Splenic lymphangioma is a rare malformation of splenic lymphatic channels characterized by cysts resulting from increased number of enlarged thin-walled lymphatic vessels. In our case, there were no clinical manifestations. Lymphangioma was congenital and diagnosed by ultrasound as an accidental finding. Surgery is the only method of radical treatment of splenic lymphangioma. We describe an extremely rare case of pediatric isolated splenic lymphangioma and laparoscopic resection of spleen as the most advantageous variant of surgical treatment.

Introduction. Bronchogenic cysts is a rare congenital malformation of the tracheal tree that develops because of violated differentiation of the foregut on week 5–8 of embryogenesis. This disease is often complicated with respiratory failure due to trachea compression; heart failure may develop as well due to of heart and large main vessels compression. One of the most serious complications is erosion of the vessel wall and massive bleeding from main vessels.Clinical observation. A 7-month-old child with cough and stridor was admitted to the surgical thoracic department of National Medical Research Center for Children’s Health in Moscow. Examination revealed a bronchogenic cyst which caused compression stenosis of the trachea. The patient successfully survived thoracoscopy. This technology promoted adequate visualization of the formation and of the adjacent anatomical structures what allowed to isolate the formation in a precise manner. So, the cyst was completely removed without any pathological immature tissue left. In this particular case, there was a high risk of perforation of the trachea posterior wall at surgery and at early postoperative period. Such complication could require intraoperative conversion with circular resection of the trachea using high-frequency jet ventilation with Twin Stream apparatus, or the patient had to be transferred to extracorporeal membrane oxygenation so as to provide an adequate surgical intervention.Conclusion. In a multidisciplinary medical center, there has been performed a successful surgical treatment of a 7-month-old child with a large bronchogenic cyst that compressed the trachea using minimally invasive modern technologies.

INTRODUCTION:Complete tracheal rings are a rare malformation that occurs in 1 out of 100,000 live births. It is rare, isolated tracheal or tracheobronchial anomaly developed due to abnormal cartilage growth with formation of complete ring and often resulting in airway stenosis. Slide tracheoplasty, as it was originally described by Tsang et al. and popularized by Grillo et al., overlaps stenotic segments of trachea, shortening trachea itself, thus, doubling the circumference and diameter of the stenotic area. MATERIALS AND METHODS:We have performed slide tracheoplasty in 12 children during the period of 2019-2021 in thoracic surgery department of our center. Median age was 15 ± 21,1 months (2 months-6 years),median weight - 8,04 ± 4,75 kg (3-20,7 kg),tracheal lumen varied from 2.5 to 3.0 mm, stenosis length - from 40 to 70% of the trachea length. RESULTS:Slide tracheoplasty was performed using central veno-arterial extracorporeal membrane oxygenation in 7 cases and using cardiopulmonary bypass in 5 cases. Concomitant heart disease was revealed in 5 children (pulmonary artery sling in 3 cases, ventricular septal defects - 1, aberrant subclavian artery -1). 5 children underwent one-stage correction of VSD: plastic VSD -1; left pulmonary artery reimplantation - 3; subclavian artery reimplantation - 1. All patients were on mechanical ventilation for 4,3 ± 2,78 days at postoperative period. Patients were discharged 16,3 ± 5,14 days after surgery. Satisfactory result of treatment in the form of respiratory failure relief was achieved in 10 patients. It was possible to increase the trachea lumen from 1.5 to 2 times in all cases. There were 2 (16,6%) fatal cases due to sepsis and multi-organ failure development. CONCLUSIONS:Children with complete tracheal rings are very complicated patients with various comorbidities. Despite the advances in medicine, sometimes it is impossible to save lives of these children. The use of extracorporeal circulation (ECMO and bypass) allows us to safely perform reconstructive surgery on the trachea and save the child from respiratory failure manifestations. If needed, simultaneous correction of heart and tracheal defects is possible. Slide tracheoplasty allows to increase trachea lumen at least in 1.5-2 times. Mechanical ventilation is an unfavorable predictive factor for the outcomes of congenital tracheal stenosis management. LEVEL OF EVIDENCE:III.

Introduction. Currently, eosinophilic esophagitis (EoE) is a big and urgent problem for modern pediatrics. Its pathogenesis is associated with the formation of stenoses and strictures of the esophagus during a long course of the disease without treatment, which leads to serious disorders in the nutrition of children. In widespread practice, X-ray contrast examination of the esophagus is used, however, it is also necessary to perform esophagogastroduodenoscopy (EGDS) with taking multiple biopsies with morphological examination to verify the diagnosis. Materials and methods. Boy Y. 12 years, was admitted in March 2021 with complaints of difficulty in swallowing solid food, as well as poor weight gain. From the anamnesis of the disease, it is known that the phenomena of dysphagia were noted from the preschool period. Symptoms have progressed over the past year. EGDS was performed. A biopsy was taken: 6 fragments of the esophagus, 2 fragments from each third. Results. Diagnosed with eosinophilic esophagitis, complicated by esophageal stenosis. Chronic gastritis, Helicobacter pylori-not associated, incomplete remission. Chronic duodenitis, incomplete remission. Protein-energy malnutrition, mild. Appropriate treatment was prescribed. An allergological examination of the child was carried out and recommendations for nutrition were given. Against the background of the therapy, the child’s condition with pronounced positive dynamics - the appetite improved, the phenomena of dysphagia were completely stopped. When the child was re-hospitalized a month later, there was an increase in body weight (900 g) and growth (3 cm). Conclusions. The high efficiency of complex conservative therapy has been shown. The prescribed conservative treatment made it possible to avoid dilatation and bougienage of the esophagus. In this case, all three components of EoE treatment were applied: elimination diet, proton pump inhibitors, and topical corticosteroids. In the future, it is necessary to observe the allergist, taking into account the data obtained on multiple sensitization with a decision on the question of further treatment.

Introduction. Subglottic stenosis is one of the most common causes of upper airway obstruction. The incidence of post-intubation stenosis ranges from 0.9% to 3% (Rodríguez H. et al.), or from 0.2% to 20% (Haranal M.Y. et al.). Currently, there is no consensus on the choice of surgical tactics due to a large number of modalities for surgical restoration of the laryngeal lumen.Material and methods. 44 patients with postintubation laryngeal stenosis were treated in the surgical thoracic department of the National Medical Research Center of Children’s Health subordinate to the Ministry of Health of the Russian Federation during 2019-2021. The average age of patients in this group was 4 years 8 months ± 3 years 8 months. Endoscopic treatment was done to 24 patients (54.5%). Laryngoscopy, fibrobronchoscopy, multispiral computed tomography and, if necessary, barium esophagogram were done for additional diagnostics.Results. The average number of endoscopic procedures per patient was 2.9 ± 1.5 (range from 1 to 7). Good results were seen in 20 patients (83.3%).Conclusions. Endoscopic techniques are alternative options to open reconstructive surgery. These techniques give good results in treating stenoses in the subglottic space and give a good chance to avoid tracheostomy in a certain group of patients, which, according to the results of our study, was as large as 79.1%.

Introduction. Subglottic cysts are a rare clinical entity among infants and children. The annual incidence of congenital laryngeal cysts is quoted as 1,82 per 100,000 live births. The majority of cases present in neonates born at the extremes of prematurity and invariably have been intubated and managed in neonatal intensive care units. Clinically, the pathology manifested as upper airway obstruction, stridor, and dysphonia. Various surgical techniques have been proposed for the treatment of patients with laryngeal cysts. In a large percentage of cases, tracheostomy is required, especially in patients with large cysts due to the development of symptoms of respiratory failure. Purpose. The aim of this study is to demonstrate that endoscopic technologies in the treatment of laryngeal cysts in children can be useful to avoid tracheostomy and lead to an uneventful recovery. Materials and methods. We present a clinical case of managing a 7-month-old child with multiple laryngeal cysts from the Department of Thoracic Surgery in the National Medical Research Center for Childrens Health Federal state autonomous institution of the Russian Federation Ministry of Health. Conclusion. In the presented case, we demonstrate that modern minimally invasive techniques to treat laryngeal cysts restore the lumen of the respiratory tract. facilitate the course of the postoperative period, achieve complete patient recovery, and avoid tracheostomy.

Introduction: Complete tracheal rings are a rare pathology occurring in 1 out of 100,000 live births. It is rare isolated tracheal or tracheobronchial anomaly resulting from abnormal cartilage growth, forming a complete ring, and leading to airway stenosis. A sliding tracheoplasty, primarily described by Tsang et al. and later widely presented by Grillo et al., overlaps the tracheal stenosing segments and shortens the trachea itself, and thus increases the diameter and circumference of the stenosing area double up. Materials and Methods: We have performed four slide tracheoplasties in the period between February 2019 and December 2020 in children who underwent medical treatment in the department of thoracic surgery in our center. Median age was 10 ± 5.5 months (2 months-1 year 6 months). Median weight was 6.9 ± 1.9 kg (4.5-9 kg). Slide tracheoplasty was performed using central venoarterial extracorporeal membrane oxygenation in 3 cases and using cardiopulmonary bypass in 1 case. Results: Patients were on artificial lung ventilation for 2-6 days in the postoperative period. Patients were discharged 14-18 days after the surgery. There were no lethal outcomes in our study. Discussion: Long segment congenital tracheal stenosis is an often and serious life-threatening anatomical malformation that bounded the length of trachea >50%. There is no unique treatment strategy for patients with such pathology. Sliding tracheoplasty can be recommended for all, but not for the shortest segments of stenosis, as it creates permissible voltage fluctuations during tracheal anastomosis. Excellent results in management of such severe patients can be achieved only through the collaboration of multidisciplinary team of specialists sharing organized and consistent patient-oriented approach.

The acute allergic condition may carry life-threatening character and requires the provision of the immediate medical assistance, which is governed by approved standards and clinical guidelines on appropriate forms of pathology. There are presented data concerning the routing of patients with allergic forms of pathology through stages from emergency medical assistance, evacuation of the patient till the discharge from the hospital with recommendations for outpatient care, with the purpose of the analysis of correspondence of medical aid in acute allergic pathology to existing algorithms and clinical guidelines at different stages of the management of patients. There was performed an analysis of the data of 1327 children with acute allergic pathology requesting emergency medical assistance. 78% of patients were left in place with recommendations for further referral to specialists, 22% of patients were evacuated to various clinics for specialized medical care (SMC). At the stage of the rendering of SMC 69% of children received corticosteroids in 2014, 66% - in 2015. 60% of children were prescribed first-generation H1-antihistamines in 2014, 63%-in 2015; 25% of children were administered the lytic mixture. Only 4% of children received inhalation therapy. At the stationary stage in 2014, all children with broncho-pulmonary disease and laryngotracheitis received antibiotic therapy, 89% and 59% - in 2015, respectively Conclusion The quality of rendering of medical aid to children with acute allergic pathology at prehospital and hospital stages is not always consistent with clinical recommendations.

The article presents a literature review of pediatric abdominal surgical emergencies in the Russian Federation. The article considers the issues of the development of laparoscopic surgery in pediatrics, the current state of this problem in surgical hospitals, the difficulties associated with transition to minimally invasive surgical interventions, in providing emergency surgical care for children. The possible risks of laparoscopic access and methods for their reduction were analyzed. The advantages of this technique were specified in comparison with open surgical interventions. The reliable economic efficiency of the offered technique was demonstrated. The analysis of the literature sources showed that there was no consensus on laparoscopic treatment for complicated abdominal diseases after previous open repair; and there were also no clear algorithms in clinical practice for complete transition to laparoscopic surgery in children. The analysis revealed very few economic studies on the efficacy of laparoscopic interventions.

Background.The assessment of the condition of a child with acute abdominal pain and a diagnostic search algorithm at the prehospital stage determine the further routing of the patient and the timeliness of healthcare delivery.Objective.Our aim was to evaluate the possibility of using immunochromatographic rapid tests (ICA) to determine the rota- and adenovirus infection in pre-hospital differential diagnosis of abdominal syndrome in children.Methods.In a retrospective cohort study, we analyzed the medical records of patients with a combination of abdominal and intestinal syndromes who applied for medical assistance to the emergency pediatric department of the FSAI “NMRC of Children’s Health” of the Ministry of Health of Russia from January 2015 to December 2017.Results.Outpatient medical records of 201 patients aged from 4 months to 17 years have been analyzed. In patients with a positive ICA, only 6% (5/88) of cases had doubtful or positive symptoms of peritoneal irritation, whereas in the case of a negative rapid test, almost all children needed a surgeon’s consultation. The frequency of leukocytosis detection in a clinical blood test was not different in patients with different results of ICA. The increase of C-reactive protein as a marker of bacterial inflammation was more common in patients with a negative rapid test. The volume of additional diagnostic care in the group of patients with a negative ICA result was significantly higher than in patients with confirmed viral gastroenteritis. None of the children with confirmed viral gastroenteritis required a surgical treatment. In the group with a negative ICA result, surgical treatment was performed in 11% (12/113) cases.Conclusion.Patients with confirmed viral gastroenteritis require significantly fewer diagnostic measures; they also have a minimal probability of acute surgical pathology. The use of laboratory rapid tests at the pre-hospital stage plays an important role in the timely diagnosis and the reduction in the frequency of non-specialized hospitalization.

Chronic liver diseases in children are a group of pathological conditions which varies greatly in etiopathogenetic features heterogeneity and clinical picture, tends to progress if associated with cirrhosis and decompensate hepatic functions consequently following by orthotopic transplantation. Despite the introduction of many non-invasive methods of examination, biopsy continues to be a standard in the diagnosis of histopathological changes in liver tissue. The article reflects modern ideas about the efficacy and safety of various methods of liver biopsy in children. Comparative analysis results on the informative value of hepatobioptates obtained by various puncture techniques are provided.

Background. Introduction of laboratory rapid tests into the practice of emergency teams (EMS) and carrying out a simple etiologic point-of-care diagnosis can affect the quality of medical care for children at subsequent stages. Objective. Our aim was to assess the quality of pre-hospital emergency care for children with acute abdominal pain using laboratory rapid tests. Methods. An open prospective comparative randomized study was conducted. Patients who called an emergency team for acute abdominal pain were randomized into two groups. In the study group (n = 243), the proposed model of pre-hospital emergency care with laboratory rapid tests was used. With patients of the control group (n = 242), the emergency teams worked according to the traditional schedule. The quality of medical care for children was assessed taking into account the emergency team specialty. We also carried out the analysis of case management in case of admission to a surgical department. Results. In the study group, the frequency of refusals of hospitalization was 2.5 times lower; the frequency of repeated calls was 75% less; unreasonable admission to a surgical department was 1.5 times less than in the control group (p < 0.05 for all parameters). Non-specialized hospitalization was 5% in the control group no cases in the study group. Conclusion. The use of a laboratory rapid point-of-care diagnosis at the pre-hospital stage helps to improve the quality of care for children with acute abdominal pain.

Background. Differential diagnosis of exacerbations of allergic diseases in children at pre-hospital and hospital stages of rendering emergency medical care (EMC) remains a relevant issue. One of the reasons is that medical care does not always comply with current clinical guidelines.Objective. Our aim was to analyze the quality of emergency medical care for children with acute allergic pathology.Methods. A retrospective study with a retrospective analysis and extraction of data from medical records (in 2 stages) was conducted.Results. The study analyzed the data of 595 children with acute allergic pathology who applied for emergency medical care (girls — 215; 36.13%). The average age of patients was 43.12 ± 41.09 months, 455 (76.47%) were under 5 years of age. 513 (86.22%) children applied for medical care for the first time, 24 (4.03%) children — for the second time; in 58 (9.75%) emergency team call records, this column was not filled. Based on the complaints and diagnoses indicated in the medical documentation, the children were divided into 3 groups: Croup, Cutaneous Manifestations of Allergy, and Bronchopulmonary Manifestations. We analyzed the reliability and validity of final diagnoses made at pre-hospital and hospital stages and assessed the adequacy of the carried out pharmacotherapy.Conclusion. According to our study, the quality of medical care at pre-hospital and hospital stages does not always correspond to current standards, algorithms, and available clinical guidelines.

Inguinal hernia in children is one of the most common diseases requiring surgical treatment. There are two methods of surgical interventions for inguinal hernia in children: open and laparoscopic. In international clinical practice, open hernia repair is widely used due to the simplicity of the technique which does not require special tools. However, the percentage of complications and relapse frequency remain high when open hernia repair is performed. The article presents the analysis of the treatment results in 209 children with strangulated inguinal hernia who underwent open and laparoscopic surgery in the period from 2003 to 2014. The open hernia repair (Krasnobaev or Martynov technique) was performed in 89 children. The following complications were registered: edema of the spermatic cord — in 34 patients, non-viable loop of the intestine — in 2; one child had a vermicular appendix with signs of striation in the hernial sac, 4 patients — a vermiform appendix with signs of inflammation. In 6 cases the contents of the hernial sac included the strand of the greater omentum, in 1 — the strand of the greater omentum with signs of acute ischemia. In 12 children, the hernial protrusion was absorbed to the abdominal, and therefore no revision was required. In 1 patient, the early postoperative period was complicated by peritonitis due to bowel wall necrosis. Laparoscopic hernioplasty was performed in 120 pediatric patients. The contents of the hernial sac in 86 cases included a loop of the small intestine, in 7 — an appendix and a site of the caecum, in 15 — the ovary and fallopian tubes, in 5 — the strand of the greater omentum. In 14 children, unobliterated internal inguinal rings previously not diagnosed were detected when examining the abdomen. Simultaneous appendectomy was performed when the cecum and the appendix were strangulated. Laparoscopic techniques omitting the disadvantages of an open repair method make it possible to remove a restrained organ from the abdominal sac, to assess its viability, to visualize the neck of the hernial sac avoiding mobilization of the elements of the spermatic cord, and to perform hernioplasty. The endosurgical technique allows diagnosing the obliteration of the peritoneum (processus vaginalis) from the contralateral side and performs interventions simultaneously from both sides.