The article describes clinical case of a patient with two rectovaginal fistulas of high and low level. The first stage included diverting loop sigmostomia and latex seton for low fistula. Three months later, on the second stage, fistulectomy with invagination of the fistula to rectal lumen with compression of invaginated part by titanium nickelide clamp was done. The fistulectomy with sphincteroplasty was done for the lower fistula. No postoperative complications developed; the complete recovery was detected. Seven months later, on the third stage, the stoma closure was done. No complications and fistula recurrence were obtained in 2 months of follow-up.

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In modern surgery, choledocholithiasis has acquired the status of an independent problem, on the solution of which the further progress of surgery of the hepatobiliopancreatoduodenal zone depends. The article is based on a clinical case of surgical treatment with a diagnosis of a complicated form of cholelithiasis, choledocholithiasis. Purpose of the study. To demonstrate minimally invasive surgical treatment of choledocholithiasis in an elderly patient, based on the example of our own clinical case. Materials and methods. A retrospective analysis of a case of surgical treatment of a complicated form of cholelithiasis, choledocholithiasis, in an elderly patient was carried out. The patient is 84 years old. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP), non-cannulation papillosphincterotomy (NPST) and stenting of the common bile duct for choledocholithiasis. The calculi were not removed due to their large size. Later she turned to JSC “NSC” Neftyanik” (Tyumen). Results. Taking into account the patient’s extrahepatic bile duct calculi, the phenomena of previous cholangitis, the patient underwent laparoscopic cholecystectomy, choledochotomy, extraction of calculi and stent, intraoperative choledochoscopy, and completed the operation with laparoscopic choledochoduodenoanastomosis under ETN on 11/19/2019. Conclusion. In this clinical case, we come to the conclusion that the only possible treatment option is the removal of calculi. If it is impossible to remove calculi by minimally invasive antegrade or retrograde methods, they can be considered as preparing the patient for further radical surgical treatment. Modern minimally invasive methods, in particular, laparoscopy, makes it possible to carry out an operation at almost any age aimed at completely eliminating the disease, thereby improving the quality of life.

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The foreign and domestic literature analysis was conducted in PubMed, Google schoolar and eLibrary databases, considered tactical aspects of the surgical treatment of colorectal cancer complicated with acute large bowel obstruction. The results of different surgical techniques by acute large bowel obstruction were compared. There is still high rate of post-operative complications and morbidity non-depending on the chosen techniques. The problem of colorectal cancer treatment complicated with large bowel obstruction needs further studies and careful examinations. Using prognostic scales for patient stratifications seems to be prospective as the tactic optimization and therefore might be useful for choosing an optimal way of surgical treatment for acute large bowel obstruction.