The article is devoted to the problem of emergency surgery for abdominal organs – perforated ulcer of the posterior duodenal wall (duodenum). 140 patients with perforated duodenal ulcer were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine between 2016 and 2019. Eight patients had perforation from the penetrating ulcer of the posterior duodenal wall. The average age of patients with perforation from the penetrating ulcers in the posterior duodenal wall was 62.25 years (27 to 78 years). Most of the cases were found in men – 87.5%. 7 patients had surgery at the Institute, one was transferred from another medical institution where he underwent surgery. Four patients were discharged with a favorable outcome, and four died. Two of the deceased patients had perforation associated with penetrating duodenal ulcer that was diagnosed during laparotomy; in two other cases, perforation associated with the penetrating ulcer was detected only during autopsy. A feature of perforated gastroduodenal ulcers when they are localized on the posterior wall of the duodenum is poor clinical manifestation, which is associated with the entry of duodenal contents into a limited retroperitoneal space, leading to a significant inflammatory process of retroperitoneal tissue. Complex use of X-ray examination, oesophagogastroduodenoscopy, and CT allows to correctly assess and timely diagnose perforation associated with the penetrating ulcer of the posterior wall of the duodenum into the retroperitoneal space.

Relevance Inhalation trauma (IT) is a combined injury of the respiratory tract, lung parenchyma and the central nervous system. Alterations of a mucous membrane during thermochemical airway burn as a result of inhalation of combustion products is most fully described in the literature, while the lesion of pulmonary parenchyma hasn’t been studied. The aim of the study To determine the capabilities and significance of the X-ray method in the study of lungs in patients with IT.Material and methods We examined 184 victims with IT, of which 53 patients had airways burn of the 1st degree, 92 patients had airways burn of the 2nd degree, and 39 patients had airways burn of the 3rd degree. Methods used: X-ray, chest X-ray computed tomography, ultrasound of the chest, study of the function of external respiration, morphological examination of lungs, statistical methods.Results X-ray studies in patients with IT revealed changes in peripheral parts of both lungs like network deformation of pulmonary pattern to forms resembling “mulberries” or “a bunch of grapes”. A study of the function of external respiration revealed signs of decreased lung ventilation and obstructive changes in bronchioles. The X-ray computed tomography of peripheral regions of the lungs in some patients revealed multiple local areas of reduced density with no visible walls corresponding to alveoli holding the air. Histological examination of the peripheral parts of the lungs found round air formations and significantly expanded alveoli. These changes are associated with exhalation disorders due to the constriction of respiratory bronchioles.Conclusion The X-ray method allows to detect signs of damage to the pulmonary parenchyma in patients with IT. Using a statistical evaluation, we showed that the presence of network deformation of the pulmonary pattern under the conditions of IT is an objective feature, confirmed with Cohen’s kappa coefficient (0.6±0.14; 95% CI [0.32–0.88]).