[Duodenal atresia]. / Atreziia dvenadtsatiperstnoi kishki.

The article deals with 5-year (1986-1992) experience in the diagnosis and treatment of duodenal atresia in 26 infants. Timely diagnosis of this developmental anomaly, the variants of operative treatment, and the principles of postoperative management are discussed. The necessity of antenatal ultrasonic examination and the high diagnostic value of radiological and endoscopic methods of diagnosis are emphasized. Operations were conducted on 25 children for total high intestinal obstruction, on 23 infants in the neonatal period. The continuity of the intestinal tube was restored by duodenoduodenostomy (12), duodenojejunostomy (3), gastroduodenostomy (1), excision of the membrane (4), and dissection of the membrane (5). The latter is technically the simplest and is the operation of choice. Preliminary jejunostomy for adequate preparation for the radical operation is recommended in profoundly preterm infants with as serious premorbid background. Of high importance is postoperative enteral catheteral feeding which is begun from the first day after the operation. Seven out of the 26 patients died from severe combined developmental anomalies and infection. The mortality was 26.9%.

[Removal of giant trichobezoars of the stomach in children]. / Udalenie gigantskikh trikhobezoarov zheludka u detei.

The removal of trichobezoars of the stomach in children is discussed. This disease occurs as a rule in individuals with mental or some borderline abnormality which is attended by trichophagy and usually requires prolonged treatment. This determines the high probability of recurrent trichobezoar. With each repeated operation on the stomach in such cases the techniques become more and more difficult, injurious, and is a risk for the patient. All the known methods of endoscopic removal of bezoars cannot be used to remove trichobezoars because of their strength. The authors suggest a new endoscopic method by means of which trichobezoars of any size can be removed. It was successfully applied in the treatment of two patients with this disease who were thus free of an injurious operative intervention.

[Comparative evaluation of various methods for feeding children with pyloric stenosis]. / Sravnitel'naia otsenka razlichnykh sposobov pitania detei pilorostenozom.

Pylorostenosis is still the most frequently encountered type of congenital intestinal obstruction. A severe course of the disease with a fatal outcome is observed today. Successful treatment is linked in many respects with adequate feeding of the patient. The authors examined and performed operations on 90 children. According to the type of feeding they were divided into 3 groups. Group 1 consisted of patients given the generally accepted oral diet in portions, group 2 was made up of infants fed according to a "forced" schedule (the physiological requirements were supplied by the natural way by the 3rd-4th postoperative day), and group 3 received enteral feeding through a tube. The tube was introduced by means of an endoscope before or during the operation. It was found that in feeding through a tube children with pylorostenosis could be given 2-3 times more milk before the operation and in the first days after it. Regurgitation and the phenomena of esophagitis and jaundice are arrested in this case. The gain in weight is 3 times that in children of group 1. The authors consider this type of feeding to be justified in gravely ill patients. The "forced" schedule is used in an uncomplicated course of the disease. Feeding of infants with pylorostenosis by the generally accepted method was found to be unsatisfactory and the authors rejected it.