[Small bowel volvulus due to a giant mesenteric lipoma]. / Zavorot tonkoi kishki, obuslovlennyi gigantskoi lipomoi bryzheiki.

Mesenteric lipomas are very rare. They are asymptomatic in most cases, but some patients can develop certain complications such as small bowel volvulus and acute small bowel obstruction. We report a 78-year-old patient with giant mesenteric lipoma complicated by jejunum volvulus and acute small bowel obstruction. The patient underwent laparotomy, en-bloc resection of small bowel, mesentery and lipoma followed by side-to-side anastomosis.

[Isolated splenic metastasis from colorectal cancer]. / Izolirovannyi metastaz kolorektal'nogo raka v selezenku: klinicheskii sluchai.

Splenic metastases are a rare finding and usually associated with advanced cancer. At the same time, isolated splenic metastases are an exception. The authors report a 62-year-old woman with isolated splenic metastasis from colon carcinoma in 28 months after surgery. Splenectomy was successfully performed.

[The possibilities to improve the outcomes in patients with colon cancer complicated by acute obstruction]. / Lechenie bol'nykh rakom tolstoi kishki, oslozhnennym ostroi kishechnoi neprokhodimost'yu (s kommentariem).

AIM: To improve the outcomes in patients with colon cancer complicated by acute obstruction via development of combined and complex treatment strategies. MATERIAL AND METHODS: We observed 442 patients with colon cancer complicated with acute obstruction. Original classification and diagnostic algorithm were applied. RESULTS: Time of preoperative opening-up, volume and type of surgery were defined using obtained data. Also we are able to perform delayed radical surgery after correction of metabolic disorders and comorbidities, to create the conditions for combined and complex methods of treatment, to decrease the incidence of postoperative complications and mortality rate. CONCLUSION: Three-stage surgery with shortened time between interventions decreases the incidence of anastomosis failure, allows to refuse Hartmann's procedure and to avoid severe reconstructive surgical stage without prolongation of rehabilitation period.

[Diagnostic and treatment program in acute adhesive obturative obstruction of the small bowel].

Clinical classification of acute adhesive obturative obstruction of the small bowel is presented. Four stages of acute obstruction are distinguished. The proposed treatment and diagnostic program permitted to predict the course of obstruction, specify indications for surgical and conservative treatment, determine the terms of preoperative preparation. This program permitted to decrease the number of operated patients to 16% and decrease lethality in acute adhesive obturative obstruction of the small bowel to 1,67%.

[Surgical rehabilitation of patients with intestinal stoma].

The results of treatment of 145 patients with different type of intestinal stoma created due to urgent abdominal diseases were analyzed. The analysis of rate and nature of postoperative complications in the control group (67 patients) revealed risk factors of postoperative complications and suggested prophylactic measures during all stages of stoma creation and closure. Individual surgical policy reduced number of complications from 34.3 to 12.8%.

[Surgical approach for destructive cholecystitis in elderly and old patients].

The individual surgical policy in the treatment of patients over 60 years of age with destructive cholecystitis was developed. Urgent radical surgical procedures using total intravenous anesthesia with endotracheal intubation and ALV were performed in patients with a low surgical and anesthetic risk and without concomitant acute pancreatitis and obstructive jaundice. Cholecystostomy and delayed cholecystectomy were performed in patients with these concomitant pathologies. Palliative operations were performed in patients with high surgical and anesthetic risk. Patients with disseminated peritonitis underwent cholecystectomy through laparotomy using total intravenous anesthesia with epidural blockade. Choice of method of cholecystectomy and anesthetic management depended on nature of concomitant diseases and complications. Proposed individual surgical policy permitted to decrease postoperative lethality to 0.8%.

[Surgical treatment of gunshot wounds to the colon]. / Khirurgicheskoe lechenie ognestrel'nykh ranenii obodochnoi kishki.

An analysis of treatment of 76 patients with gunshot wounds of the colon was made as well as of the causes of the development of pyo-inflammatory complications. The morphological alterations of the intestine wall were studied in 22 patients at different distance from the wound at the light optical and electron microscopic levels. A conclusion is made that resection of the intestine with colostomy is necessary with regard to the zone of contusion. The formation of the colostomy should be performed by the proposed method which makes the restorative operation easier. Using these methods allowed the number of intraabdominal inflammatory operations to be reduced from 46.7% to 6.5% and lethality from 17.7% to 6.5%.

[Surgical tactics in gunshot wounds of the colon]. / Khirurgicheskaia taktika pri ognestrel'nykh raneniiakh obodochnoi kishki.

Results of treatment of 76 patients with gunshot wounds of the colon received during local military conflicts and peacetime are analyzed. The patients were hospitalized within 30-120 min since the injury moment. Clinical examination, primary surgical treatment and laparoscopy were the best diagnostic methods. This order of diagnostic methods permitted to reduce time of examination from 60-80 to 20-40 min. Resection of injured part of the colon over the limits of contusion zone with "extraabdominal partial anastomosis" creation, Hartman's or Lachey's operation were the optimal surgery. In injury of contramesenteric part of the colon it makes sense to create loop colostoma by original method. The number of intraabdominal inflammatory complications decreased from 57 to 6.9%, lethal outcomes--from 17.6 to 6.9%.

[Surgical treatment of obturation obstruction of the colon]. / Khirurgicheskoe lechenie obturatsionnoi neprokhodimosti obodochnoi kishki.

Treatment results of 336 patients with obturative obstruction of the colon were analyzed, stages of disease development were demonstrated (4 stages). Based on this classification treatment-diagnostic algorithm was developed, which permitted to make terms and scope of preoperative preparation more correct. Individualized preoperative policy and developed complex of inflammatory complications prophylaxis allowed to expand indications for radical operative interventions including combined operations to 85.1%. Only technically unremovable tumors and multiple distant metastases were contraindications for primary resections. Lethality decreased to 7.1%, local inflammatory complications--to 12.7%.

[Surgical methods in the treatment of colonic obstruction]. / Khirurgicheskaia taktika pri obturatsionnom narushenii prokhodimosti obodochnoi kishki.

The treatment of 365 patients with carcinoma of the colon complicated by intestinal obstruction is analysed. In 30.9% of patients the signs of acute obstruction were relieved by decompression therapy including a method suggested by the authors. The other patients were subjected to an urgent and even emergency operation. Two group of patients are compared. I the first group the traditional surgical tactics were used, in the second group new methods for decompression of the large intestine were applied both before and during the operation: endolymphatic and intravenous infusion of antibiotics, formation of double-channel colostomy of the type of "partial anastomosis". With such changed tactics the number of postoperative complications and fatal outcomes reduced from 38.7 and 20.4% to 12.1 and 6.4%, respectively. The percentage of patients subjected to a radical operation increased from 69.3 to 85.7%.