Iliopsoas abscess comprises a frequently missed and late-diagnosed pathology that can be encountered by specialists of various profiles. Depending on the etiology and pathogenesis, iliopsoas abscess can be primary, if the infectious process initially develops in the iliopsoas muscle, or secondary, if the infection spreads from another inflammatory focus. The disease often has non-specific clinical manifestations and, in secondary abscesses, may be masked by symptoms of the underlying disease. The most informative diagnostic methods include CT scanning and magnetic resonance imaging. In the case of early detection and adequate treatment, the prognosis is generally good. Untimely treatment can lead to such serious complications as purulent leakage into neighboring areas, severe sepsis, septic shock, and persistent functional disorders. Without treatment, the mortality rate reaches 100%. To date, no uniform approaches to the management of patients with iliopsoas abscess has been developed.

Background. The incidence of liver malignancies is increasing, radical surgery can be performed in a small number of patients, most of them receive drug treatment. Isolated liver chemoperfusion (ILP) is a method of regional chemotherapy that is effective for some metastases but has a high complexity and frequency of complications. An improved method of hybrid ILP may offer new opportunities for patients with unresectable liver tumors. Case report. A 64-year-old patient diagnosed with stage IV sigmoid colon cancer underwent hybrid ILP. The patient was discharged after 6 days in a satisfactory condition without complications. Systemic chemotherapy was performed 21 days after the first hybrid chemoperfusion. The second hybrid chemoperfusion procedure was performed without the laparotomy stage, mobilizing the right common femoral vein and artery. As a result of the chemotherapy, the patients received a positive result on the mRECIST scale – a complete tumor response. Conclusion. The developed method of hybrid ILP has several advantages over traditional ILP and chemosaturation with infusion into the hepatic artery. This method can also be performed repeatedly, which is not possible with traditional ILP.

Necrotizing infection of the skin and soft tissues is a disease that is often accompanied by severe sepsis and septic shock. The fulminant nature of the course, complex differential diagnosis in the early stages of the disease determines the high mortality rate in patients with necrotizing infections. The presented clinical case provides an example of successful treatment of this pathology in a patient with severe comorbidity, in the complex treatment of which local negative pressure therapy was used at an early stage, before the end of the necrobiotic phase, during the course of the infectious process. Further management and preparation of the wound for closure was carried out using an installation type NPWT system.

Background. Treatment for inoperable secondary liver cancer remains challenging especially in patients with colorectal cancer. Traditional systemic drug therapy is often ineffective, and the use of transarterial chemoembolization is limited due to the systemic toxicity of some drugs. Combining high efficacy and low systemic toxicity, isolated chemoperfusion is a promising treatment option for patients with liver metastasis. Case report. A patient with mesentery leiomyosarcoma underwent several surgeries and chemotherapy courses, but liver metastases continued to grow. Isolated liver chemoperfusion with melphalan was performed after resection of liver segment and mobilization of liver vessels. To reduce the tumor volume and prevent complications, atypical liver resection was also performed. Conclusion. Isolated liver chemoperfusion for the treatment of liver cancer remains a subject of debate and is not included in the standards for treatment of primary and metastatic liver tumors. This technique was shown to be safe and promising in treating liver metastasis from leiomyosarcoma. However, further research is required to assess the role of this procedure in overall survival.

According to the Department of ambulance organization of the I. I. Dzhanelidze Research Institute of Joint Venture in the structure of the “acute abdomen” UGDB takes 4th place in 2021. Transcatheter arterial embolization (TAE) is an alternative to palliative surgical interventions when conservative treatment of ulcerative bleeding using endoscopic hemostasis methods is ineffective, especially in patients with a high risk of surgery and an unfavorable outcome. The aim of the work is to evaluate its role in improving the results of treatment of patients with UGDB who underwent TAE in an ambulance hospital in order to prevent recurrence of bleeding, to assess its role in improving the results of treatment of this category of patients. Materials and methods. The analysis of the results of treatment of 30 patients with UGDB who were on inpatient treatment at the I. I. Dzhanelidze Research Institute of SP from 2018 to 2021, the use of TAE is an alternative to open palliative surgery. As a result of the conducted examination, it was found that the use of endovascular hemostasis in order to prevent recurrence of bleeding in a group of somatically severe patients with UGDB is advisable.

Anatoly Alekseevich Kurygin was born on September 10, 1932 in the village of Zaborye, Solotchinsky District (now Ryazansky District), Ryazan Region, into a peasant family. In 1950, Anatoly Kurygin graduated from the Solotchinsk complete secondary school with excellent and good marks and applied for admission to the Ryazan Medical Institute. A. Kurygin decided to become a surgeon already at the beginning of his studies at the Institute and persistently went to achieve this goal. After graduating from the 4th year, Anatoly Alekseevich, along with other most successful students, received an offer to continue the study at the Military Medical Faculty at the Kuibyshev Medical Institute named after D. I. Ulyanov, agreed and joined the ranks of the Soviet Army. In July 1956, having received a diploma with honors, lieutenant of the medical service A. A. Kurygin, together with his wife Lyudmila Nikiforovna, departed for the Belarusian Military District. In April 1961, having got the highest grades (five) in the entrance exams, Anatoly Alekseevich was enrolled in the postgraduate course at the Department of Faculty Surgery named after S. P. Fedorov. As a dissertation research, Anatoly Alekseevich was instructed to study the state of lavsan prostheses and a new vascular bed at different times after arterial alloplasty. Soon after defending his dissertation, V. M. Sitenko suggested Anatoly Alekseevich to take up the issue of chronic pancreatitis, which was little studied at that time. During the year, A. A. Kurygin studied the literature on this topic and came to the convincing conclusion that it was impossible as a doctoral dissertation. Anatoly Alekseevich reported his thoughts to the head of the department, substantiated the futility of this topic and expressed a desire to study the physiological and surgical aspects of vagotomy as a new and alternative method of gastric resection for the treatment of chronic duodenal ulcers and its complications. In June 1978, the deputy head of the department, associate professor A. A. Kurygin, successfully defended the first doctoral dissertation in the USSR on the treatment of duodenal ulcers by vagotomy in combination with pyloroplasty. Five years later, in November 1987, professors of the Military Medical Academy V. M. Sitenko, A. A. Kurygin and A. I. Nechay, as part of a group of surgeons from Moscow, Kyiv and Tallinn, were awarded the title of Laureate of the USSR State Prize «For the development and implementation of new methods of treatment of peptic ulcer». In 1985, Professor A. A. Kurygin was appointed head of the Department of Surgery № 2 (for advanced medical training) of the Military Medical Academy. Anatoly Alekseevich was the author and co-author of more than 300 scientific papers, including 39 monographs and manuals, more than 25 teaching aids, 14 inventions, as well as the editor of the Abdominal Surgery section of the Small Medical Encyclopedia. Also, A.A. Kurygin published three collections of poetry. On November 12, 2011, after a severe and prolonged illness, the doctor Anatoly Alekseevich Kurygin was no longer with us. Major-General of the Medical Service A. A. Kurygin was buried on November 15 at the Serafimovsky cemetery in St. Petersburg.

The OBJECTIVE was to improve the treatment of victims with liver injury in blunt abdominal trauma by using minimally invasive methods of diagnosis and treatment. METHODS AND MATERIALS. We analyzed the treatment results of 76 patients with blunt liver injuries using traditional treatment and 78 patients who were treated with the developed new algorithm. In the second group, patients with ultrasound signs of liver injuries and stable hemodynamics (BP>90 mm Hg) underwent MSCT with intravenous contrast. In the absence of ongoing bleeding signs, conservative treatment was carried out; if they were detected, angiography with selective angioembolization was performed. RESULTS. There were no statistically significant differences in gender, age, mechanism and severity of injury (according to the ISS, Tsibin, VPH-P scales) and severity of the condition (VPH-SP) between the patients of the groups. More than half (52.3 %) of the victims of the main group were treated without abdominal surgery. By using the proposed algorithm in patients with stable hemodynamics, laparocentesis gave way to less traumatic and more accurate methods of diagnosing intra-abdominal bleedings. All laparotomies in the main group were performed for other abdominal injuries. In the victims of both groups, video laparoscopy was diagnostic in nature. One patient of the main group with liver injury of IV degree according to the AAST scale with ongoing intraparenchymatous and intraperitoneal bleeding underwent endovascular hemostasis. CONCLUSION. The use of non-operative and minimally invasive treatment of hemodynamically stable patients with liver ruptures in isolated and combined blunt abdominal trauma allowed to reduce the number of the performed diagnostic video laparoscopies by 24 %, laparotomies by 29 %, and completely abandon laparocentesis as a diagnostic method, reduce mortality rate by 4.6% and the duration of inpatient treatment of surviving patients for 4 days.

Background. Mechanical injury occupies a leading position among the causes of mortality in the working-age population. Diagnosis and treatment of isolated and combined abdominal traumas accompanied by bleeding appear to be a specific challenge. Due to difficulties in diagnosis and treatment, they are characterized by frequent complications and an increased mortality rate.Currently, there is no uniform tactics for diagnosing and treating patients with liver damage. In Russia and globally, new approaches are being actively introduced for the treatment of patients with closed liver traumas using minimally invasive techniques.The aim of study was to present a clinical case of a patient with a closed liver injury treated using interventional methods, such as angiography and embolization.Materials and methods. According to conventional techniques, the patient had to undergo laparotomy with complex manipulations to stop intra-abdominal bleeding from a ruptured liver, which would inevitably worsen her condition in the context of a presenting severe injury.Multiple studies reported that the number of postoperative complications after laparotomy is up to 41%, and in case of combined trauma 10-35% of complications can be one of the causes of death [6, 7, 8]. In order to avoid more traumatic treatment approaches, we applied tactics using minimally invasive high-tech diagnostic and treatment options.Results. To stop intra-abdominal bleeding from a liver rupture, which was previously diagnosed during multislice computed tomography (MSCT) with intravenous contrast, using interventional options, selective embolization of the segmental branch of the right hepatic artery was performed with an adhesive composition. The post-traumatic period proceeded without complications; in 14 days after the injury, the patient was discharged in satisfactory condition.Conclusion. Minimally invasive and conservative treatment of patients with closed abdominal traumas using interventional radiology can be successfully applied in specialized trauma centers.

Hepatic artery thrombosis (HAT) following liver transplantation (LT) is a severe life-threatening complication that can lead to graft loss and mortality after LT. According to different reports, HAT incidence ranges from 2% to 9%. Modern endovascular and radiosurgical techniques allow for minimally invasive liver graft revascularization. Nonetheless, a major consequence of even a successful revascularization is ischemic cholangiopathy, which can lead to ischemic biliary strictures and anastomotic leak. The paper presents a clinical case of long-term complex treatment of combined complications of LT using minimally invasive endovascular and endoscopic techniques.

В статье проанализированы сроки госпитализации, проведения лечебно-диагностических мероприятий в стационаре и морфологические изменения удаленных червеобразных отростков у больных острым аппендицитом, пролеченных в Санкт-Петербургском научно-исследовательском институте скорой помощи им. И.И. Джанелидзе в 2017 году. Эти показатели могут служить объективными критериями качества оказания медицинской помощи у больных острым аппендицитом. The article analyzes the timing of hospitalization, therapeutic and diagnostic measures in the hospital and morphological changes in remote аppendix in patients with acute appendicitis treated at the St. Petersburg research Institute of emergency care I.I. Dzhanelidze in 2017. These indicators can serve as objective criteria for the quality of medical care in patients with acute appendicitis.

We present successful treatment of a patient with tubular colonic duplication complicated by fecal impaction, perforation and fecal peritonitis. This anomaly is usually detected in children younger 2 years old. In adulthood, this diagnosis is of a precedent-setting nature. If the diagnosis was not confirmed in early childhood, the absence of typical clinical picture, long-term course of disease and difficult interpretation of clinical data complicate subsequent verification of congenital anomaly. Only infectious complications and emergency surgery in adults can make a correct diagnosis.

. The article presents a clinical observation of a patient with an aggressive (proliferative activity index Ki67 — 70%) form of small intestine cancer (SIC). After the diagnosis was established in 2017, the patient underwent radi-cal (April 2017) and cytoreductive (February 2019) surgical interventions with postoperative intra-abdominal normothermic chemoperfusion at the oncology center, as well as systemic chemotherapy for 3 years. Despite the complex treatment, due to the unfavorable biological properties of the tumor, the progression of the oncological process in the form of peritoneal carcinomatosis was stated. Against the background of ongoing systemic chemotherapy, the patient developed life-threaten-ing complications — a violation of the small intestine patency of carcinomatous genesis and necrosis of recurrent tumor nodes. The severity of the clinical situation determined the necessity of using cytoreductive technologies in the provision of surgical care in a multidisciplinary emergency hospital. The article describes in detail the tactics of complex treatment of a patient with advanced complicated small intestine cancer, discusses the indications for surgical treatment, its volume and stages, as well as evaluates immediate and long-term outcomes.