Purpose: to report a case of a giant stomach trichobezoar successfully treated with a laparoscopic technique. Methods. A 14-year-old girl with signs of partial upper gastrointestinal obstruction was admitted to the hospital. Stomach trichobezoar was found during an endoscopic examination. The child was discharged following conservative therapy, as her parents gave no consent to surgery. In 2 months, she was admitted to the hospital again for planned surgery. Result. Gastrotomy was performed laparoscopically. Giant bezoar was removed from the stomach, placed in an endosac and then removed from the abdominal cavity through a Pfannenstiel incision. No postoperative general or wound complications were found. The patient recovered and was discharged. Conclusion. Treatment of stomach trichobezoars should be surgical. The method depends on a certain case. We believe that laparoscopy is more useful as compared to open surgeries and recommend it in uncomplicated forms of stomach trichobezoars.

Introduction. Intestinal intussusception is the most common type of non-congenital intestinal obstruction and one of the most common nosologies in emergency pediatric surgery. This disease occurs mainly in children of the fi rst year of life and is extremely rare in older age. In children over 3 years of age, intussusception usually has leading points in the form of organic causes: diverticulum, doubling of the intestinal tube, polyps, tumors and others. Material and methods. A child of 7 years old, entered the department of pediatric surgery with acute abdominal pain syndrome, repeated vomiting, the duration of the disease is about 20 hours. The child was operated on urgently basis with a preliminary diagnosis of acute appendicitis. Results. Intraoperative ileocecal invagination with necrosis of the ileum was detected, about which a resection with an anastomosis of the intestine was performed. Histological examination of a remote small intestine revealed the presence of Peutz-Jeghers polyps. After discharge from the surgical department, the child was sent under the supervision of an oncologist and a gastroenterologist. Conclusion This clinical case demonstrates one of the possible causes of intestinal invagination in children older than 1 year. Peutze-Jeghers syndrome is an autosomal dominant condition defined by the development of characteristic polyps throughout the gastrointestinal tract and mucocutaneous pigmentation. Invagination of the intestine is one of the frequent complications of this disease and occurs, as a rule, in older children.

The article provides a brief description of the causes and mechanisms of intestinal intussusception and a description of two cases of invagination in children over 7 years. The occurrence of intestinal intussusception in children older than 1 year often has a pathological leading point – a disease or pathological condition, as a result, of the course or complication of which it is possible to introduce one section of the intestine into another. Two children, 8 and 7 years old, were hospitalized at our clinic with signs of acute surgical pathology in the abdominal cavity, were operated on in an emergency order. In both cases, necrosis of the intestinal area, as a result, of invagination was detected, resection and anastomosis were performed. The leading points in these cases were Schönlein-Genoch purpura and Peutz-Jeghers polyps. Invagination of the intestines in these diseases occurs with atypical clinical symptoms, making it difficult to diagnose in time and leads to more frequent development of ischemia and necrosis of the intestinal wall.

The authors aim to consider a clinical case of treatment of a newborn baby with gastroschisis by staged immersion of intestinal loops and anterior abdominal wall plasty. A defect of the anterior abdominal wall was detected by ultrasound scan at 15 weeks gestation of a baby born at 33 weeks gestation (the Apgar score is 6–7, weight is 2,000 g). The child had a surgery 5 hours after the birth. After revision of the retained organs a pronounced visceral and abdominal disproportion was found. It was decided in favor of two-stage procedure of gastroschisis. A silicon bag with an elastic fixing ring hermetically placed under the abdominal wall was used during silo placement. It is an alternative to original bags for silo placement. At day 9 after the surgery (immersion of intestinal loops) the plasty of the anterior abdominal wall was done. As a result, the patient recovered and was transferred from the neonatal resuscitation department when he was 36 days old. By describing the advantages of the technique, the authors suggest it should replace other types of silo replacement which are widely used in our country.

In the Republican perinatal center, there was a premature newborn girl who had a combination of various risk factors in the antenatal and postnatal period. From birth, the child was in the intensive care unit, required intensive care. Against the backdrop of positive dynamics, at the 4th week of life, the child’s condition worsened noticeably, signs of pneumoperitoneum appeared. After emergency laparocentesis, it took several days to stabilize the condition. Laparotomy was performed in a deferred order, in which isolated perforation of the posterior wall of the stomach was detected. The scope of the operation was limited to suturing the opening, since no other changes from the small and large intestine were detected. In the postoperative period, the child’s condition remained severe for a long time, was in the neonatal intensive care unit. The child was discharged home with recovery after 3 months.