Sonographic approach to the tumours of retroperitoneal space

Background: Timely diagnosis of primary retroperitoneal tumours is one of the current challenges of clinical oncology. This is due to the rarity, polymorphism and diagnostic difficulties of primitive retroperitoneal tumours. Material and methods: The study is cross-sectional, prospective and retrospective. The study group is represented by 118 patients with abdominal and retroperitoneal space tumours. Using the receiver operating characteristic (ROC) analysis curve and calculating the average quality of the diagnostic model, the informativeness of ultrasonography in the diagnosis of primary retroperitoneal tumours (PRT) was appreciated. Results: For tumour localization, the ultrasonography (USG) as a diagnostic model demonstrated an appropriate use criteria (AUC) of 0.641 (95% CI 0.541, 0.740, p <0.001), and the mean quality of the diagnostic model was 0.54. Following the statistical analysis, was found a partial correlation between the size of the tumour and the dimensions estimated at USG of 0.540 (95% CI 0.295, 0.737, p <0.001), which represents a high positive correlation. To determine the uni- or multicentric character of the tumour, the USG demonstrated an integrative value of sensitivity and specificity of 0.644 (95% CI 0.415, 0.873, p <0.001. In assessing the proximity ratio of retroperitoneal tumours, the highest AUC was recorded in the assessment of the ratio of tumour to pancreas – 0.838 (95% CI 0.705.0.971, p <0.001) and kidney – 0.861 (95% CI 0.699, 1.024, p <0.001). Conclusions: Ultrasonography is a fairly informative imaging diagnostic method in the diagnosis of retroperitoneal tumours. The characteristics of the tumours obtained after the ultrasound examination provide indirect information about the malignant or benign nature of the primitive tumour, which allows the assessment of the next stages of diagnosis and treatment.

Comparative evaluation of surgical methods for low invasive surgical treatment of diseases of the kidneys and urinary tract

Background. The rapid development of laparoscopic surgery can significantly reduce trauma during operations in the retroperitoneal space. These goals are also achieved by retroperitoneoscopy (RPS), which has become widespread in the last twenty years. The main difficulties for surgeons were associated with a small workspace and a lack of clear anatomical landmarks. Different access methods have different features, advantages and disadvantages, the analysis of which helps to optimize surgical treatment and accelerate patient rehabilitation.Aim: to study the advantages and disadvantages of retroperitoneoscopic and transperitoneal laparoscopic surgical methods of treatment.Materials and methods: We analyzed 305 case histories of patients operated on for various kidney diseases. The patients were divided into 2 groups: Group 1 – patients who underwent surgery using an extraperitoneal retroperitoneoscopic approach, Group 2 – patients who used the transperitoneal laparoscopic approach. A comparison of two methods of surgical treatment of kidney diseases, retroperitoneoscopic and laparoscopic access, was carried out. The following indicators were compared: duration of surgery, length of hospital stay, need for analgesics, frequency of postoperative complications.Results. The duration of the operation with retroperitoneoscopic surgery was reduced by more than 15 % compared with the laparoscopic approach. Shorter periods of pain relief were required, and the number of complications also decreased. The duration of inpatient treatment did not differ significantly.Conclusion. Retroperitoneoscopic approach can be used as the method of choice for operations on the retroperitoneal space.

Non-Operative Management of Blunt Abdominal and Retroperitoneal Solid Organs Trauma, with Retroperitoneal Hemorrhage – Indications, Methodology and Necessity

Introduction. The article is devoted to an actual problem — blunt trauma of the abdomen and organs of the retro­peritoneal space.Aim of study. Specify the indications for non­operative management of patients with blunt trauma of the solid organs of the abdominal cavity, retroperitoneal space, with retroperitoneal hemorrhage and measures for this treatment option.Material and methods. The analysis of literature sources of Russian and foreign authors is carried out and the indications, methods and necessity of non­operative management of patients with blunt trauma of solid organs of the abdominal cavity and retroperitoneal space, retroperitoneal hemorrhages are substantiated.Conclusion. Non­operative management of patients with blunt trauma of solid organs of the abdominal cavity and retroperitoneal space, retroperitoneal hemorrhages is possible only in large specialized centers with a wide range of diagnostic and therapeutic capabilities.

Extrathoracic lung sequestration in newborns: cases report

BACKGROUND: Extrathoracic lung sequestration is a rare variant of a developmental malformation that can be diagnosed prenatally and should be included in the differential diagnosis of abdominal tumor-like formations. CASES REPORT: From 1996 to 2020, 70 children with confirmed lung sequestration were treated at the Children's City Hospital No. 1 in St. Petersburg. Of these, 29 had intralobar sequestration, and 41 had extralobar sequestration. Four of these patients were diagnosed with a rare extrathoracic (intraabdominal) form. All four were born full-term without clinical manifestations of the defect. Ultrasound examination of all children revealed a solid formation up to 3 cm in diameter, located in the upper left quadrant of the abdominal cavity or retroperitoneal space in the projection of the left adrenal gland. Due to the location of the formation and the inability to visualize the aberrant arterial vessel during ultrasound examination, the first two patients were differentially diagnosed with an adrenal tumor (neuroblastoma). The cancer markers were negative, and adrenal cortex hormones were normal. The children underwent multispiral computed tomography-angiography to clarify the diagnosis. In both cases, the diagnosis of intraabdominal extrapulmonary sequestration with a feeding arterial vessel extending from the thoracic aorta was confirmed. Two children, previously treated in the last two years, were diagnosed by the ultrasound examination results that enabled the visualization of an aberrant arterial vessel feeding the sequester. Indications for surgical treatment have been set. The parents of one child refused treatment. Three children underwent sequestration removal (two by laparoscopic access, one had a laparotomy). Histologically, extrathoracic sequestration in combination with cystoadenomatosis was confirmed. The postoperative period proceeded without complications. RESULTS: Long-term treatment results were observed in all operated patients for a period of four to 10 years. The assessment was performed based on complaints and ultrasound data. All patients matured and developed according to their ages. CONCLUSIONS: Extrathoracic lung sequestration is a rare type of defect that is subject to surgical treatment. This pathology should be included on the spectrum of differential diagnosis of tumorous formations of the abdominal cavity and retroperitoneal space in newborns. The main methods for postnatal diagnosis of the defect are ultrasound and multispiral computed tomography-angiography.

Clinical and Anatomical Substantiation of Access to the Splenic and Left Renal Veins in the Operation of Distal Splenorenal Anastomosis

Aim of study. Development in an anatomical experiment of a technique for operative access to the splenic and left renal veins during distal splenorenal bypass surgery with justification of the possibility of its successful application in clinical conditions.Material and methods. In the conditions of an anatomical experiment on 40 unfixed corpses of adults of both genders, objective volumetric and spatial indicators in surgical wounds were studied in two variants of exposure of retroperitoneal space vessels, as the first stage of distal splenorenal anastomosis. In clinical conditions in 40 patients with portal hypertension of various genesis, during the operation of distal splenorenal anastomosis, the wide exposure of the anterior surface of the pancreas, spleen, left renal veins and most of their branches was performed using the original method of partial left — sided medial visceral rotation, followed by an objective assessment of the volume-spatial parameters of access. Measurements were performed using a medical goniometer in relation to the mobilized areas of the left renal and splenic veins. Statistical processing of the study results was carried out using the method of variation statistics. To identify statistically significant differences, the Student’s t-test was used for disjoint samples.Results. An original method of operative access to the splenic and left renal veins was developed during the operation of distal splenorenal bypass by lifting the internal organs of the left flank of the abdominal cavity from the posterior abdominal wall and diverting them to the right. In the anatomical experiment in the original method of partial left-sided medial visceral rotation, all indicators were better (depth of the wound is less and the angles of operative activity and the inclination of the axis of operative activity — larger) than with a classic approach of intraoperative intraperitoneal access via transverse incision in the mesentery of the transverse colon. Despite the various variants of vascular architectonics and various anthropometric indicators of patients, there were no any forced refusal of distal splenorenal bypass surgery or unintentional damage to both the vessels themselves and the pancreas, specific complications associated with the implementation of the proposed operative approach to the vessels of the left retroperitoneal space, including damage to the spleen and ischemia of the descending colon, in any of 40 clinical cases.Conclusion. The suggested option of operative access to the splenic, left renal veins and their branches at the first stage of performing distal splenorenal anastomosis in patients with portal hypertension of various genesis provides convenient spatial relations in the operating wound; creates comfortable conditions for performing the main surgical technique — applying vascular anastomosis; has a minimal risk of developing specific complications associated with the approach to the vessels of the left retroperitoneal space.

Necrotizing fasciitis of the left lower limb complicated with the abscess of retroperitoneal space: case report presentation and a retrospective study

BackgroundNecrotizing fasciitis(NF) is a severe progressive infectious disease where a synergistic action of multiple bacteria results in suppurative necrosis of the skin and soft tissue. Despite being a relatively uncommon infection, its mortality is significantly high. In this case report ,we describe the clinical presentation, management and outcome of a patient with NF of the left lower limb complicated with the abscess of retroperitoneal space and ensuing septic shock and dysfunction of heart and liver. Finally, we analyzed six cases we have treated before including this one and a retrospective study was performed.Case presentationA 69-year-old male patient, complaining about the pain of left lower limb and high fever due to uncertain reasons, featuring the tenderness of affected limb and left lower abdomen, was diagnosed with the NF complicated with the abscess of retroperitoneal space. The patient then develop septic shock and dysfunction of heart and liver. After repeated debridement of necrosis tissue, in combination with multiple antibiotics, laboratory test methods and the vacuum-assisted closure(VAC) therapy, the patient survived ,gradually improved and finally got a full recovery.MethodsA retrospective study was performed on six patients with NF of unilateral lower limb from March 2018 to October 2019. All patients were given systemic antibiotics and nutrition support. During the first stage, repeated surgical debridement with negative-pressure wound therapy(NPWT) was performed. Direct suture of the wound was performed in the second stage.ResultsThe incision healed well in all patients, and no infection or necrosis occurred in the wound. During the follow-up of 6.5 months (range, 5–9 months), no recurrence of infection or incision rupture occurred.DiscussionAlthough prompt diagnosis and adequate antibiotic therapy are basic for the treatment of patients with NF, early and repeated surgical intervention is vital for a favorable outcome. Thus, adjuvant treatment for NF such as negative pressure wound therapy (NPWT) using the VAC are very useful to accelerate wound healing.ConclusionsPrompt diagnosis, adequate antibiotic therapy and more crucially, early and repeated surgical debridement of the necrotic tissue combined with VAC therapy play a collaborative role in the successful treatment of NF.

Necrotizing Fasciitis of the Left Lower Limb Complicated with the Abscess of Retroperitoneal Space: Case Report Presentation and a Retrospective Study

Background: Necrotizing fasciitis(NF) is a severe progressive infectious disease where a synergistic action of multiple bacteria results in suppurative necrosis of the skin and soft tissue. Despite being a relatively uncommon infection, its mortality is significantly high. In this case report ,we describe the clinical presentation, management and outcome of a patient with NF of the left lower limb complicated with the abscess of retroperitoneal space and ensuing septic shock and dysfunction of heart and liver. Finally, we analyzed six cases we have treated before including this one and a retrospective study was performed.Case presentation: A 69-year-old male patient, complaining about the pain of left lower limb and high fever due to uncertain reasons, featuring the tenderness of affected limb and left lower abdomen , was diagnosed with the NF complicated with the abscess of retroperitoneal space. The patient then develop septic shock and dysfunction of heart and liver. After repeated debridement of necrosis tissue, in combination with multiple antibiotics, laboratory test methods and the vacuum-assisted closure(VAC) therapy, the patient survived ,gradually improved and finally got a full recovery.Methods: A retrospective study was performed on six patients with NF of unilateral lower limb from March 2018 to October 2019. All patients were given systemic antibiotics and nutrition support. During the first stage, repeated surgical debridement with negative-pressure wound therapy(NPWT) was performed. Direct suture of the wound was performed in the second stage. Results: The incision healed well in all patients, and no infection or necrosis occurred in the wound. During the follow-up of 6.5 months (range, 5-9 months), no recurrence of infection or incision rupture occurred.Discussion: Although prompt diagnosis and adequate antibiotic therapy are basic for the treatment of patients with NF, early and repeated surgical intervention is vital for a favorable outcome. Thus, adjuvant treatment for NF such as negative pressure wound therapy (NPWT) using the VAC are very useful to accelerate wound healing.Conclusions: Prompt diagnosis, adequate antibiotic therapy and more crucially, early and repeated surgical debridement of the necrotic tissue combined with VAC therapy play a collaborative role in the successful treatment of NF.

Video assisted surgery: a unique approach for non-resolving retroperitoneal abscess

Abdominal gunshot injuries and its management has always been challenging for surgeons. Challenges start from diagnosis and extent of injury and its immediate management and further its long term complications and their management. Injuries extending up to retroperitoneal space complicated by abscess formation are difficult to manage because the retroperitoneal space is relatively inaccessible leading to very poor outcome, and a tailor made approach is the best method of treatment for an individual patient. Current study report a rare case of video assisted approach for non-resolving retro-peritoneal abscess caused by abdominal gunshot injury with previous laparotomy and unilateral nephrectomy (left-side) with retro-peritoneal abscess along with sepsis, acute renal failure and hemopneumothorax.