Dmitry Oscarovich Ott — the foundator of endoscopy in gynecology

On April 19, 1901, at a meeting of the St. Petersburg Obstetric and Gynecological Society, Professor Dmitry Oskarovich Ott for the first time made a report on the method he developed for illuminating the abdominal cavity when performing operations with a vaginal access. He called the proposed method ventroscopy (ventroscopia; Latin venter stomach + Greek skopeo consider). The latter used terms such as celioscopy, abdominoscopy, pelvioscopy, etc. At present, it is customary to call the examination of the abdominal organs using an endoscope inserted through the anterior abdominal wall, the method of laparoscopy, and when the endoscope is introduced through the posterior vaginal fornix - cultoscopy.

An unusual case of right iliac fossa lump-spigelian hernia: a case report

Spigelian hernia is a relatively uncommon hernia of anterior abdominal wall, occurring in different anatomical tissue planes. It is a variant of inter-parietal hernia. Preoperative diagnosis of obstructed inter-parietal hernia is based on imaging. Once correctly diagnosed it is easily amenable to surgical repair. We present a case of Spigelian hernia presenting as right iliac fossa lump with features of small bowel obstruction.

Digital Unwrapping of the Mummy of King Amenhotep I (1525–1504 BC) Using CT

The mummy of King Amenhotep I (18th Dynasty c.1525–1504 BC) was reburied by the 21st Dynasty priests at Deir el-Bahari Royal Cache. In 1881 the mummy was found fully wrapped and was one of few royal mummies that have not been unwrapped in modern times. We hypothesized that non-invasive digital unwrapping using CT would provide insights on the physical appearance, health, cause of death, and mummification style of the mummy of King Amenhotep I. We examined the mummy with CT and generated two- and three-dimensional images for the head mask, bandages, and the virtually unwrapped mummy. CT enabled the visualization of the face of Amenhotep I who died around the age of 35 years. The teeth had minimal attrition. There was no CT evidence of pathological changes or cause of death. The body has been eviscerated via a vertical left flank incision. The heart is seen in the left hemithorax with an overlying amulet. The brain has not been removed. The mummy has 30 amulets/jewelry pieces including a beaded metallic (likely gold) girdle. The mummy suffered from multiple postmortem injuries likely inflicted by tomb robbers that have been likely treated by 21st Dynasty embalmers. These included fixing the detached head and neck to the body with a resin-treated linen band; covering a defect in the anterior abdominal wall with a band and placing two amulets beneath; placement of the detached left upper limb beside the body and wrapping it to the body. The transversely oriented right forearm is individually wrapped, likely representing the original 18th Dynasty mummification and considered the first known New Kingdom mummy with crossed arms at the chest. The head mask is made of cartonnage and has inlaid stone eyes. The digital unwrapping of the mummy of Amenhotep I using CT sets a unique opportunity to reveal the physical features of the King non-invasively, understand the mummification style early in the 18th Dynasty, and the reburial intervention style by 21st Dynasty embalmers. This study may make us gain confidence in the goodwill of the reburial project of the Royal mummies by the 21st dynasty priests.

DIAGNOSTIC CRITERIA FOR VISCEROABDOMINAL DISPROPORTION SYNDROME IN GASTROSCHISIS

The objectives of this study were to determine the frequency and search for additional criteria for the diagnosis of visceroabdominal disproportion syndrome (VADS) in newborns with gastroschisis. Materials and methods of research: prospective controlled observational cross-sectional analytical study was carried out in 61 newborns with gastroschisis, admitted from June 2009 to July 2021. To search for the most significant factors indicating the presence of VADS, the following parameters were recorded in the studied patients: the size of the defect in the anterior abdominal wall, the composition of eventrated organs, the presence of a conglomerate of intestinal loops, the diameter of the intestinal tube, the thickness of the intestinal wall, the degree of visceroabdominal disproportion (VAD). Results: VAD was detected in 50 (82%) newborns with gastroschisis. In 10 (17%) cases, VAD was mild, in 27 (44%) – moderate, and in 13 (21%) patients – severe. A moderate direct relationship was found between the size of the anterior abdominal wall defect (r=0.29, p=0.022), intestinal tube diameter (r=0.56; p=0.001) and the severity of VAD. There was a strong direct correlation between the thickness of the intestinal wall, and the frequency and severity of VAD (r=0.93, p=0.001). A direct association was found between the presence of a conglomerate of intestinal loops in the eventrated organs and the frequency of VAD (p=0.002). There was no statistically significant relationship between the number of eventrated anatomical structures with the frequency and degree of VAD (p=0.36). Conclusion: to determine VADS, it is advisable to diagnose the following pathological conditions in patients with gastroschisis: thickening of the intestinal wall, dilatation of the intestinal tube, the presence of a conglomerate of tightly welded eventrated organs, the severity of which is directly proportional to the degree of disproportion.

RARE COMPLICATION OF CROHN’S DISEASE WITH LOCALIZATION IN THE INFLAMMATORY INTESTINE IN THE F0ORM OF THE SPREAD OF INFLAMMATORY OF THE PROCESS ON THE ANTERIOR ABDOMINAL WALL WITH FORMATION ABSCESS AND ITS DISCLOSURE IN THE NAVEL

The purpose of the study. Show a rare variant of the clinical course of complications of Crohn’s disease (СD). To analyze the anamnestic data, symptoms, clinical manifestations, preoperative diagnosis, features of surgery, postoperative period and the results of histological examination in a patient with CD who had complications in the form of transition of inflammation from the ileal wall to the anterior abdominal wall with abscess formation, opening it in the navel and the formation of a fistula. Material and methods. An analysis of the case of a complicated course of CD, manifested by the transition of inflammation from the ileum to the anterior abdominal wall, the formation of an abscess, its breakthrough into the navel and the formation of a fistula in the umbilical region. This complication was detected only after urgent computed tomography of the abdominal cavity and small pelvis (CTACSP). Results. The patient, despite the history of complaints, performed appendectomy, in which the removed appendix did not fully correspond to the clinical manifestations and data of CTACSP, in which CD was suspected, did not complete the examination, was not consulted by gastroenterologists and proctologists. He was urgently hospitalized with a clinic similar to acute purulent omphalitis. Only careful collection of the anamnesis and performance of urgent CTACSP allowed to suspect existence at the patient of the complicated course of CD. This allowed us to predict the course of surgery, perform a right hemicolectomy with excision of the altered tissues of the anterior abdominal wall and suturing the wound in the form of a laparostomy. The patient’s condition improved, he was discharged from the hospital. Conclusions. Patients with suspected CD should be monitored and treated by gastroenterologists and proctologists. Careful collection of anamnesis in patients of this group and the implementation of emergency CTACSP allowed to establish a correct diagnosis in the preoperative period.

Active extraperitoneal hematoma in the anterior abdominal wall after blunt injury

A 65-year-old male patient had extraperitoneal hematoma of the anterior abdominal wall after blunt trauma. The patient was treated with conservative management because of stable hemodynamics without deterioration of physical examination and laboratory tests; however, computed tomography revealed active bleeding. In abdominal wall hematoma, physical examination, hemodynamic monitoring, and laboratory tests may be the most important factor in determining a therapeutic plan. Repetitive imaging can be obtained and invasive treatment should be considered if these indices suggest hematoma exacerbation. Patients with abdominal trauma who have altered coagulation status should be carefully monitored for abdominal wall hematoma. Detecting abdominal wall hematoma is important because it may be the clue for potential intra-abdominal organ injury or delayed complication.

Vaginal birth vs caesarean delivery: impact on gastroschisis anatomy in newborns (a 33-year experience)

Background. Despite the existence of numerous studies on the optimal delivery mode in gastroschisis (GS), their results remain controversial. Therefore, the presented study is focused on establishing the delivery mode impact on GS anatomy in newborns.Research objective. The study was conducted to determine the impact of the delivery mode on the features of GS anatomy in newborns.Materials and methods. A retrospective analysis of medical records of 135 pregnant women and 135 their newborns with GS born between 1987 and 2020 was conducted. All newborns are divided into 3 groups. Newborns delivered by caesarean section are included in group I (n = 80); children born exclusively naturally are included in groups II (n = 25) and III (n = 30). The following anatomical features of GS in newborns were studied: localization and size of the anterior abdominal wall defect, confluence with the abdominal cavity, the nature and frequency of the eventrated organs.Results. The size of the anterior abdominal wall defect was significantly smaller in children with GS delivered by caesarean section (3.02 ± 0.58 cm; p < 0.01) than in children born naturally (4.17 ± 0.3 cm in group II, 4.7 ± 0.29 cm in group III). The frequency of retroperitoneal organs eventration was significantly less (20.0%; p < 0.01) in caesarean delivery grope than in II and III groups (52% and 63.3%, respectively). There was no significant difference in frequency of other abdominal organs eventration, localization of the anterior abdominal wall defect and confluence with the abdominal cavity. Level of evidence – III. Conclusions. The mode of delivery affects the size of abdominal wall defect and frequency of the abdominal organs eventration in newborns with GS.