Doc. of Med. Sci., professor, head of the department of pediatric surgery, pediatric surgeon; Scopus Author ID: 56925375800 Резюме Основные методы диагностики врожденной непроходимости кишечника (ВНК)-рентгенологические. УЗИ играет вспомогательную роль при проведении дифференциальной диагностики. * Иллюстрации к статье-на цветной вклейке в журнал. * Illustrations to the article are on the colored inset of the Journal. Диагностика и лечение врождённой кишечной непроходимости… | Diagnostics and treatment of newborn intestinal obstruction… Заключение: УЗИ выявляет патологию, не определяемую рентгенологическими методами, но требующую немедленных действий (заворот, перитонит), исключает обследования с контрастом, когда они противопоказаны (перитонит), не требует транспортировки пациента, специального положения для выполнения исследования, существенно сокращает лучевую нагрузку. УЗ-контроль позволяет безопасно выполнить малоинвазивное лечение: дренирование брюшной полости при перитоните.

A study of manifestations of etiological, age and morbidity aspects of intussusception has been carried out in Arkhangelsk and the Arkhangelsk region in different periods of time of observation and development of the disease’s model in the region. A retrospective analysis of 270 cases of IS in 264 children treated in the Arkhangelsk Children's Hospital from 1980 to 2011 has shown that age and etiological aspects and clinical manifestations of the disease changed with time. The average age of patients increased in the last period of 12.5 (7.0; 30.0) months; Me (Q1; Q3). IS often develops in autumn months (p = 0.001) and in more than a half of the cases - in connection with other diseases. The classical «triad» of the symptoms including abdominal pain, abdominal intussusception and blood from the rectum is detected less frequently, currently in 34.5 % of cases, more often, there is monitored the «diad» of the symptoms (vomiting and abdominal pains) (p < 0.001). Conclusion: the etiology, pathogenesis and clinical manifestations of intussusception have changed with time and have their own characteristics in a particular region. Creating a model of the disease will improve quality of intussusception diagnosis.

BACKGROUND: The diagnosis of acute appendicitis in children is often established late, which leads to complications, lethal outcomes are recorded. AIM: To identify and analyze the factors contributing to the late diagnosis of acute appendicitis in children. MATERIALS AND METHODS: A retrospective analysis of 279 case histories of children was carried out. The duration of symptoms is divided into time 1 (before hospitalization) and time 2 (from hospitalization to surgery). Patients were divided into two groups: 1st with destructive uncomplicated appendicitis (phlegmonous, gangrenous), 2nd with complicated appendicitis (unrestricted peritonitis, infiltrate, abscess). The causes of late hospitalization, symptoms indicated in the case histories, examinations performed, postoperative complications were analyzed. The diagnosis was established on the basis of intraoperative data, histological examination. RESULTS: In the 1st group, time 1 and time 2 were significantly less than in the 2nd (p 0.001; 0.028). Late presentation (24 hours) in 21.9%, misdiagnosis in 12.2% of cases. In the hospital, the observation of the patient 12 hours in 21.1% of patients. The frequency of presence / absence of a description of clinical and laboratory signs of acute appendicitis is from 100 to 19.7%. The 2nd group was characterized by: duration of symptoms 24 hours, repeated vomiting (p 0.001), febrile condition (p 0.001), increase in neutrophils 90% (8792%). Ultrasound examination with evaluation of the appendix in 20.1% of cases with a diagnostic accuracy of 89.3%. Laparoscopic appendectomy in 53.2% Alvarado scores are significantly higher in 2nd group (810) than in 1st group (79, p 0.001). In 1st group, complications were significantly less than 3.4% than in 2nd group 22.7 % (p 0.001). CONCLUSIONS: Factors contributing to the late diagnosis of appendicitis in children are: late treatment, diagnostic errors at the prehospital stage, incomplete clinical examination and observation, insufficient use of laboratory and instrumental methods.

The intussusception (IS) often is followed mesadenitis, however a question, whether it is the reason or a consequence of formation of the intussusception, remains disputable. Aim: To estimate a role of the mesadenitis in formation of the intussusception in children. Methods: Retrospective study of results of treatment of all treated children with intussusception (n = 270) in the Arkhangelsk regional children's hospital in 1981-2012 is executed. Estimated the frequency of the background infectious and inflammatory diseases capable to be the cause for the mesadenitis. Studied the frequency of identification and the sizes of lymph nodes (LN) in structure of the intussusception according to ultrasonography and hydrocolonic sonography (HS) depending on duration of symptoms of IS. Results: It was verified that symptoms of diseases which are followed mesadenitis initially met in 66 % of patients. Thus according to ultrasonography in structure of intussusceptum LN in 82 % of patients were defined. It wasn't revealed statistically significant interrelation between time from the moment of the beginning of an IS, length of the LN (x2(2) = 0,11; р = 0,948) and cross size (x2(2) = 0,05; р = 0,975). The largest LN was localized in the head of the intussusceptum. Reduction by method of HS allowed to visualize LN in structure of the intussusceptum, its efficiency made 95,6-100 %. Conclusion: Mesadenitis is the most frequent reason of the intussusception in small children. The understanding of the role of mesadenitis in formation of the IS promotes more effective conservative treatment.