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The incidence is approximately 1 in 10 live births with the small intestinal duplication in most cases. Malformations with a long duplication part are considered technically complex.
A successfully treated clinical case of the subtotal small intestinal duplication in a child is presented in the article.
The proximal part of the intestinal duplication and its mucous membrane of the distal part with the common wall were completely removed.
Histological examination found ectopia of the gastric mucosa and pancreatic tissue. Surgical treatment of this malformation is aimed at the complete removal of the duplication part due to possible ectopia of the gastric mucosa or pancreatic tissue.
If the resection of an entire part of the intestinal duplication is technically impossible, the mucous membrane can be removed.
Presentation of clinical cases of rare combination of omphalocele with pylorostenosis in the postoperative period and additional liver lobe.
In patients with malformations of the anterior abdominal wall in the postoperative period, when regurgitation syndrome appears, it is necessary to make a differential diagnosis between the functional and organic causes of obstruction.
When confirming the organic nature of the obstruction, surgical intervention is indicated. It is necessary to be able to timely and objectively assess the risks and expediency of the approach when choosing surgical tactics in each individual case.
To demonstrate an interesting and rare case in the clinical practice of testicular feminization syndrome in a child, as an accidental finding when performing a planned surgical intervention.
A mother with a child E. The child was examined on an outpatient basis and the next day a scheduled surgical intervention was prescribed — hernia repair on both sides.
At the opening of the hernial sac on the right, the contents were the testicle, 1. Then an opening of the hernial sac was performed on the left, the contents of the hernial sac was also a testicle measuring 1.
Examination was performed: on an ultrasound of the pelvic organs — the bladder is full, the effusion in the pelvis is up to 12—15 mm high, the uterus and ovaries are not located at the time of the examination.
The clinical case that we have provided will be of interest to pediatric surgeons and geneticists in view of the unusual and complex clinical diagnosis of this condition.
In the presence of a female phenotype, the child completely lacked the organs of the female reproductive system, this disease was detected only due to the presence of a concomitant pathology in the child, a bilateral inguinal hernia.
The early diagnosis of STF is especially important given the risk of malignancy of the gonads in the post-pubertal period.
The biggest difficulties of pulmonary sequestration treatment appear when they are combined with other congenital malformations.
This article describes a rare case of combination of infradiaphragmatic extralobar sequestration of the lung and duplication cyst of the gaster.
The antenatal ultrasound investigation at 21 week of gestation visualized a retroperitoneal mass that had a cystic-solid structure and a vessel that departed directly from the aorta.
CT-scan that was performed after the birth, confirmed an existence of infradiaphragmatic cystic mass that had a vessel that departed directly from the aorta.
Tumor markers were without pathology. Surgical treatment was performed: laparotomy and removal of the cyst and extrapulmonary sequestration.
The histological investigation confirmed a pulmonary sequestrum and duplication cyst of the gaster. A nowadays method of visualization allows to find congenital malformation in earliest stages of gestation.
The tradition surgical treatment and also minimal invasive surgical treatment are the main option of cure such congenital malformations.
Also literature review of rare clinical forms of pulmonary sequestration presented in this article. The article provides an overview of modern methods of sedation and analgesia during therapeutic and diagnostic manipulations in children, indicates indications and contraindications.
Special attention is paid to the assessment of sedation and anaesthesia effectiveness, scales used for this purpose in children of different ages are described, criteria of sedation depth are given, equipment and measures necessary to ensure patient safety during manipulation are described.
It has been noted that BIS index values correlate with sedation scales in children and adults, but values that determine deep sedation in children are currently not clearly defined, which requires further research.
Drugs for sedation, their main characteristics and limitations for use are presented. The differences between sedation and monitored anesthesiology care MAC , which can be provided only by a qualified anesthesiologist, are described in detail.
It has been demonstrated that monitored anesthesiologic care implies deep sedation with control of vital functions, control of breathing and hemodynamics during manipulation, and it is noted that capnography is a mandatory element of monitoring in this type of anesthesiologic care in order to detect apnea as early as possible.
Criteria for recovery of consciousness after completion of sedation are specified, which include normal airway, adequate ventilation, stability of hemodynamic, restoration of initial level of consciousness, motor activity and possibility to receive liquids through mouth in absence of vomiting.
It is noted that the average time from the end of procedural sedation to the restoration of the original state is about 2 hours.
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