Case Report: Unique management strategy for rare case of esophageal foreign body.

Background: Foreign bodies that enter the esophagus can cause serious complications that may require extensive surgical intervention, including open surgery. The treatment method depends on the location, size, configuration, and number of foreign bodies in the esophagus, but to date, the best method to remove foreign bodies from the esophagus remains uncertain. Foreign bodies which can damage the walls of esophagus varies from bones and bone fragments, to metallic objects and batteries. In this article, we present a rare case of a "fish bone" penetrating through the esophagus walls and directly punctured the aorta, forming a post-traumatic saccular pseudoaneurysm of the descending thoracic aorta, which was successfully treated with endovascular stent placement to the aorta and with endoscopic foreign body removal. Case summary: We reported a case of a 16-year-old male with a 6-day history of chest pain after consuming fish. As result of immediate test in regional hospital using oral flexible esophagogastroduodenoscopy abnormalities were not reported. Due to persistence of beforementioned symptoms, a fiberoptic esophagogastroduodenoscopy was performed 3 days later, revealing a 1.5-2.0 cm long altered area with contact bleeding 33.0 cm from the incisors, but no visualization of any foreign body. Computed tomography revealed a fish bone that had completely passed through walls of the esophagus and punctured the aortic wall, forming an aneurysm. Patient was urgently hospitalized by air ambulance to our hospital for high-specialized medical intervention after 6 days. After the endovascular placement of a stent graft, the fish bone was successfully removed by endoscopic intervention. 12 months follow up showed no abnormalities. Conclusion: Endoscopic removal of foreign bodies in the esophagus and extracting a foreign body after thoracic endovascular aortic stent may be a feasible option for some cases.

The Technique of Mobilization of the Colon for Pull-Through Procedure in Hirschsprung's Disease.

Background: In patients with Hirschsprung's disease (HD), persistent obstructive symptoms may develop after surgery. The causes of mechanical obstruction may be a retraction of the pulled-through bowel due to insufficient mobilization of the mesentery or impaired blood supply in the area of the coloanal anastomosis in the case of excessive ligation of the supplying vessels. Leakage and stenosis are formidable complications and require repeated surgical intervention. Objective: The purpose of this study is to describe our experience and short-term results of the developed method: mobilization of the descending colon for its pull-through during the surgical treatment of the children with HD, which allows ensuring good mobility to the descending colon and maintaining blood supply at the same time. Methods: The medical records of 20 patients with rectosigmoid HD, who underwent parietal mobilization of the descending colon with preservation of the marginal artery, sigmoid arteries, and ligation of the left colon artery, were reviewed. This method is aimed at increasing the mobility of the brought-down bowel and maintaining the blood supply to the distal part of the brought-down bowel not only from the superior mesenteric artery but also from the lower one.The SPSS Statistics 26.0 package was used for statistical analysis. To describe the analyzed data with a normal distribution, the mean values and the error of the mean were used. To determine the differences, Student's t-test was used, and the differences were considered significant at a significance level of p < 0.05. Results: In all patients, the postoperative period was uneventful, without complications. The patients were discharged for outpatient treatment on average on the seventh day after the surgery. In all cases, there were no signs of anastomotic leakage or stricture on follow-up after 6-12 months. Conclusion: The method of mobilization of the colon in the rectosigmoid form of HD, parietal mobilization of the descending part of the colon preserving the marginal artery, sigmoid arteries, and ligating the left colon artery, can reduce the risk of complications by eliminating the tension of the descending colon.

Case Report: A Rare Case of a Combination of Omphalocele With Umbilical Teratoma.

Omphalocele is a congenital malformation of the abdominal wall, which occurs with a frequency of 1-5,000 newborns. The prognosis of treatment often depends on the presence of concomitant malformations. The most common contents of the hernia with omphalocele are the intestinal loops, liver, spleen. However, all organs of the abdominal cavity can be part of the hernial sac with large sizes of omphalocele. Teratoma is a germ cell tumor made up of several different types of tissue, such as hair, muscle, teeth, or bone. They are a type of germ cell tumor and divided into two types: mature and immature. In this article, we describe a rare case of a combination of an omphalocele with a mature teratoma and report the successful single step surgical treatment. On the first day after birth, a simultaneous operation-Removal of teratoma with abdominoplasty was performed. The postoperative period was uneventful, and the child was discharged for recovery.