Medical news of north caucasus 2019. Vоl. 14. Iss. 2 303 used. The greatest number of complications was observed in children with cupula agenesia after alloplasty of the diaphragm. The highest percentage of relapses (5.7 %) was recorded with limited defects of the diaphragm. Lethal cases after surgical correction of a hernia of the esophageal opening of the diaphragm were not noted; high mortality was among the newborns with diaphragm cupula agenesia (94.1 %).

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Spontaneous perforation of the external biliary tract is an extremely rare pathology in childhood, presented in the literature by description of clinical cases. To date, a unified approach to the treatment of children with this pathology has not been developed. The paper presents a clinical case of spontaneous perforation of the anterior wall of the common hepatic duct in a child of seven months, with the development of bilioperitoneum against the background of obstruction of the common bile duct by bilirubin calculi. CASE REPORT. The disease began acutely with repeated vomiting, stool acholia, dark urine, and an increase in the size of the abdomen in a 7-month-old child. Examination in the hospital revealed ascites, cholecystitis and shadows of calculi in the projection of the hepatoduodenal ligament. According to the results of laparocentesis, bilioperitoneum was noted. The patient underwent laparotomy, 300 ml of serous-biliary effusion was removed from the abdominal cavity. On the anterior semicircle of the common hepatic duct there is a defect from which bile flows. Suturing of the perforation of the biliary tree, cholecystectomy and drainage of the external bile ducts through the stump of the cystic duct were performed. The cholangiostomy was removed after 1.5 months. Follow-up 1 year and 3 months, pathology is not determined during the examination. CONCLUSIONS. Sewing up the site of primary perforation with drainage of the external biliary tract can help accelerate the reparative process with a decrease in the risk of developing a biliary fistula. Performing primary reconstructive interventions on the abdominal cavity compromised by bilioperitoneum, in our opinion, is too risky.

Acute pancreatitis in children is relatively rare, about 3-13 cases per 100,000 population annually, and complicated forms are three times less common than in the adult cohort of patients. However, recently there has been an increase in the number of acute pancreatitis in the pediatric group, which entails a relatively higher incidence of complicated forms of acute pancreatitis, including the formation of parapancreatic acute fluid accumulations, and determines the relevance of this problem for pediatric surgeons. In this article, using the example of 2 observations, the technology of puncture of a parapancreatic pseudocyst under ultrasound and X-ray control is presented, followed by the introduction of a conductor string into the cavity of the pseudocyst and further stenting of this anastomosis with two plastic double-pigtail stents. In the first case, a 12-year-old boy was operated on with idiopathic pancreatitis and the formation of an acute parapancreatic fluid accumulation in the tail of the pancreas. In the second observation, in a 10-year-old girl, the formation of a parapancreatic pseudocyst occurred as a result of drug-induced pancreatitis (a complication of long-term use of the antiepileptic drug - valproic acid). Both children were operated on using this technique. Antisecretory therapy was carried out in the postoperative period. Catamnesis after 1 year and 6 months: children do not complain, ultrasound and x-ray studies did not reveal any pathology. Conclusion. Endoscopic cystogastrostomy under ultrasound guidance is a method that has found wide application in the complicated course of pancreatitis in adult patients. These observations show its effectiveness in pediatric practice. But the relatively short period of observation of treatment results requires additional research on a much larger number of outcomes of these surgical interventions in children.