Adhesive intestinal obstruction is one of the most urgent problems in pediatric abdominal surgery due to its high rate resulting in a lot of complications, recurrences and relaparotomies.The objective of the research was to examine the clinical efficacy of using intraoperative antiadhesive drugs in children to prevent recurrent adhesive intestinal obstruction.Materials and methods. The examination and analysis of medical records of 86 children with adhesive intestinal obstruction treated in the clinic of pediatric surgery of the Ivano-Frankivsk National Medical University over the past 5 years was carried out. We identified two groups of patients: the comparison group included 40 children who received traditional treatment; the main group included 14 children who underwent the application of antiadhesive gel intraoperatively. The assessment of treatment effectiveness was carried out on the base of the postoperative course (recovery time of intestinal peristalsis, onset of enteral feeding, duration of hospital stay, incidence of early postoperative complications) and long-term outcomes (severity of adhesive disease symptoms, presence of recurrent adhesive intestinal obstruction and relaparotomies).Results and discussion. In comparative evaluation of the postoperative course in two groups of patients we noticed a more favorable course in children of the main group that was shown by faster recovery of peristalsis, reduced duration of gastric stasis, quicker occurrence of self-defecation and shortened term of hospital treatment. In the comparison group recurrent adhesive intestinal obstruction occurred in 8 (20.0%) patients, in 6 (15.0%) cases relaparotomy was performed. In the main group of patients, recurrent adhesive intestinal obstruction was observed in one (7.1%) child; however, relaparotomy was not performed.Conclusions. The intraoperative application of antiadhesive gel is a highly effective and safe way to prevent the recurrence of adhesive intestinal obstruction in children.

No abstract

The long-term observations of leading endocrinologists, cardiologists, and gastroenterologists all over the world have shown that the quality of medical care and the level of the patient’s knowledge about alimentary-dependent diseases significantly affect their course and prognosis. As a part of the classes at the Children’s Health School, the interns of the 1st and 2nd years of study give interactive classes for the child patients and their parents on the prevention of diseases and the promotion of a healthy lifestyle, namely nutrition, physical activity, psychological health, work and rest regimes, personal hygiene, etc. Taking into account the conducted classes, such training can be argued to be useful and necessary both for children for the purpose of obtaining new educational knowledge and for interns in order to learn and develop communicative skills.

Клінічний випадокЧитайте нас на сайті: http://med-expert.com.ua О.Д. Фофанов, В.О. Фофанов, О.Ю. Фофанова, Я.Я. Сікорин Рідкісна вада розвитку -вроджена сегментарна дилатація товстої кишки у новонародженого. Огляд літератури та власне спостереженняІвано-Франківський національний медичний університет, Україна У статті наведені літературні дані про розповсюдження, морфологічні ознаки, клініку, діагностику та лікування рідкісної вади розвитку травного тракту -вродженої сегментарної дилатації товстої кишки (ВСДТК) у дітей. Наведено також власне клінічне спостереження даної вади у новонародженої дитини. У новонароджених дітей вада діагностується дуже рідко і проявляється симптомами кишкової непрохідності, переважно діагностується інтраопераційно. У більш старших дітей клінічна маніфестація нагадує хворобу Гіршпрунга. Автори дійшли висновку, що ВСДТК може бути діагностована у новонароджених дітей до операції. Патогномонічними ознаками її є наявність великого кістоподібного розширення товстої кишки за клінічними та ультрасонографічними даними, відсутність моторики ураженого (розширеного) відділу зі збереженням моторики привідної та відвідної ділянок товстої кишки за даними іригографії. При патоморфологічному дослідженні, за даними літератури, в ураженій ділянці товстої кишки, як і у дистальному відділі, виявляють звичайні гангліозні клітини. У наведеному спостереженні були виявлені ганглії з ознаками дисплазії у розширеній та дистальній ділянках товстої кишки. Тактика хірургічної корекції значною мірою залежить від локалізації та протяжності ВСДТК і відрізняється від операцій при хворобі Гіршпрунга. Тому важливою є ретельна диференціальна діагностика цих вад.Ключові слова: вроджена сегментарна дилатація товстої кишки, новонароджені діти.

The objective of the research was to analyze personal experience and world literature on the diagnosis and treatment of boys with testicular torsion and to improve the process of providing specialized care. Problem statement and analysis of the recent researchTesticular torsion (TT) is an emergency condition caused by twisting of the spermatic cord which results in strangulation of the blood supply leading to testicular infarction and organ loss [5,9,10,14]. TT is one of the most common acute conditions accompanied by syndrome of hyperemic and swollen scrotum [1,3,4,6]; it is reported to occur in approximately 90% of adolescents [2,7]. The objective of the research was to analyze personal experience and world literature on the diagnosis and treatment of boys with TT and to improve the process of providing specialized care. Materials and methods of the researchThe results of diagnosis and treatment of 141 children with TT who were treated in the surgical department of the IvanoFrankivsk Regional Children's Clinical Hospital over a period of 10 years (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) were analyzed. The patients' age ranged within 1 month to 18 years. All the boys were hospitalized to the emergency department and examined: a complete anamnesis was collected, testicular examination and Doppler ultrasound examination were performed, the organs of the scrotum were palpated. In addition, all children underwent a standardized clinical examination. Results of the research and their discussionThere was a tendency toward the increase in the incidence of pathology during the following years (2007 -9 cases, 2008 -12 cases, 2009 -13 cases, 2010 -9 cases, 2011 -18 cases, 2012 -10 cases, 2013 -11 cases, 2014 -14 cases, 2015 -19 cases, 2016 -26 cases). Torsion of the left testicle was observed in 98 (70%) boys; torsion of the right testicle was found in 43 (30%) boys. Torsion of cryptococcal testicle was detected in 18 (12.8%) children. 1 (0.7%) child was at the age of 0 -1 months; 15 (10.6%) children were at the age of 1 month -1 year; 13 (9.2%) children were at the age of 1-3 years; 11 (7.8%) children were at the age of 3-6 years; 16 (11.3%) children were at the age of 6-12 years old; 85 (60.3%) children were at the age of 12-18 years. The degree of twisting of the testicle ranged from 180 to 10800. In 133 cases, surgery was performed (44 (33.3%) children underwent detorsion, ipsilateral and contralateral orchiopexy; 29 (21.9%) children underwent orchiectomy with contralateral orchiopexy, 24 (18.1%) boys underwent orchiectomy, 24 (18.1%) boys underwent orchiopexy and in 12 (9.09%) cases, detorsion was performed); manual testicular detorsion was attempted in 8 (5.7%) cases only. Only 24 (17%) children were hospitalized timely (up to 6 hours). In this group, 18 boys were surgically treated, 3 boys underwent detorsion, and in 4 cases, manual detorsion was attempted.64 (45.4%) children were examined 7-24 hours after TT. In this group, the auxiliary procedures including heating of the