INFECTED MECKELS DIVERTICULUM MASQUERADING AS SPONTANEOUS RUPTURE OF UMBILICAL GRANULOMA - A CASE REPORT IN ONE MONTH OLD INFANT

Meckels Diverticulum can present as umbilical cord infection which mimicking an umblical granuloma. A 1 month, old infant had presented with herniated bowel loops, following an ultrasound procedure. The purpose of the report is to highlight on variable presentation of Meckels Diverticulum in a suspected case of umblical granuloma.

Improvement of surgical methods for the treatment of spontaneous rupture of the esophagus ­complicated by purulent mediastinitis

Aim. To improve surgical treatment outcomes of patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis. Methods. Over the past 30 years, we have experience in the surgical treatment of 31 patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis. Depending on the tactics and techniques of surgical treatment, we identified two groups of patients. The first group (n=8) consisted of patients operated with conventional techniques: thoracotomy, transpleural mediastinotomy according to Dobromyslov, suturing of the esophagus with drainage of the mediastinum and pleural cavities, blind mediastinal drainage. The second group (n=23) consisted of patients treated with programmed re-thoracotomy. Re-thoracotomy was performed along with the postoperative thoracotomy wounds. The delimited foci of purulent mediastinitis were opened and sanitized (necrotic tissues were excised and removed). Preventive hemostatic methods were used in the area of pressure ulcers from drainage tubes. Replacing and changing the position of the drainage tubes in the mediastinum was a strictly compulsory technique. Pus and necrotic soft tissue that appeared in the thoracotomy wound were subsequently eliminated by a device consisting of two titanium brackets connected by a lock embodied in the form of an oval ring during the wound suturing at the stage of programmed re-thoracotomy. The groups were comparable in age and comorbidities. The average diagnosis of spontaneous esophageal rupture took 3.5 days; the maximum time is 10 days. The statistical significance of differences in immune status indicators was assessed by using the Student's t-test and Pearson's 2 test. Results. A systematic approach using the tactical and technical surgical techniques developed by us (such as suturing esophageal wall defects regardless of the rupture time, multifunctional nasoesophagogastric tube installation; the imposition of a purse string suture to prevent reflux from the stomach into the esophagus; programmed re-thoracotomy using the method of temporary fixation of the ribs) allowed to reduce the number of complications, such as haemorrhage from the mediastinal vessels, by 3 times, sepsis 1.5 times, mortality almost 2 times. Conclusion. The introduction of patented techniques allowed to reduce the number of life-threatening complications and mortality in patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis.

Spontaneous rupture of the ovarian vein in association with nutcracker syndrome: a case report

Background Nutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in renal vein pressure and certain symptoms. We report a very rare case of retroperitoneal hematoma caused by the rupture of varicose veins of the left ovary. Case presentation A 77-year-old Japanese woman, para 7, experienced sudden left lower abdominal pain. She had no history of trauma or treatment complications. Computed tomography revealed a left retroperitoneal hematoma, but her abdominal pain subsided quickly; thus, urgent treatment was not required. We then scheduled her for an assessment regarding the cause of her bleeding. However, 6 days after the pain onset, abdominal pain symptoms recurred, confirming hematoma regrowth. Magnetic resonance imaging and three-dimensional computed tomography revealed an abnormal vascular network from the left side of the uterus to the left adnexa. Subsequent angiography revealed that the retroperitoneal bleeding originated from rupture of the distended left ovarian vein, which caused blood reflux from the left renal vein to the left ovarian vein. Although angiography confirmed a passage between the left renal vein and inferior vena cava, computed tomography showed obvious stenosis in the left renal vein. In accordance with these findings, we diagnosed the cause of the distention and rupture of the left ovarian vein as nutcracker syndrome. She underwent embolization of the left ovarian vein as hemostasis treatment, and had a good course thereafter. Conclusions This is the first report of a spontaneous rupture of the left ovarian vein caused by nutcracker syndrome. Nutcracker syndrome is not yet well known to clinicians and should be considered as part of the differential diagnosis when an abnormal vascular network in the pelvis is found.

SPONTANEOUS RUPTURE OF THE RIGHT CONGENITAL DIAPHRAGMATIC EVENTRATION ON THE RIGHT SUBJECTED TO SURGICAL CORRECTION IN A CHILD WITH MEGADOLICOCOLON

Спонтанний розрив гемідіафрагми у випадках вродженої діафрагмальної евентрації зустрічається вкрай рідко, у літературі повідомляють про унікальні випадки.In this context, the authors present the case of an 8-year-old child who was hospitalized in the coloproctology service for abdominal pain, lack of stool for more than 7 days, pronounced abdominal distension. The child suffers from Down's disease. In 2017, he was occasionally diagnosed with right diaphragmatic eventration and underwent surgical correction by thoracic approach. After a thorough evaluation, with signs suggestive of diaphragmatic hernia on the right, the child underwent surgery, intraoperatively the rupture of the right hemidiaphragm was found with intrathoracic ascension of the malrotated intestinal loops, transverse colon and omentum. The repair of the diaphragmatic eventration complicated by rupture was used using the “overcoat” folding procedure, on the suture line being carefully applied a collagen foil covered with components of the fibrin adhesive. The postoperative period passed without complications.Conclusion. Spontaneous rupture of the diaphragm is a rare complication in children with diaphragmatic eventration, especially on the right side, in this case obstruction of the malformative colon ascended intrathoracically with progressive dilation of the intestinal loops being responsible for distension with gradual thinning of the hemidiaphragm sac resulting malformation in diaphragmatic rupture with herniation and progressive obliteration of the pleural space. The case of rupture of the diaphragmatic eventration associated with megadolicocolon confirms that the respiratory symptoms characteristic of this clinical situation may be overshadowed by the predominance of signs of intestinal obstruction, without leading to sudden progressive clinical deterioration, which proved to be a misleading moment in diagnosis. certainty of this serious complication rarity.