Chylothorax in children is a fairly rare but at the same time serious pathology. Accumulation of a large amount of fluid in the pleural cavity leads to the development of respiratory, cardiovascular failure, and even death. In some children, this process can be initiated even before birth. The main components in the treatment of chylothorax are as follows: conservative measures aimed at reducing the amount of chyle, paracentesis, and drainage of the pleural cavity, mini-invasive surgery. To date, universal approaches to the management of patients with chylothorax have not been fully developed, there are no common diagnostic algorithms, terms, and optimal treatment tactics. There are only a few publications on this issue in literature, which are descriptive in nature and based on a small number of observations. The low prevalence of chylothorax in newborn infants, different etiology, various pathogenetic mechanisms of the disease make it difficult to conduct large-scale randomized trials in this area that would fully meet the modern requirements of evidence-based medicine. In this article, the authors demonstrate a multidisciplinary approach to treating a child with congenital chylothorax.

Aim: to demonstrate a child with early ileocecal resection in stenosing Crohn’s disease, taking into account the risk factors of surgical intervention. Crohn’s disease (CD) is a chronic recurrent segmental granulomatous lesion of any part of the gastrointestinal tract, with a wide range of manifestations and various phenotypes of the disease. Despite the great diagnostic and therapeutic possibilities today, there is an increase in primary and secondary resistance to therapy, largely associated with an incorrect assessment of the CD phenotype, patient management strategy. In the above observation of CD in a teenager, clinical signs of ileocecal stenosis were observed 3 months after the supposed onset of the disease, which caused a planned laparoscopic ileocecal resection with the formation of a ileo-colon anastomosis. The start of CD in adolescence, positive ASCA-status are regarded as risk factors for surgical intervention in this child. Timely diagnosis did not allow to avoid surgery. It is necessary to make individual algorithms for the management of a child with CD, taking into account the predictors of surgical intervention, complications and unfavorable course of the disease already at the time of diagnosis.

Background: The need to minimize the immobilization of the elbow joint in multifragmental fractures of the distal metaepiphysis of the humerus is confirmed by a number of factors, including the complexity of its anatomical structure, the uniqueness of biomechanics, as well as the limited ability of hyaline cartilage to regenerate. The restoration of the motor potential of the limb in multifragmentary fractures of the distal metaepiphysis of the humerus determines the priority of the treatment technique, which allows the patient to return to his usual lifestyle in the near future.Objective: Demonstration of the effectiveness of percutaneous spinal osteosynthesis with wires in fractures of distal metaepiphysis of the humerus in adolescent children.Clinical cases: This paper describes two clinical cases in adolescent children with multifragmentary fractures (open and closed) of the distal part of humerus (12В and 13С according to the AO classification). In both cases, the treatment consisted of sequential application of skeletal traction, for fragments traction and their mobility increase, then closed reposition of fragments under the control of electron-optical converter with metal osteosynthesis with wires. Moreover, taking into consideration the U- and T-shape nature of the fractures, the first stage of reposition included stabilization and fixation of the distal fragments to each other and then to the proximal fragment.Conclusion: In our opinion, it is the combination of traditional methods of treatment (application of skeletal traction system), modern technologies (EOC control), alternative (atypical) options for using metal structures that allow achieving good functional treatment results in this category of patients.

The pathology of the esophagus is diverse, therefore, disorders of the structural and functional state of the esophagus require different approaches both in the diagnosis of its pathology and in treatment. The review presents data on innovative diagnostic methods for the pathology of the cardio-esophageal transition in pediatric patients. The methods used were literature search in the databases PubMed, Medlit, RSCI, Scopus, Web of Science, EMBASE. Modern ideas about the neurophysiology of the gastroesophageal transition, the mechanisms of its antireflux function, and the pathogenesis of various pathologies of this anatomical localization, mainly gastroesophageal reflux disease (GERD), are described in both infants and school children. The features of the clinical picture of GERD depending on the age of the patient and the nature of the reflux agent are presented. The phenotypes of reflux disease are determined. The characteristics and modifications of existing original methods for studying the cardio-esophageal transition (both their advantages and disadvantages) are described in detail. The approaches to the possible optimization of management of this group of patients are proposed.

Introduction. Fecal incontinence of various origins still remains a complex medical and social problem that reduces both the quality of life and the chance of child’s full integration into the modern society. Antegrade enema, originally described by Malone, consists of creating an appendicostomy or neoappendicostomy of the ileum, which allows to irrigate the entire colon in order to empty the colon and rectum. As a result, children stay clean from 24 to 72 hours. Thus, surgical intervention can significantly improve the quality of life of children suffering of incontinence. Laparoscopic access minimizes surgical trauma and shortens rehabilitation period.Purpose. To analyze the obtained outcomes after treating children with laparoscopic umbilical appendicostomy.Material and methods. We report our own results obtained after performing laparoscopic umbilical appendicostomy in 3 children at the Federal Scientific and Clinical Center for Children and Adolescents, FMBA of Russia. Two children had neurological disorders of the pelvic organ; the third child suffered a severe combined injury, which led to the development of gross scarring changes in the sphincter area with a complete loss of its contractility. All children underwent laparoscopic umbilical appendicostomy. The article describes in detail all the stages of preoperative preparation and surgical intervention.Results. The duration of surgery ranged from 60 to 80 minutes. An appendicostomy intubator was left for 1 month in all cases. Hospital stay ranged from 8 to 11 days. The catamnesis was traced for 3–7 months. Therapeutic effect was assessed by children’s parents as satisfactory; the child remained clean for 12–18 hours, which contributed to socialization and significantly improved the quality of life. Conclusion. Performing laparoscopic umbilical appendicostomy is a relatively affordable technique. Our own experience has proven its effectiveness. Laparoscopic access minimizes surgical trauma, reduces rehabilitation time, and brings excellent cosmetic results. Malone surgery in children should be considered as a method of choice.