ель исследования. Изучить возможности МСКТ в выявлении причины острой абдоминальной боли (ОАБ) у пациентов без травмы в анамнезе. Материалы и методы. Проведен анализ результатов МСКТ органов брюшной полости и малого таза у 880 пациентов с острой абдоминальной болью, поступивших в приемное отделение ГКБ им. С.П. Боткина в течение 2018 года. Всем пациентам после первичного осмотра хирургом приемного отделения выполнялись рентгенография органов грудной клетки, брюшной полости и УЗИ органов брюшной полости в качестве методов первого ряда. При недостатке полученных данных для постановки диагноза выполнялись КТ исследования на 128-срезовом томографе Phillips Ingenuity Core, с толщиной среза 1 мм, нативно, с пероральным и/или внутривенным введением водорастворимого неионного йодсодержащего контрастного вещества в зависимости от предполагаемой патологии. Все результаты МСКТ сопоставлялись с задокументированным окончательным диагнозом. Результаты. По данным МСКТ структура заболеваемости изучаемой группы пациентов выглядела следующим образом: острая кишечная непроходимость (в том числе опухолевая)-27%, острый панкреатит-9%, почечная колика-8%, опухоли органов брюшной полости (в том числе метастатическое поражение паренхиматозных органов, но исключая стенозирующие просвет кишки)-7%, абсцессы (паренхиматозных органов и паракишечные)-6%, нарушения мезентериального кровоснабжения-3%, воспалительные изменения желчных протоков и желчного пузыря-3%, перфорации полых органов-2%. У 5% пациентов убедительных данных за наличие патологических изменений органов брюшной полости и малого таза выявлено не было при сохранении клинической картины острого живота. Показатель диагностической эффективности МСКТ для перечисленных заболеваний варьировал от 95% до 97%, показатели чувствительности и специфичности метода в зависимости от заболевания составили 95-97,8% и 93,2-97%, соответственно. Выводы. При неоднозначных клинических, лабораторных данных и результатах методов медицинской визуализации первого ряда (рентгенография, УЗИ) МСКТ проявляет высокую информативность и точность, что позволяет в кратчайшие сроки установить диагноз и назначить своевременное, адекватное лечение у пациентов с острой абдоминальной болью без травмы в анамнезе.

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Страница 61of hemorrhage (non-traumatic hematoma) in the brain can be a hypertensive crisis, aneurysm rupture, hemorrhagic transformation of an ischemic stroke, and a brain tumor. As a rule, differential diagnosis of ischemic stroke has to be performed with astrocytic brain tumors. Also, ischemic stroke should be differentiated from such inflammatory diseases of the brain as encephalitis and vasculitis. Thus, in terms of admissions, multidisciplinary medical institutions have to deal with a variety of acute brain diseases, tomography picture which can be similar and different tomographic manifestations ("masks") of the same pathological processes that requires a mandatory comparison of CT -and MRI-semiotics of these pathological processes with a history and clinical disease.

During laparoscopic surgery for colorectal cancer, vascular structures may be incorrectly identified and damaged due to ignorance of the variant anatomy of the inferior mesenteric artery (IMA), lack of tactile sensations, narrowed field of vision, which leads to complications such as massive bleeding and intestinal ischemia. Therefore, the preoperative study of the variant anatomy of the IMA is of paramount importance. Knowing the variant anatomy of the vessels before surgery, you can make an operation plan in advance, which will ensure fast and safe vascular ligation at the required level and lymph dissection.Aim: To develop a classification of IMA variability for practical use in operations for colorectal cancer. Optimize the standard abdominal scanning protocol to improve the accuracy of MSCT and the best visualization of the IMA and its branches.Material and methods. From February 2013 to March 2022, 214 computed tomograms (CT) of abdominal organs with intravenous contrast were analyzed. We studied the variant anatomy of the IMA. The abdominal cavity scanning protocol was optimized using a 100 kV tube voltage, the contrast density of the NBA and its branches was compared using standard and optimized scanning protocols during a retrospective analysis of 105 CT studies of abdominal organs.Results. We proposed the classification of structure of the IMA and its branches. This is especially important when the safe lymph node dissection along the IMA is necessary. I type – several colonic branches derivate from the IMA by independent trunks (54%); II type – all colon branches derivate from the IMA in one point like a “goose paw” (25%); III type – one colon branch departs from the IMA by a single trunk; then it divides into colonic branches (21%).The accuracy of MSCT of the abdominal organs with intravenous contrast, which was determined by comparing the results of studies with intraoperative data, was 97.9%. The sensitivity of the method is 95.8%, the specificity of the method is 100%.The use of a scanning protocol with a tube voltage of 100 kV makes it possible to simplify and speed up the determination of the anatomical type of structure, improve the visualization of the IMA and its branches.Conclusion. CT with 3D-reconstruction of vessels allows the surgeon to perform an extended LND for colorectal cancer with a minimal risk of complications.

Acute abdominal pain (AAP) is a clinical symptom complex that develops with injuries and acute surgical diseases of the abdominal organs. This condition is one of the most frequent causes of admission of patients to the hospital through the ambulance. Patients with AAP consist of a large and heterogeneous group at the same time due to the etiology and many variations of the clinical picture of this condition. The article presents the results of CT scan of the abdominal cavity and small pelvis in 5 patients with AAP admitted to the S.P. Botkin Moscow City Clinical Hospital emergency department during 2017–2018, without indication of the possible traumatic nature of the pathology. All patients underwent a primary surgeon examination and first-line medical imaging methods such as plane radiography and ultrasound. The selection criterion for inclusion in the search was the need for CT due to the lack of data obtained for diagnosis. Subsequently, the findings of the CT scan were compared with the final diagnosis in the electronic medical file of the patient concerned, to assess the contribution of CT data to the diagnostic process. In a group of 5 patients included in the study, the results of CT were the decisive step in the diagnostic process in 100% of cases. Therefore, the study emphasizes the importance of using CT in patients with AAP. Using this method allows you to complete a diagnostic search as soon as possible from the time the patient enters the hospital, to begin timely treatment.