Teratoma (from the Greek τέρατος - monster, ομα - tumor) is a tumor formed from monocytes, common location of which is the ovaries in females, testicles in males, sacrococcygeal area in children, as well as the brain. Teratoma of the ovary is one of the types of germinogenic tumors, which has synonyms of embryo, «parasitic fetus», «complex cell tumor», «mixed teratogenic neoplasm», «monodermoma». The aim - to analyze the clinical symptoms and diagnostic and treatment tactics for the combined pathology of the appendix and pelvic organs in girls, to draw the attention of the medical staff to the pathology called appendicular-genital syndrome. Clinical case. We observed torsion of the left uterine appendages in an 11-year-old girl, which caused diffuse serous-purulent peritonitis and secondary phlegmonous appendicitis. Thus, in this case, we can talk about the appendiсular-genital syndrome, which had its origin in the left appendages of the uterus as a result of organic damage and their twisting. Patient Hanna B., 11 years old, was hospitalized on January 25, 2021, in the surgical department № 1 of the Vinnytsia Regional Clinical Hospital with abdominal pain localized above the bosom, in the right and left iliac regions, which lasted for 4 days. During this period, there was also a rise in body temperature within subfebrile values. They were not treated independently. Until the moment of hospitalization, the girl had never had menstruation. The patient was operated on the day of admission to the emergency department due to the presence of the «acute abdomen» clinic. During the surgical intervention, the following findings were revealed: the left uterine appendages were black, swollen with under-capsular hemorrhages, which included a neoplasm with the dimensions and a hyperemic, swollen, injected appendix, which was mace-like thickened at the apex. In connection with the appearance of complications in the form of peritonitis and the development of secondary appendicitis, operative treatment had the following volume. Left tubovariectomy, appendectomy, sanitation and drainage of the abdominal cavity were performed. Conclusions. In case of suspicion of appendicular-genital syndrome, it is necessary to use a laparoscopic technique instead of an open one after carrying out pre-operative medical and diagnostic measures. It is laparoscopic surgery that has an advantage over appendictomous access in the right pubic region, because during laparoscopic intervention there is a wider field for examination of the pelvic cavity with the help of a camera. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Inflammation of the appendages of the uterus as a separate pathology and in appendicular-genital syndrome (AGS) leads to a violation ovarian, histogematic and follicular barriers, which in the future can cause reproductive function disorders, primary infertility, menstrual cycle disorders, the development of adhesions in the pelvis, as well as pain syndrome. Purpose - to analyze the frequency of detection of ACS among the children's population; to draw the attention of medical personnel to this pathology. Materials and methods. In the period 2019-2022, to the Pediatric Surgery Clinic of the National Pirogov Memorial Medical University 310 patients with acute appendicitis and gynecological pathology were hospitalized. Of them, 227 (73.23%) girls were operated on for acute appendicitis, 70 (22.58%) patients had a gynecological problem. ACS was detected in 13 (4.19%) patients. Results. Specific weight AGS among monopathology of the appendix and uterine appendages was 4.19%. All children from AGS had abdominal pain syndrome at the time of hospitalization. Most of the patients had localization of the pain syndrome in the right pubic area and above the pubis. According to the ultrasound examination of pathological changes in the appendages of the uterus were noted in 10 (76.92%) patients, signs of inflammatory transformation of the appendix were observed in 5 (38.46%) patients. All children from AGS were operated. In 4 (30.77%) patients, surgical intervention was completed by removal of the uterine appendage due to tissue necrosis on the background of torsion. Conclusions. So, when pathology of the uterus and appendages and appendix were detected, it should be followed conductrevision of abdominal organs. According to clinical protocols and our judgment, it is necessary to remove the appendix in case of catarrhal changes in the wall of the appendix. Indications for adnexectomy are necrosis of uterine appendages, malignant neoplasms of uterine appendages. In doubtful cases, a diagnostic laparoscopy should be performed regarding the localization of the pathology focus. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the children's parents was obtained for the research. No conflict of interests was declared by the authors.

The importance of preserving the reproductive potential of the population of Ukraine is due to the increase in the number of women with infertility due to infectious and inflammatory diseases of the abdominal cavity and pelvic organs, which were suffered in childhood and adolescence. Purpose - to determine and systemize of the most significant factors of appendicular-genital syndrome depending on the primary pathological focus; to develop a practically significant classification signs and an algorithm for examination and treatment of girls with combined pathology to improve the results of treatment of this group of patients. Materials and methods. It was carried out an analysis of the medical records of inpatients, girls, for the period from October 2019 to May 2022, who were hospitalized for urgent indications and operated on for acute surgical pathology of the organs of the abdominal cavity and pelvis of an inflammatory nature. The age of the patients ranged from 4 to 17 years old (average age 11.0+0.5 years old). In the process of preliminary analysis, it was found that out of 203 patients who were to be treated surgically for the clinical picture of «acute abdomen», combined appendicular-genital pathology occurred in 13 girls. Results. It was determined that the key feature of appendicular-genital syndrome is the non-specificity of the clinical picture. In the appendicular form of the disease, the symptoms of acute appendicitis predominate in the pathological state, and in the genital form, the symptoms of acute adnexitis dominate. Connective appendicular-genital pathology in the catarrhal form of inflammation of the appendix was determined in 2 (15.39%) cases, in the phlegmonous form in 8 (61.54%) cases, in the gangrenous form in 2 (15.39%) cases, in periappendicular abscess - in 1 (7.68%) case. All patients in the study group underwent surgical treatment, the extent of which in each case was determined by the surgical findings and the prevalence of the pathological process. Most (61.58%) surgical interventions were performed laparoscopically, in compliance with the principles of maximally organ-preserving techniques (appendectomy, organ detorsion, stopping bleeding, excision of cysts, sanitation of the abdominal cavity, and, if necessary, drainage of the pelvic cavity). Only in 2 (15.38%) cases was the removal of the uterine appendages during their torsion, under the conditions of their obvious necrosis and the duration of the disease more than 72 hours. Conclusions. In order to improve the quality and speed of diagnosis of the combined inflammation of the appendix and uterine appendages, as structural elements of the syndrome «acute abdomen», the preoperative examination of patients should be multidisciplinary and necessarily include an examination by a pediatric surgeon, a pediatric gynecologist, and a pediatrician, with ultrasound of the abdominal cavity, pelvis, and retroperitoneal space. Frequency occurrence of appendicular-genital syndrome in girls is on average 6.4% of the total number of patients with the syndrome «acute abdomen». During the surgical remediation of the primary focus of inflammation relative to the appendages of the uterus, the tactics should be as organ-sparing as possible with extensive use of laparoscopic techniques for mandatory visual assessment of the organs of the abdominal cavity and pelvis. Patients who underwent surgical treatment for acute appendicitis in combination with diseases of the uterine appendages should form a separate dispensary group, in which preventive examinations are recommended once every 3 months during the first postoperative year, and thereafter once every 6 months until the moment of patient’s transfer to an adult medical and preventive institution. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

The issue of acute appendicitis remains extremely relevant today, as it is the most common inflammatory disease of the abdominal cavity. Despite significant advances in pediatric surgery in recent decades, when mortality from acute appendicitis is an exceptional event, the number of complicated forms in children is observed in 26.4% of cases, and morphologically unconfirmed appendectomies in 8.8% of cases. In girls, the rates are higher at the age of ≤10 years. Acute appendicitis has been and remains a very common disease in underdeveloped countries. In industrialized countries, the incidence of acute appendicitis ranges from 4-6% to 12-23%, in Ukraine - 20-21 cases per 10 thousand population, mostly young people. Purpose - to state the peculiarities of differentiation of surgical pathology of the abdominal cavity and pelvic organs in girls using ultrasound examination; to develop an algorithm for diagnosing surgical pathology in girls. Materials and methods. The study was conducted on the basis of the at the Vinnytsia Regional Children's Clinical Hospital, National Pirogov Memorial Medical University (Vinnytsia, Ukraine) for the period 2019-2021. For visual differential diagnosis, girls aged 4-16 years were involved in the study: 100 healthy children (the Group 1), 100 children diagnosed with acute phlegmonous appendicitis (the Group 2), 100 children with bulky uterine appendages of various types of pathology (the Group 3). Results and conclusions. The following advantages of ultrasound have been established: high specificity of the study, low cost and absence of ionizing radiation. Ultrasound of the abdominal cavity makes it possible to diagnose acute surgical and gynecological pathology, as well as to carry out differential diagnosis of diseases simulating acute appendicitis. An algorithm for diagnosing surgical pathology in girls has been developed. Such an algorithm increases the effectiveness of ultrasound of acute appendicitis and neoplasms of the pelvic cavity, and this allows the doctor to establish the correct diagnosis in time and choose the appropriate treatment tactics. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Most often, acute appendicitis occurs in premature babies. The mortality rate from neonatal acute appendicitis in 2000 was 25-28%. Most often, the cause of inflammation of the appendix in newborns is a local form of necrotizing enterocolitis. Purpose - is to provide up-to-date information and to familiarise a wide range of medical professionals with the current issues of diagnosis and treatment of acute appendicitis in newborns. Acute appendicitis in newborns has a similar course to necrotizing enterocolitis. However, it should be noted that treatment tactics for these diseases are different. Necrotic enterocolitis in the absence of perforation and peritonitis is treated with conservative methods, while appendicitis is treated surgically in all cases. Ultrasound diagnosis has an advantage over computed tomography because it does not have a radiation burden on the newborn, so it is recommended as the first line of diagnosis among other imaging methods. In the case of appendage perforation, an important method is inspection radiography and the search for free gas in the abdominal cavity (52% of appendage perforations are visualized by inspection roentgenography). Сonclusions. Due to the rare occurrence of acute appendicitis among newborns, doctors may be less wary of this pathology, which often causes significant changes in the child's body and is a frequent cause of septic conditions due to the rapid spread of the inflammatory process due to the anatomical and physiological characteristics of newborns. The speed of diagnosis and medical care, the correct determination of treatment tactics directly reduces the frequency and severity of postoperative complications, including purulent inflammatory diseases of the abdominal cavity and abdominal wall, as well as adhesive disease and adhesive intestinal obstruction in the first place. No conflict of interests was declared by the authors.