This clinical observation is an example to show the complexity of diagnosing and treating children with SARS-CoV-2-associated multisystem inflammatory syndrome. A 17-year-old patient who had a mild form of COVID-19 two weeks ago had a fever again and felt severe abdominal pain, and his general condition deteriorated rapidly. Moreover, on the fifth day from the onset of the disease, a child from the district hospital was admitted to the Ivano-Matreninsky Childrens Hospital in critical condition. Due to peritoneal symptoms, a diagnostic laparoscopy was performed to exclude acute surgical diseases which revealed mesadenitis and hydroperitoneum. Subsequently, the patient had a prolonged fever, severe multiple organ failure developed, including myocarditis with damage to the conduction system of the heart and a marked decrease in the left ventricular ejection fraction, bilateral pneumonia, hydroperitoneum and hydrothorax, acute kidney injury, lymphopenia, thrombocytopenia, coagulopathy, increased markers of inflammation. Non-invasive artificial lung ventilation was performed for 3 d. On day 10, an atrial temporary pacing system was installed, removed 11 d after heart rhythm normalization, and the pleural cavity was drained due to spontaneous pneumothorax. There was a gradual positive trend in respiratory status, the state of the cardiovascular system, normalization of laboratory parameters, and a decrease in inflammation markers. The patient was discharged from the hospital in a satisfactory condition on day 39. This clinical case demonstrates a severe course of childhood inflammatory, multisystem syndrome with multiple organ failure. The peculiarities of the case include the severity of abdominal pain syndrome, requiring laparoscopy, impaired cardiac activity, and requiring a pacemaker for 11 days.

Introduction. The earliest mention of total colonic aganglionosis, as the form of Hirschsprung’s disease, is dated 1926. According to various sources, total colonic aganglionosis is met approximately in 1 per 500 000 live births. Currently, the curative strategy in total colonic aganglionosis is strongly personalized. There are various surgical techniques for managing this severe congenital colon anomaly. Recent achievements in pediatric coloproctology have minimized the mortality rate in children with intestinal neuronal dysplasia and total colonic aganglionosis. However, despite of the evident progress in coloproctology, questions about the volume of reconstructive surgery in total colonic aganglionosis, application of “reservoir” surgical techniques so as to promote child’s further development and socialization are still unsolved.Material and methods. The patient was successfully treated with a reservoir technique which included an ileo-transverse anastomosis by Martin-Kimur with the formed conduit pulled to the anterior abdominal wall. Then, a radical intervention was made which consisted of combined abdominoperineal transanal endorectal pull through (TEPT) of the ileo-transverse conduit/reservoir, of the resection of rudimentary colon and a coloanal anastomosis by Boley.Conclusion. The obtained small intestine-colon reservoir in total aganglionosis allows to preserve motor function due to peristaltic movements of the small intestine wall and to prevent intestinal obstruction, thereby facilitating the physiological function of the intestine. In addition, the colon wall in the reservoir saves the area of absorbing surface and minimizes water-electrolyte disorders.

Introduction. One of the actual problems of reconstructive colorectal surgery in childhood is a high frequency of complications after the initial reconstructive procedures for Hirschprung disease. Currently, in the clinical practice there is a wide range of surgical techniques, the combination of which allows to avoid serious outcomes leading to child’s disability. The choice of the volume of repeated surgeries is strictly individual, depending on the nature of complications, types of previously performed surgeries as well as on patient’s initial status. The key for developing a curative tactics is findings after instrumental and morphological examination which were obtained for previous interventions and which often require additional further clarification.Material and methods. In 2010–2021, in the Center of Pediatric Colorectal Anomalies (Irkutsk, Russia) redo endorectal pullthrough surgeries were performed in 18 patients with Hirschprung disease after previous correcting interventions. Surgeons made transanal resection in combination with posterior sagittal perineotomy. Indications for repeated surgical procedures, in most cases, were residual aganglionic segments and the constipation relapses – 11 (61,2%) patients; scar deformation and anus channel stenosis – 5 (27,8%) patients; stricture of coloanal anastomosis – 1 (5,5%) patient; scar stenosis of the neorectum with a rectobulbar fistula – 1 (5,5%) patient.Results. 13 (72,2%) patients had good clinical outcomes: no parents’ complaints, stable rhythms of defecation (from 1 to 4 times per day), feces contents (type 3–6 by Bristol scale of feces). In 4 (22,2%) cases, there was chronic constipation where defecation was 2–3 times a week with preserved defecation urgencies and rare episodes of anal overflow incontinence requiring conservative treatment under the bowel emptying program. One patient had a stricture of coloanal anastomosis which was corrected with its dissection and further dilatation.Conclusion. To confirm indications for redo surgeries, a comprehensive assessment of the colon and perineum with clinical, functional and morphological examination is required. Transanal pull-down is a relatively safe procedure which, in most cases, has good and satisfactory clinical postoperative results and which may be performed even after previous endorectal resections. The rehabilitation program after the discussed surgery is strictly personified and developed under close interaction of a surgeon and a gastroenterologist after assessing the state of the formed coloanal anastomosis and the distal part of the pulled-down intestine.

BACKGROUND: In the presence of severe comorbid pathology, children get sick with coronavirus disease 2019 (COVID-19) as severe as adults. CASE REPORT: This paper describes the treatment of a 17-year-old patient with severe bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 that damage a large volume of the lung tissue (69% on the right, 87.1% on the left, and grade IV lung lesions according to computed tomography) with an unfavorable premorbid background (grade IV obesity with a body mass index of 54.5 kg/m2, Down syndrome, moderate mental retardation, and primary hypothyroidism). The child was admitted to the hospital on day 10 of illness in an extremely serious condition. On admission, she received artificial lung ventilation and then high-flow mask ventilation with an oxygen flow of 12 L/min. In addition to respiratory support, she received etiotropic (hydroxychloroquine), anticoagulant (enoxaparin), antibacterial, (ceftriaxone), and antihypertensive treatments. Levothyroxine sodium was administered for hypothyroidism. Permanent monitoring of the acidbase balance, general and biochemical blood tests, and coagulography were performed. Gradual positive dynamics of the respiratory status was observed, and oxygen flow decreased. The case was constantly consulted to a pulmonologist, endocrinologist, and cardiologist, who corrected antihypertensive therapy depending on blood pressure indicators. Oxygen support was given for 13 days. After receiving a double-negative PCR test for COVID-19, the patient was transferred to the pulmonology department, from which she was discharged in satisfactory condition for outpatient observation. CONCLUSION: Our patient with COVID-19, severe lung damage with a combination of comorbid pathologies, extremely unfavorable prognosis (grade IV obesity, Down syndrome, and hypothyroidism), who received active complex treatment in accordance with modern guidelines, recovered despite late admission to the hospital.