[Upper gastrointestinal duplication complicated by perforation in a child]. / Udvoenie verkhnikh otdelov zheludochno-kishechnogo trakta, oslozhnennoe perforatsiei u rebenka.

Gastrointestinal duplications are rare congenital malformations occurring in embryonic period of development of digestive system. These abnormalities are usually found in infancy or early childhood. Clinical presentation is extremely diverse depending on dimensions, localization and type of duplication. The authors present duplication of antral and pyloric parts of the stomach, the 1st segment of the duodenum and pancreatic tail. Mother with a 6-month-old child turned to the hospital. According to the mother, the child was sick for about 3 days when episodes of periodic anxiety first appeared. Upon admission, abdominal neoplasm was suspected after ultrasound. On the second day after admission, anxiety increased. There was impairment of appetite, and the child rejected food. Abdominal asymmetry in umbilical area was observed. Considering clinical data on intestinal obstruction, emergency transverse right-sided laparotomy was performed. A tubular structure was found resembling intestinal tube was found between the stomach and transverse colon. Surgeon found duplication of antral and pyloric parts of the stomach, the 1st segment of the duodenum and its perforation. During further revision, additional pancreatic tail was diagnosed. En-bloc resection of gastrointestinal duplications was carried out. Postoperative period was uneventful. Enteral feeding was initiated after 5 days, and the patient was transferred to surgical unit. The child was discharged after 12 postoperative days.

THE RELATIONSHIP OF THE IMMUNE AND METABOLIC DISORDERS DURING VARIOUS METHODS OF MULTICOMPONENT GENERAL ANESTHESIA IN LAPAROSCOPIC CHOLECYSTECTOMY.

BACKGROUND: In addition to operating injury in the pathogenesis of immunological and metabolic disorders after surgical interventions anesthesia plays an important role. THE AIM: to establish the relationship of the immune and metabolic disorders during various methods ofmulticomponent general anesthesia in conditions of laparoscopic cholecystectomy in patients with cholelithiasis. MATERIALS AND METHODS: Under constant observation there were 68 women admitted to the hospital for surgical treatment of cholelithiasis. Patients were divided into 3 groups depending on multicomponent general anesthesia (halothane, propofol, sevoflurane). We determined the concentration of cytokines (TNFa, IL-la, IL-i/8, IL-4, IL-iRA, IL-2, IFNy), components of the complement system (C,, C3, C4, C, and C, factor H, C,-inhibitor), the activity of neutrophilsperipheral blood, the concentration of the products ofperoxidation, catalase, superoxide dismutase in blood plasma. RESULTS: The level of immune-inflammation and metabolic disorders in patients with cholelithiasis was higher in patients operated with the use of halothane. The use of sevoflurane has had the most positive effect on the studied indices. CONCLUSION: The close correlation between the investigated immune and metabolic parameters on the background of the use of different schemes of multicomponent general anesthesia in patients with cholelithiasis have let to the conclusion that in the conditions of use of sevoflurane has the least place a "tension" immune and oxidative status.