Lobar emphysema still remains a significant issue of pediatric surgery. It accounts for 14% of all congenital anomalies of the respiratory system. The development of intra-thoracic tension syndrome leads to a critical oxygen supply disorder. The main method of treatment of congenital pathology in case of severe respiratory disorders is operative. However, an unrecognized anomaly of lung development leads to incorrect surgical tactics. A clinical case of surgical treatment of a newborn with lobar emphysema of the lung complicated by intra-thoracic tension syndrome is presented. Video-assisted thoracoscopic resection of the lower lobe of the left lung was performed. Six months after the intervention, a complete restoration of the function of external respiration was detected. Timely full-fledged surgical treatment contributed to the elimination of the cause of the development of an urgent condition in congenital lung abnormality, effective restoration of organ functions and favorable outcome.

Introduction. Pneumothorax is a life-threatening condition which may be the first manifestation of a tumor in the chest cavity in children.Material and methods. The article describes a clinical case of a two-year-old patient with spontaneous pneumothorax.Results. By literature data, pleuropulmonary blastoma is the most common malignant tumor of the thoracic cavity in young children. It is a thin-walled single or multi-cavity formation located on the lung periphery. It has a high risk of metastases, relapses as well as a tendency to higher malignancy degree. Therefore, the overall survival of patients is significantly reduced in case of late tumor detection. It is known that at early stages the structure of pleuropulmonary blastoma is similar to that of the bullous transformation in lungs, and in most cases it does not have characteristic clinical manifestations; therefore, early diagnostics of the neoplasm in case of pneumothorax depends on surgeon’s oncological alertness and on the tactics chosen by him/her to treat the complication. The performed videothoracoscopic resection of the cystic formation in the left lung did not only helped to achieve aerostasis within the short time, but it also helped to find out the cause of the complication: it was a rare malignant tumor of the lung - pleuropulmonary blastoma.Conclusion. The tumor process at the preoperative stage is difficult to suspect in children because in most cases there are no specific clinical symptoms. So, an active surgical tactics in treating cystic lung formations in patients with pneumothorax allows not only to eliminate the complication, but also to identify a malignant neoplasm at the initial stage.

Introduction. Emphysematous changes in the lung tissue are the main cause of pneumothorax in children. To restore the lung function is one of the most challenging tasks in pediatric surgery.Purpose. To confirm the effectiveness of videothoracoscopy in the treatment of children with spontaneous pneumothorax.Material and methods. A retrospective analysis of case histories of 12 patients with spontaneous pneumothorax was made. Outcomes of treatment were monitored in patients during their stay in the hospital. Time of air release cessation, expansion of the lung, complications and length of stay in the hospital were analyzed.Results. In the first group of patients (n=7) only the drainage technique was used; aerostasis was achieved by the end of the second week (14.3±1.5 days). The drainage was in place till the air leakage was eliminated. The length of patient's stay in the hospital was 20.3±2.3 days. In the second group (n=5), the resection intervention was made. The complete lung expansion was achieved on the first day. Lung hermeticism was achieved by 4.2±1.3 day (p<0.05). There were no any bronchopulmonary complications. The length of stay in the hospital was 14.1±1.1 days (p<0.05).The advantage of the thoracoscopic technique applied for the treatment of spontaneous pneumothorax is in creating conditions for faster elimination of the source of air leakage, in accelerating functional recovery and in shortening the length of patient's stay in the hospital. The combination of thoracoscopic lung resection with pleurectomy in children can significantly reduce the risk of pneumothorax recurrence.Conclusion. To eliminate the prolonged air release in case of confirmed bullous changes in the lungs, when minimally invasive techniques are ineffective, surgical treatment in the form of video-assisted thoracoscopic resection can be applied early, even with the first episode of pneumothorax.

Diagnosis and treatment of esophageal injuries remain the most difficult problems in pediatric urgent surgery with high mortality rates. Restoration of function in severe multiple-organ disorders associated with the development of mediastinitis and sepsis in children requires a multidisciplinary approach and the search for alternative treatment methods that help close the esophageal defect and prevent inflammation. These methods include a constant negative pressure system. Severe polytrauma led to the development of local inflammation and mediastinitis. The formed esophageal fistula with clinical sepsis required multistage surgical treatment and support of several specialists. At the Regional Childrens Clinical Hospital No. 1 in Vladivostok, at the first stage of treatment, the mediastinum and soft tissues of the neck were drained, which made it possible to stop the spread of inflammation and stabilize the patients condition. The effectiveness of the second stage of surgical treatment using the VAС system was noted in the first 48 h, in the form of a significant reduction in local inflammation and elimination of skin maceration. The VAС system provided adequate drainage of the wound cavity and promoted wound cleansing and growth of granulation tissue. Dissociation of the fistula by applying a gastrostomy made it possible to create favorable conditions for the healing of the esophageal defect and ensure adequate enteral nutrition for the patient. Damage to the esophagus with the development of mediastinitis and sepsis are critical conditions; therefore, treatment outcomes depend on early diagnosis and timely surgical treatment. A full-fledged surgical treatment in a specialized hospital helps eliminate complications of damage to effectively restore functions and lead to patient recovery.