthopedics, both at the beginning of their internship, as well as at the beginning of their general practice. GPs emphasized the importance of broad exposure to common acute surgical pathology and interventions across several surgical subspecialties, as well as a need for foundational technical skills and surgical knowledge. The results of our study underscore the necessity of a surgical education providing a solid basis in the foundational knowledge and techniques of surgical care.

Study of senile astheny markers against the background of acute inflammatory process in elderly and senile patients in emergency abdominal surgery

The aim of our work was to determine the influence of the acute inflammatory process on the diagnostic value of markers of senile asthenia in emergency abdominal surgery. Material and methods. The basis of the work included 92 (100.0 %) patients, the average age in the entire group was 72.0 ± 2.3 years. All patients were divided into three groups: group A – 32 (34.8 %) patients with acute surgical pathology and confirmed senile asthenia syndrome. The group included 15 (16.3 %) patients with acute cholecystitis and 17 (18.5 %) with perforation of a gastric or duodenal ulcer. Group B included 30 (32.6 %) people with acute surgical pathology, which was statistically comparable in terms of the number of surgical diagnoses to group A, but without asthenia. To determine the reliability of the inflammatory process influence on markers of senile asthenia, we formed group C – 30 (32.6 %) patients without acute surgical pathology, but with the syndrome of senile asthenia. Based on the literature analysis, we selected markers of malnutrition syndrome: total protein, albumin and cholesterol levels, and the marker of sarcopenia – somatotropic hormone. Results. Based on the comparison of the obtained results, we found a decrease in the level of total protein in groups A and C, which was not significantly different, p = 0.2519, U = 372.0. Whereas when comparing groups, A and B, a significant decrease was found in the group of patients with asthenia (A) – p = 0.0009, U = 224.0. The same data were obtained when comparing the level of albumin; in groups A and C the level of albumin was reduced but did not differ significantly between groups – p = 0.1932, U = 361.5, whereas comparing groups with senile asthenia syndrome (group A) and without it (group B), a significant difference was found – p = 0.0072, U = 268.0. When determining the cholesterol level, we did not find a significant difference between the groups with asthenia (A and C) – p = 0.0614, U = 323.0, as well as between the groups with asthenia and without asthenia with acute inflammation (A and B) – p = 0.01646. It was determined that the level of somatotropic hormone in the groups with asthenia (A and C) was equally low – p = 0.9646, U = 466.5, while when comparing the group with and without asthenia (A and B), a significant decrease in this hormone was found in group A – p = 0.0030, U = 248.5. Conclusions. The absence of acute inflammatory process influence on the diagnostic value of the studied markers of senile asthenia in the groups was determined. When comparing the results between group A (acute surgical pathology + senile asthenia syndrome) and group B (acute surgical pathology without senile asthenia syndrome), a significant decrease in the level of total protein, albumin, and somatotropic hormone was revealed, p = 0.0009, p = 0.0072 and p = 0.0030, respectively, while when comparing groups with asthenia (A and C) no significant difference was found, p = 0.2519, p = 0.1932 and p = 0.9646. The level of total cholesterol cannot be used as a marker for the diagnosis of senile asthenia in emergency abdominal surgery, as there are a significant number of factors that directly affect the results of the diagnosis. Comparison of the results of the groups with asthenia and without asthenia on the background of acute inflammatory process (A and B) showed no significant difference, p = 0.1646. The same negative results were obtained when evaluating groups with asthenia (A and C) – p = 0.0614.

Peritoneal Dialysis-Induced Encapsulating Peritonitis: Diagnostic and Therapeutic Challenges in Women with Benign Gynecological Pathology

Background: Peritoneal sclerosis (PS) and its most severe form, encapsulating PS (EPS), are rare entities that can occur in various procedures (liver transplantation, intraperitoneal chemotherapy) or secondary to medications (beta-blockers); however, PS or EPS typically occur in patients undergoing peritoneal dialysis as a form of renal function substitution. Medical or surgical treatments can be applied, but morbidity and mortality have high rates. This condition typically presents clinically as an intestinal obstruction caused by the inclusion of the intestinal loops in the peritoneal fibrous membrane. Methods: Herein, we present data from a single tertiary surgery center that has dedicated teams for patients receiving dialysis. Over 12 years, we analyzed a group of 63 patients admitted for catheter replacement/removal or for acute surgical pathology. In five cases (7.9%), we diagnosed EPS. Two patients with EPS presented with atypical abdominal pathologies requiring emergency surgery: one case of hemoperitoneum caused by a ruptured ovarian cyst and one case of uterine fibroids and metrorrhagia. Results: The definitive diagnoses were established intraoperatively and by analyzing the morpho-pathological changes in the peritoneum. The possible intraoperative challenges included laborious dissection, difficulties in restoring the correct anatomical landmarks, an increased duration of the surgical intervention and a high rate of incidents and accidents. Conclusions: The aim of the present study was to emphasize the possibility of other surgical pathologies overlapping with EPS, increasing the complexity of the surgical intervention.

Assessment of the risk of venous thrombosis and embolism in operated patients with acute surgical pathology of abdominal organs against the background of COVID–19

Assessment of the risk of venous thrombosis and embolism in operated patients with acute surgical pathology of abdominal organs against the background of COVID–19

A clinical case of surgical treatment of appendiceal stump abscess

In Ukraine, the share of patients with acute appendicitis is 89.1% of the total number of patients with acute surgical pathology. In modern surgical practice, early and late complications occupy the first place in the structure of acute surgical diseases of the abdominal organs, regardless of the age and gender of the patients, and the postoperative mortality is on average 0.15%. In the remote period after an appendectomy, despite the progress of modern surgery, a very rare complication known as inflammation of the stump of the appendix can occur. The patient, 25 years old, turned to the department of purulent surgery with complaints of a «small wound» at the site of the postoperative scar in the right inguinal area and minor purulent discharge from it. Four months ago, in July, he was operated on for acute phlegmonous appendicitis. On November 1, after physical exertion, the wound reappeared, and on November 3, the patient independently sought a consultation at the reception department of the Clinical City Hospital No3. He was examined by a surgeon and hospitalized. During the revision of the wound, a tumor‑like formation measuring 2.5x3.0x2.5 cm, as well as the parietal peritoneum, was revealed. Appendectomy was performed by the method of pouch ligation with drainage of the abdominal cavity through a separate contraperture with polyvinyl chloride drainage. After the operation, a diagnosis was established: abscess of the stump of the appendix, and external fistula of the anterior abdominal wall. The postoperative wound healed with primary tension, and the sutures were removed. The diagnosis of appendicitis may be mistakenly excluded from the clinical search due to the presence of a postoperative scar after appendectomy. A clear clinical picture of acute appendicitis or the opening of a fistula at the site of a postoperative scar in the right iliac region indicates the need for a computer tomography of the abdominal organs with contrast to establish an accurate diagnosis and choose the correct treatment tactics. The only treatment for inflammation of the appendiceal stump is a complete appendectomy with appendix removal either by open or laparoscopic surgery, which should be performed urgently to avoid further complications.

Multifaktorska etiologija atipičnog hemolitičko uremijskog sindroma - prikaz slučaja

Abstract: Introduction: Hemolytic uremic syndromes are characterized by the simultaneous occurrence of hemolytic anemia, microangiopathy, thrombocytopenia, and acute renal insufficiency. In terms of the clinical prodrome, they can be classified as typical, which is more common and occurs in 90% of cases, often preceded by diarrheal syndrome induced by enterohemorrhagic Escherichia coli. Alternatively, there is an atypical and rarer form associated with pneumococcal infection, dysregulation of the alternative complement pathway, and cases involving the use of cyclosporine. Hemolytic anemia is confirmed in laboratory analyses (presence of fragmented red blood cells, decreased hemoglobin, undetectable haptoglobin values, and elevated LDH values), along with thrombocytopenia and an increase in nitrogenous substances (urea and creatinine). Case report: The report details the case of an 18-month-old girl who experienced acute renal insufficiency subsequent to a respiratory infection. Ten days preceding admission, the patient exhibited nasal discharge, and during the seven days leading up to hospitalization, she presented with fever. Furthermore, two days prior to admission, the onset of persistent vomiting and abdominal pain occurred. Suspected of bowel intussusception, the patient underwent a surgical assessment where acute surgical pathology was ruled out. The absence of urination, coupled with heightened urea and creatinine levels, prompted consideration of hemolytic-uremic syndrome, later confirmed as atypical during hospitalization. This was grounded in the clinical presentation, devoid of diarrhea syndrome but marked by nasal discharge over the preceding ten days. The administration of fresh frozen plasma yielded no improvement, and there were decreased values of the C3 complement component, H factor, and reduced ADAMTS13 activity. The lack of verotoxins from enterohemorrhagic Escherichia coli further supported the diagnosis of atypical hemolytic-uremic syndrome. After the first dose of eculizumab, a terminal complement C5 component inhibitor, the girl recovered renal function and established diuresis. Conclusion: The prompt diagnosis of atypical hemolytic-uremic syndrome is challenging due to nonspecific symptoms like nasal discharge, vomiting, fatigue, and abdominal pain. Laboratory analyses, lacking specific criteria, make it difficult to conclusively identify aHUS at the disease's onset. In Serbia, pneumococcal immunization is recommended as a preventive measure, administered through a conjugated vaccine in three doses starting from the second month of life. Rapid and accurate differentiation between typical and atypical HUS is crucial for effective treatment and prognosis. Typical HUS requires hemodialysis and plasmapheresis, whereas atypical HUS is managed with plasmapheresis, immunosuppressive therapy, and eculizumab. Administering eculizumab heightens the risk of meningococcal infection by inhibiting the C5 complement component. Therefore, it is crucial not to disregard the importance of meningococcal immunization.

Atypical course of incarcerated post-traumatic diaphragmatic hernia

The article focuses on the instrumental imaging methods which greatly enhance the possibilities when arriving at correct and quick diagnosis of acute surgical pathology. Analysis of clinical and anamnestic data of the disease course and the results of instrumental research methods made it possible to arrive at clear clinical diagnosis, determine the indications for surgical treatment in this specific clinical case. The use of modern visualization methods while examining the patients prevents errors in diagnosis and helps to determine the optimal treatment tactics.

Endoscopic stenting of a tumor of the rectosigmoid junction

Annotation. Obturational obstruction of the large intestine of tumor genesis belongs to acute surgical pathology and the issue of operative tactics in this case is extremely important in emergency surgery. The current trend in the treatment of complicated colorectal cancer is to carry out radical surgical interventions with the formation of primary anastomoses and compliance with basic oncological principles. However, carrying out such interventions under adverse conditions, including neglected oncological processes, the presence of severe concomitant pathologies, late hospitalization, instability and uncompensated indicators of the patient's homeostasis, leads to a high risk of developing various postoperative complications and postoperative mortality. Therefore, the use of endoscopic methods of restoring the patency of the large intestine with the help of stents is becoming widely used. Endoscopic colonic stenting is one of the modern, promising methods of treatment for patients with intestinal obstruction. It is characterized by minimal invasiveness, and a significantly lower frequency of post-surgery complications and mortality. According to the recommendations of the European Society of Gastrointestinal Endoscopy, colonic stenting is used for patients with clinical symptoms and radiological signs of tumor obstruction of the colon without signs of perforation; installation of a stent for compensation of homeostasis systems, for comprehensive preoperative preparation (if necessary, with the use of chemotherapy or X-ray therapy). The article presents the results of our own clinical observation of an endoscopic colonic stenting case as a method of symptomatic treatment of colonic obstruction in a patient with colorectal cancer and severe concomitant diseases. We analyzed the peculiarities of using colonic stents and determined the importance of mastering this method for proctologists and oncoproctologists.

Why aren't patients having emergency laparotomy when presenting with acute surgical pathology - a single site experience

Abstract Aim To establish the documented cause for not proceeding to emergency laparotomy for the acute general surgical patient Methods Retrospective single site review of all emergency patients admitted over three calendar months. Identification of and further collection of data for patients that did not proceed to Emergency Laparotomy despite indicative pathology. Results A total of 619 emergency general surgical patients were admitted from 1st January to 31st March 2023. 39 (6.3%) patients had an Emergency Laparotomy. 17 (2.7%) patients did not proceed to laparotomy despite pathology that could indicate the need for emergency laparotomy. 100% of these patients has CT imaging to diagnose the pathology. Of the 17 patients without laparotomy median age of 86 years (range 42 – 91 years) and 12 were female. Two patients made the decision that they did not want to proceed with emergency laparotomy, both male (75 and 88 years old) and both were reviewed by Care of the Elderly. Relatives were also involved with decision making. Both died in hospital. Two were managed conservatively, the decision was made by the Consultant Surgeon, both patients were female (42 and 55 years old) and both survived to discharge and at 30 days. All remaining 13 patients had documentation of frailty as being the cause for not proceeding. Although all >65 years, 4 did not see a Care of Elderly. 4 patients survived to 30 days. Conclusion Principles of futility in medical care are published in literature and surgeons should use these in documentation for clarification.

ОСТРАЯ ПЕРФОРАТИВНАЯ ЯЗВА ТОЩЕЙ КИШКИ У РЕБЕНКА С ЮВЕНИЛЬНЫМ ДЕРМАТОМИОЗИТОМ (СЛУЧАЙ ИЗ ПРАКТИКИ)

Background. Juvenile dermatomyositis (JD) is an inflammatory myopathy in children with predominant involvement of the proximal muscles of the extremities, the development of systemic vasculitis and characteristic skin changes. It is accompanied by progressive muscle weakness, including smooth muscles of the respiratory and digestive organs, as well as striated muscle tissue of the heart. Joint damage and calcification are noted. JD is confirmed by the detection of myositis antibodies in the blood. Corticosteroids and cytostatics are usually prescribed. It should be noted that as of 2023, only 4 patients with this disease were registered in the Republic of Belarus. Objective. To demonstrate a rare case of diagnosis and treatment of perforated jejunal ulcer in a child with JD. Material and methods. Data from the clinical observation of patient Sh., aged 3, treated in the department of emergency surgery of Grodno Regional Children's Clinical Hospital in October 2023. Results. The child was admitted to the children's hospital complaining of abdominal pain, vomiting (3 times), the duration of the disease being 17 hours. The dynamic observation revealed no acute surgical pathology. Acute gastritis was diagnosed, the concomitant pathology being JD (acute course, 2nd degree activity). On the 5th day (on the day of discharge) the child had a sudden bloating. Plain radiography revealed free gas under the diaphragm. The child underwent diagnostic laparoscopy that detected a perforated jejunal ulcer with peritonitis. Laparotomic jejunum resection with anastomosis was performed. Conclusions. We have presented a case, which the surgeons of our hospital have faced for the first time. Having analyzed literature data, we came to the conclusion that the complication was related to the underlying disease and its therapy with corticosteroids. Despite the complexity of the disease, the patient was discharged with an improvement in his condition.

Influence of the novel coronavirus infection pandemic on the structure of visits and hospitalization of children with emergency surgical pathology

BACKGROUND: The new coronavirus pandemic has dramatically impacted our lives. This study aimed to analyze the structural changes in providing emergency surgical care to children during the COVID-19 pandemic.
 AIM: The purpose of this work was to analyze.
 MATERIALS AND METHODS: We compared the number of people seeking emergency surgical care in the emergency department during the period of strict coronavirus restrictions to the same period the previous year (2019) and the number of patients hospitalized for emergency surgical treatment.
 RESULTS: Compared with the pre-COVID period, the number of visits from children with suspected acute surgical pathology (acute appendicitis, purulent-inflammatory diseases of soft tissues, and injuries of the abdomen and chest) decreased by more than twofold (from 527 to 241 patients, p 0.01). A similar trend was observed with hospitalizations, which significantly decreased from 139 to 66 children (p 0.01).
 CONCLUSIONS: The data revealed referral and hospitalization characteristics of children with acute surgical pathology. Thus, the new coronavirus pandemic has significantly impacted the delivery of emergency surgical care to children.

Analysis of working conditions, social status and health of migrant worker

Labor migration has socio-economic significance in the interests of both the host country and the country of origin. Difficult working conditions, unfavorable living conditions increase the risk of developing diseases. An analysis of the health status of migrant workers in different countries revealed that infectious diseases, injuries, including industrial, acute intoxication and acute surgical pathology are most common. Women’s health requires special attention. A study conducted at the GBUZ «GCB No. 13 DZM» revealed that the largest number of patients were from Kyrgyzstan, Tajikistan, Uzbekistan. Acute surgical pathology, injuries, gynecological diseases prevail among the reasons for hospitalization. Among the diseases of the therapeutic profile, cirrhosis, hepatitis, acute intoxication, diseases of the urinary and reproductive system, diseases of the circulatory system and cerebrovascular diseases are most common. Attention is drawn to the short period of stay in the hospital –2.4 days. Russia has taken measures aimed at preserving the health of migrant workers. Since December 2021, a medical examination has become mandatory. The developed measures to improve the quality of medical examinations of migrant workers are aimed at early detection and prevention of diseases.

Рівень післяопераційних ускладнень при хірургічній патології органів черевної порожнини та порожнини таза в дівчат

The frequency of the development of adhesion disease after surgical interventions on the abdominal cavity is 63-93%. In women who have complications, in the form of confirmed adhesion disease, there is infertility and miscarriage, menstrual cycle disorders in 60% of cases. It should be noted that among women with adhesions, 8.02% had ectopic pregnancies. In addition, every fifth woman with adhesions in the abdominal cavity has endometriosis - 3.08% of cases. Postoperative complications in patients operated on for acute appendicitis are 4-15%, and the mortality rate of acute appendicitis is 0.1-10%. Purpose - to analyze the level of postoperative complications in girls operated on for acute surgical pathology of the pelvic organs by laparoscopic or laparotomy methods. Materials and methods. An analysis of the treatment of 297 girls who were undergoing inpatient treatment for surgical pathology of the pelvic organs at the Pediatric Surgery Clinic of National Pirogov Memorial Medical University, Vinnytsia, Ukraine on the basis of the Vinnytsia Regional Pediatric Clinical Hospital of the Vinnytsia Regional Council during 2018-2022. Results. In children who underwent laparoscopic appendectomy, the rate of postoperative complications was 8 times lower compared to open methods. The use of laparoscopic technologies in the treatment of gynecological pathology in girls, in particular, in teenagers, allowed to reduce the number of postoperative complications by 5 times. Conclusions. In general, it should be recommended, according to indications, to introduce into clinical practice laparoscopic methods of diagnosis and treatment of surgical pathology of the abdominal cavity and pelvic cavity. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.

A clinical case of small intestinal intussusception caused by metastatic melanoma

Intestinal obstruction is observed in about 9.0 % of patients with acute surgical pathology of the abdominal cavity. The disease occurs at any age, but more often between 25–50 years. Mixed intestinal obstruction is only 3–7 %. The most common form of mixed intestinal obstruction is intestinal invasion. The most common cause of intussusception in adults is an intestinal tumor. Early diagnosis and the optimal amount of surgical treatment are the main components of successful treatment of the patient.
 Aim: to familiarize practitioners with a rare case of intestinal obstruction in adults and its management strategies in a surgical hospital.
 Materials and methods. The patient was treated in the surgical department of the Communal Non-Profit Enterprise “City Hospital No. 7” Zaporizhzhia City Consul. The patient underwent preoperative preparation and surgical intervention.
 Results. The patient underwent an emergency median laparotomy under total intravenous anesthesia with artificial lung ventilation. During the examination of the abdominal cavity, multiple distended loops of the small intestine were visualized. During the revision, at a distance of 1.5 meters from the ligament of Treitz, a volumetric formation of the small intestine of dense-elastic consistency, represented by small-intestinal invasion, up to 10 cm long, was detected. The proximal sections of the small intestine are distended, light purple in color. The sections of the small intestine that were distal to the site of invasion were inflamed. Manual disinvagination of the small intestine was performed. The visual examination showed that the intestine was viable. There was a tumor was found on the antrumeral margin, measuring 1.8 × 2.5 cm, dense in consistency, finely tuberculated, dark purple heterogeneous in color, infiltrating and deforming the wall of the small intestine. Resection of the invaded area of the small intestine with the tumor was performed with the imposition of a small-small intestinal anastomosis “side to side” with two-row nylon sutures.
 Conclusions. In this clinical case, it was possible to establish the final diagnosis and determine further surgical strategy only intraoperatively. Only early diagnosis of melanoma will allow avoiding the complications identified in this patient.

IMPROVEMENT OF DIAGNOSTIC METHOD FOR MICROCIRCULATORY DISORDERS IN ACUTE PANCREATITIS

Introduction. Acute pancreatitis (AP) is one of the most common diseases of the digestive system that requires hospitalization. It ranks the second position after acute appendicitis among acute diseases of the digestive system. The mortality rate from severe AP forms puts this disease in the first position in terms of lethality rates among acute surgical pathology of the abdominal cavity. At the initial stages of the disease, a cascade of immunological reactions occurs that leads to significant changes in rheology and function in the systemic microcirculatory bed in the first hours of the disease. This study aims to identify the optimal point of examination for assessing microcirculatory function in patients with AP and to improve the diagnostic and prognostic capabilities of laser Doppler flowmetry (LDF) in evaluating the AP severity.
 Materials and methods. The assessment of the microcirculatory state of patients by the LDF method was carried out using “LAKK-02” device. During the application of the LDF method, the primary studies were carried out at three points (proximal, central and distal) of the anterior surface of the right forearm. In order to study the effect of indicators on the degree of disease severity, paired correlation coefficients for each of them were calculated for the above-mentioned points.
 Results. All generalized microcirculation indicators (for M - 0.679, for o - 0.653, for Kv - 0.706), as well as respiratory, cardiac and neurogenic indicators in amplitude wavelets at the distal point, have the most significant and considerable impact compared to other points. On the other hand, frequency wavelet data have no significant correlation with the severity of AP in any of the examination points, which characterizes this wavelet as not significant in determining the degree of severity of AP in the 1-3 day examination.
 Conclusion. The findings of this study suggest that by focusing on specific examination points, it is possible to reduce overall exposure and obtain homogeneous data on essential indicators. This approach enables a more comprehensive and higher quality analysis of wavelet indicators, thus improving the diagnosis and prognosis of AP severity.

Clinical case severe course of coronavirus infection (COVID-19) in a child

A clinical case of a severe course of coronavirus infection (COVID-19) in an adolescent is described. A 15-year-old patient was admitted to the surgical department with suspicion of acute appendicitis. According to the results of the ultrasound examination of the abdomen it was decided to perform diagnostic laparoscopy, which excluded the presence of acute surgical pathology. The increase of intoxication symptoms and the data of epidemiological anamnesis, concerning the contact with patients with the catarrhal symptoms 3-4 weeks before the disease onset, were the reason for the examination for SARS-CoV-2. On the basis of a positive polymerase chain reaction for SARS-CoV-2 and existing pneumonia according to X-ray examination of the chest, the patient was transferred to an infectious disease hospital. Further examination revealed polyserositis (ascites, pleurisy); acute kidney damage (high levels of urea, creatinine, oliguria); cytolytic syndrome (increased level of aspartate aminotransferase in 1,7 times); high level of C-reactive protein and increased level of procalcitonin, which corresponded to the local infection. After the administration of the first dose of intravenous immunoglobulin the patient's condition has improved significantly. The set of symptoms of multiple organ damage in this clinical case provides grounds for differential diagnosis between coronavirus disease and multisystem inflammatory syndrome in children on the background of the coronavirus infection COVID-19. Based on the diagnostic criteria for multisystem inflammatory syndrome in children presented by the World Health Organization, the Centers for Disease Control and Prevention, the British Medical Journal, the American Academy of Pediatrics, this clinical case can be considered as multisystem inflammatory syndrome.