Introduction. Over the past 50 years, the concept of treating spleen injuries has undergone significant changes from no alternative to splenectomy to conservative treatment, and this concept is still being actively discussed. The present review shows evolution of views and approaches to the diagnostics and treatment of spleen injuries in children.Material and methods. The literature search was done using keywords in eLIBRARY, MEDLINE and GOOGLESCHOLAR. 65 sources have been selected.Results. The modern concept of spleen injury care has been formed under constantly improving techniques of non-invasive imaging of injuries (ultrasound, computed tomography), under constantly developing endoscopic and endovascular surgical techniques. Currently, conservative treatment of spleen injuries is close to 90-95%.Conclusion. The evolution of views as to the treatment of spleen injuries in children is demonstrating fundamental changes which take place in traditional surgical practice as well as in medical technologies.

Introduction. Currently, there is no any unified approach to the treatment of complicated forms of acute appendicitis in children. The purpose of our study is to evaluate the effectiveness of the local Protocol for diagnostics and treatment of appendicular peritonitis (AP) in children. Material and methods. 149 children with AP, aged 2 - 17 (11 ± 3.5 ), were included into the study. All of them were treated at the Clinical and Research Institute Emergency Pediatric Surgery and Trauma (CRIEPST) in 2015-2018. In the gender structure, boys (104; 69.8%) prevailed over girls (45; 30.2%). The following parameters were evaluated: AP structure, surgical tactics, postoperative course (incidence of postoperative intestinal failure syndrome (IFS), postoperative complications, length of hospital stay). A tactics for surgical treatment and volume of intensive care in the postoperative period were defined depending on AP severity and according to the local Protocol. Laparoscopic appendectomy was performed in 145 (97.3%) patients. There were no intraoperative complications and conversions in the studied group. In case of periappendiular abscess (PA) 3 (2.7%), patients had puncture and abscess drainage under ultrasound control. Results. While analyzing the AP structure by forms , the following picture was shown: free and abscessed forms were approximately equal - 72 (48.3%) and 77 (51.7%), respectively (p > 0.05). Diffuse peritonitis - 31.5%; generalized - 16.8%; combined - 17.4%; periappendicular abscess (PA) stage 1-14.8%; PA 2-16.8%; PA 3-2.7%. Postoperative complications - 4 (2.7%): postoperative abdominal abscesses - 3 (2.0%); early adhesive intestinal obstruction - 1 (0.7%). In postoperative abscesses, puncture and drainage were performed under ultrasound control; in early adhesive intestinal obstruction - laparoscopic adhesiolysis. All the children recovered. Length of intensive care was 2.9 ± 1.8 days; hospitalization - 12.0 ± 5.2 days. Conclusion. The local Protocol developed by the researchers helps to define a surgical tactics and volume of intensive care in the postoperative period. Laparoscopic surgery, in the vast majority of cases, is an optimal and effective technique for AP surgical treatment in children. Contraindications to laparoscopic surgery are PA 3 and total abscessing peritonitis.

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Extensive jejunal and colonic intussusception is a rare type of intestinal impaction. The aim of the work is to present a therapeutic-diagnostic algorithm for an atypical clinical picture of a rare form of intussusception of intestines (II) in a child of 4 months. A clinical observation of extensive ileocolic intussusception was carried out in a 4-months-old child admitted to the clinic to exclude craniocerebral trauma 34 hours after falling from a height of 1 m. Results. The main reason for seeking medical help was repeated vomiting and lethargy in a child, occurred one day after the fall. The identification of bloody discharge from the anus was a reason for excluding II. The consecutive use of ultrasound, colonoscopy made it possible to confirm the diagnosis, diagnose irreversible circulatory disorders in the invaginate and determine the indications for laparotomy. The absence of peritonitis allowed performing a resection of the necrotic area of the intestine with the application of intestinal anastomosis after desintussusception. Factors provoking the disease were the introduction of a new nutritional formula in the diet and the “lead point” in the form of a Meckel›s diverticulum Conclusion. The symptom of “blood in the stool”, even in the absence of a typical clinical picture, requires the exclusion of II. The diagnostic arsenal (ultrasound, colonoscopy, laparoscopy) in a specialized hospital with rare forms of II allows short-term diagnosing and choosing a rational surgical tactic. The absence of peritonitis during resection of the necrotic area of the intestine makes it possible to perform the anastomosis.

Gastrointestinal hemangioma (GIH) is a benign vascular formation located in different parts of the intestinal tube. The clinical significance of hemangiomas of the gastrointestinal tract is usually associated with the development of complications such as gastrointestinal bleeding, invagination, intestinal obstruction or bowel perforation. Aim of the study. Demonstration of a rare clinical observation of jejunal cavernous hemangioma as a cause of recurrent intestinal bleeding. Material and methods. A boy, 11 years old, admitted to the Institute with complaints of chronic anemia and recurrent intestinal bleeding of unknown etiology. There was made a complex diagnostic search, including laboratory and instrumental methods, with a video capsular study of the gastrointestinal tract and angiography of the abdominal cavity. Results. At the base of the video capsular study of the gastrointestinal tract, the vascular formation of the jejunum, which is a possible source of intestinal bleeding, is suspected. The vascular structure of the formation is confirmed by angiography. During laparoscopy, a cavernous hemangioma with a diameter of about 1.5 cm was detected. Hemangioma was located in the wall of the jejunum and prolapsed both into the lumen of the intestine and from the side of the serous membrane. Under micro laparotomic access in the umbilical region, there was performed a resection of the jejunum area with the imposition of the anastomosis "end to end". A morphological diagnosis was confirmed. The postoperative period was uneventful. Conclusion. The cavernous hemangioma of the jejunum is rare and difficult to diagnose the cause of recurrent intestinal bleeding. The use of modern diagnostic and surgical technologies ensures timely and mini-invasive treatment, which leads to rapid recovery of the patient and ensures the cost-effectiveness of treatment.