BACKGROUND: Currently, the number of childhood patients with chest injuries is increasing about 12% of peacetime injuries. This is primarily due to non-compliance with various safety measures and increased traffic accidents. CLINICAL CASE: This article presents a rare clinical observation of a 9-year-old male with a sternal fracture with displacement of fragments. The presented clinical observation draws attention to the treatment option open reposition of fragments with their further fixation with lavsan threads. DISCUSSION: In cases of treating sternal fractures with fragment displacement, various versions of osteosynthesis can be used: external fixation (with a plate and screws), intraosseous (spoke osteosynthesis), transosseous (application of a serclay or lavsan suture), off-collar (external fixing devices, original authors designs). The described method is easy to execute and accessible to almost every surgical or trauma hospital providing care to children. CONCLUSIONS: One option for osteosynthesis in isolated sternal fractures in children between 10 and 12 years old is the application of lavsan sutures in the open reposition of fragments. An important advantage of this technique is the absence of the need to remove fixing structures, which is accompanied by tissue injuries and increased patient hospital stays, reducing the quality of life. In addition, the described method has low trauma and noteworthy cosmetic results.

Crohn’s disease (CD) is nonspecific granulomatous inflammatory disease of all layers of the intestinal wall, characterized by a variety of clinical forms, heterogeneity of age groups of children and extraintestinal manifestations. The diagnosis of the disease is difficult due to the presence of many symptoms specific to a number of other surgical diseases of the abdominal cavity organs. This diagnosis is often made intraoperatively. In this study we report a case of treatment of a teenage girl who was admitted with complaints of a mass in the right iliac region extruding above the skin surface, instability of body weight, an increase in body temperature to 37.2° C for one month. As a result of laboratory and instrumental examination, the etiology was not established. Laparoscopy revealed abdominal infiltrate, consisting of the cecum, the distal ileum and a part of the greater omentum, tightly fixed to the anterior abdominal wall, which led to the destruction ofthe peritoneum, muscle tissue and aponeurosis with further infiltration into the sub-cutaneous fat. Appendectomy and separation of the infiltrate were performed. After that, the girl was discharged due to the categorical refusal of the parents of the further treatment.Twelve days later the patient had abdominal pain again, the dynamics of the pain syndrome intensified, the body temperature was febrile. After examination and detection of signs of peritonitis, emergency laparotomy, subtotal resection of the greater omentum, separation of the abdominal infiltrate (repeated), sanitation and drainage of the abdominal cavity were performed. During the surgery, the access to the abdominal cavity was performed with technical difficulties due to the fact that a conglomerate of intestinal loops and omentum was fixed to the anterior abdominal wall from the interior. The conglomerate was separated from the anterior abdominal wall by blunt dissection. The size of the conglomerate was up to 12–15 cm, formed by the transverse colon, the ileum and the greater omentum. The walls of the transverse colon and ileum in the area of the conglomerate had the cartilaginous density. For the purpose of further examination and determination of tactics for further treatment, the child was transferred to the Gastroenterology Department with a diagnosis of “Terminal ileitis. Purulent omentitis. Serous peritonitis. Mild normochromic anemia of mixed origin. Crohn’s disease?” After the additional examination in a specialized hospital, the diagnosis of CD was confirmed.

Meckels diverticulum is a sac-like bulge of the wall of ileum formed in result of incomplete closure of the viteline duct that participates in nutrition of the embryo. Aim. To familiarize a wide community of colleagues with an interesting clinical case of a foreign body (a coin) in Meckels diverticulum. In the article, approaches to diagnostics and operative treatment of such patients are given. This clinical observation is of interest to abdominal surgeons from the point of view that Meckels diverticulum is most commonly identified by clinical symptoms present in diverticulitis, bleeding or perforating ulcer, in intestinal obstruction caused by formation of a node or of invagination. Conclusion. A situation in which a blunt-ended foreign body permitted to identify Meckels diverticulum, is described as casuistically rare.

Purpose . To inform doctors providing aid to children of the peculiar course of abnormal processes and clinical picture of cases when a big foreign body – a pencil – enters the small pelvis. Clinical observation : A 2-yearold girl was admitted to the emergency room of Kursk Regional Children’s Hospital No. 2. According to her mother, the girl was anxious, had abnormal rectal discharge and a subfebrile rise in temperature. Three days prior to the admission, the mother went to the bathroom, whereas the girl was drawing with pencils. Then the woman found a graze wound in the perineum, scanty hemorrhagic discharge and sought medical attention. The girl was examined by the duty gynecologist and an acute gynecological pathology was excluded. During the follow-up, the child remained anxious, abnormal defecation and rise in temperature were observed. An oblong, rod-shaped opaque foreign body 8 cm long and 0.3–0.4 cm in diameter was visible paravertebral and left to L v and in the small pelvis projection on plain abdominal radiography. An upper outline of an anechoic foreign body which is 60 mm long and 8.5 mm wide is visualized posteriorly to the urinary bladder and along the rectum and sigmoid colon during an abdominopelvic ultrasound. Conclusion . The article shows an examination plan and stages to be used in a child with a big foreign body in the free abdomen. It must be noted that an important criterion of successful treatment and management in this localization consists of well-coordinated work of pediatric surgical and gynecological services. Authors also state that detailed interrogation of parents is necessary (nutrition, defecation, behavior, etc.).

Цель данной работы : информирование врачей, оказывающих помощь детскому населению, об особенностях течения патологических процессов и клинической картине случаев попадания инородного тела больших размеров – карандаш, располагавшийся в полости малого таза. Клиническое наблюдение : в приемное отделение Курской областной детской больницы № 2 обратилась мать с девочкой М. в возрасте двух лет с жалобами на беспокойство ребенка, нарушения отхождения стула, повышение температуры тела до субфебрильных значений. За три дня до обращения, вечером, мать вышла в ванную комнату, в этот момент девочка рисовала карандашами. После чего мать обнаружила осаднения в области промежности, скудное геморрагическое отделяемое и обратились за помощью. Девочка осмотрена дежурным врачом-гинекологом, по итогам осмотра острая гинекологическая патология была исключена. В динамике беспокойство ребенка сохранилось, появились нарушения отхождения кала, повышение температуры тела. Выполнено обследование: на обзорной рентгенограмме органов брюшной полости – слева паравертебрально от уровня L V и ниже, в проекции малого таза, определяется продолговатое стержневидное рентгеноконтрастное инородное тело с четкими контурами длиной 8 см и диаметром 0,3–0,4 см. При ультразвуковом исследовании органов брюшной полости и малого таза, позади мочевого пузыря по ходу прямой и сигмовидной кишки, визуализируется верхний контур анэхогенного инородного тела протяженностью около 60 мм, толщиной около 8,5 мм. Заключение . В статье наглядно продемонстрирован план и этапность обследования ребенка с инородным телом больших размеров в свободной брюшной полости. Стоит подчеркнуть, что в случае подобной локализации последнего важным критерием успешного лечения и ведения пациента является четкая и слаженная работа двух служб – детской хирургической и гинекологической. Также авторы обращают внимание читателей на необходимость тщательного расспроса родителей с особой концентрацией на мелких деталях (питание, стул, поведение и др.).