No abstract

Patient: Female, 19Final Diagnosis: Acute perforated appendicitis • appendiceal abscess • secondary necrosis of the ileal wallSymptoms: Right lower quadrant abdominal pain • feverMedication: —Clinical Procedure: Diagnostic laparoscopy • open drainage of an appendiceal abscess • appendectomy • ileal resectionSpecialty: SurgeryObjective:Management of emergency careBackground:Resectional procedures for advanced and complicated appendicitis are performed infrequently. Their extent can vary: cecal resection, ileocecectomy, and even right hemicolectomy. We present a very rare case of appendectomy that was combined with partial ileal resection for severe necrotic changes and small perforation of the ileum.Case Report:A 19-year-old female patient was hospitalized with right iliac fossa pain and fever 10 days after the onset of symptoms. On laparoscopy, a large mass in a right iliac fossa was found. The ultrasound-guided drainage of the suspected appendiceal abscess was unavailable. After conversion using McBurney’s incision, acute perforated appendicitis was diagnosed. It was characterized by extension of severe necrotic changes onto the ileal wall and complicated by right iliac fossa abscess. A mass was bluntly divided, and a large amount of pus with fecaliths was discharged and evacuated. Removal of necrotic tissues from the ileal wall led to the appearance of a small defect in the bowel. A standard closure of this defect was considered as very unsafe due to a high risk of suture leakage or bowel stenosis. We perform a resection of the involved ileum combined with appendectomy and drainage/tamponade of an abscess cavity. Postoperative recovery was uneventful. The patient was discharged on the 15th day.Conclusions:In advanced appendicitis, the involved bowel resection can prevent possible complications (e.g., ileus, intestinal fistula, peritonitis, and intra-abdominal abscess). Our case may be the first report of an appendectomy combined with an ileal resection for advanced and complicated appendicitis.

Аррозионные кровотечения осложняют хронический панкреатит (ХП) в 4-7,7% случаев [1-3]. Деструкция панкреатических протоков, особенно при наличии панкреатической гипертензии, приводит к формированию псевдокисты (ПК), частота которых при ХП достигает 50-60% [2-4]. Высокая протеолитическая активность панкреатического сока способствует аррозии артериальных сосудов, формированию ложных аневризм-ЛА [1, 3, 4]. ЛА развиваются чаще всего из селезеночной, гастродуоденальной артерий и их ветвей [1, 3, 4]. Целостность ЛА часто нарушается. К этому может привести обострение ХП [1, 3]. Летальность при кровотечении из ЛА достигает 60-80% [1, 3, 4]. Однако в связи с появлением рентгеноэндоваскулярных вмешательств (РЭВВ) и разработкой новых конструкций для эмболизации и стентирования сосудов кровотечение из ЛА уже не носит фатального характера. Селективная ангиография (АГ) позволяет выявить источник кровотечения, а эмболизация создает стойкий гемостаз [1, 3, 4]. Материал и методы Приводим собственное клиническое наблюдение. Больной А., 43 лет, поступил в клинику в экстренном порядке 10.07.13 с жалобами на боль в верхних отделах живота, тошноту, рвоту. Из анамнеза известно, что пациент много лет страдал ХП. При ультразвуковом исследовании (УЗИ) брюшной полости, магнитнорезонансной холангиопанкреатографии (МРХПГ) выявлены признаки панкреатита, киста головки ПЖ диаметром 6 см, связанная с протоком ПЖ (рис. 1). Киста дренирована под контролем УЗИ. Больному выполнена фистулография (рис. 2).

The Maikopsk diversion-dam-type hydroelectric station is located on the middle course of the Belaya River, a left tributary of the Kuban' River. The head is created by a dam of the station center with a 14-m rise of the water level in the river above its natural level and by the difference of gradients (8 m) and lengthof the stretch of the river and diversion canal on a 3-kin straightened meander. The gross head is 22 m.The Belaya River is supplied by surface runoff from precipitation, melting of snow and glaciers and groundwater. Its discharge during 45 years of observations varies from 2 to 780 mS/see, the average being 55 m3/sec. The bottom slope of the river in the region of the station before construction of the structures was 0.003, which generated a rather considerable scouring force, especially during passage of floods, which occur 10-15 times a year. The floods build up within 10-12 h with a rate of increase of discharge up to 60 mS/see in 1 h, after which a drop, lasting about 2-3 days, begins.The suspended-load discharge averages 27 kg/see and the average annual silt load is 0.49 kg/m 3. During the year the silt content varied from zero to 8-10 kg/m s. The grain-size distribution of the suspended load is given in Table 1.The bed load has not been studied; it is customary to consider that it amounts to 10% of the suspended load.The river bed consists of a movable sand-gravel-pebble mixture. The grain-size distribution of the bed material is shown in Table 2. The specific weight of the bed material is between 2.66-2.77 tous/rn 3. Frequent local scouring of the river bottom occurs during floods and reaches 6 m in depth and there is local deposition of the washed-out soil.The Maikopsk station operates from the stream flow; the discharge of the turbines is 60 m3/sec. A n excess of water in the river as opposed to the station's requirement is observed for about 110 days of the year; the water is discharged at the head works into the old channel of the Selaya River. Flowing through a 3-kin channel, the water approaches the mouth of the station tailrace, causing a rise of water in it. During the remaining time (about 250 days per year) the entire flow is taken into the diversion canal and passes through the station's turbines.The backwater on the head works is created by a reservoir which originally had a total capacity of 2.7 million m 3. During the first 4 years of operation of the station (beginning in June 1950) the reservoir was filled with 2 million m s of sediment.Removal of sediments from the river flow increased still more its scouring capacity. This led to a lowering of the river bottom for an appreciable distance from the head works downstream. On the stretch of river near the mouth of the tailrace the river bottom was lowered 0.5 m just during the first 2 years of operation and the water

No abstract