Surgical treatment of children with complications of foreign bodies of the gastrointestinal tract

Introduction. At the present time the expansion of the spectrum of urgent diseases of the abdominal cavity organs is registered due to the patients with complications of foreign bodies of the gastrointestinal tract. Development of rational treatment-diag nostic algorithm will promote to improve the results of surgical treatment of children with complications of foreign bodies of gastrointestinal tract.

Aim. To determine the efficacy of laparoscopic techniques in children with complications of foreign bodies of the gastrointestinal tract..

Materials and methods. 38 children with foreign bodies of the gastrointestinal tract of different characteristics, which required surgical treatment, were included in the study.

Results and discussion. On the basis of analysis of clinical and medical history data, results of instrumental methods of preoperative diagnostics and laparoscopy three clinical stages of the disease were distinguished. Statistically reliable differences of the presented indicators in different terms of the disease were proved. Surgical intervention involved laparoscopy, during which the volume of surgical intervention was specified. Laparoscopic techniques were effective in the groups of patients with I, II and III stages of the disease in 100, 46 and 20% of observations, respectively.

Conclusions. Clinical manifestations in complications of foreign bodies of the gastrointestinal tract are determined by the characteristics of the latter and the clinical stage of the disease. Laparoscopic techniques can be effective at initial stages of the disease. At a complicated course of the disease the required volume of surgical intervention can be performed during laparotomy. The variety of clinical manifestations of foreign bodies of the gastrointestinal tract complications is determined by the characteristics of the damaging agents and the clinical stage of the disease. Laparoscopic techniques of surgical treatment may be a priority in the absence of a complicated course of the disease; in late stages of the disease laparotomy is the operation of choice.

Conclusion. Analysis of treatment results of children with complications of FBs of GIT revealed statistically significant differences in some clinical and anamnestic data, results of instrumental methods of preoperative diagnosis and intraoperative manifestations, which allowed us to define three clinical stages of the disease.

1. Averyn V.I., Halubitski S.B., Zapalianski A.V., Vаliok L.V., Nikulenkov A.V. Diagnostics and Medical Tactics in Magnetic Foreign Bodies Gastrointestinal Tract in Children. Novosti Khirurgii = Surgery News. 2017;25(3):317–324. (In Russ.) https://dx.doi.org/10.18484/2305-0047.2017.3.317.

2. Bocharov P.W., Karavaev A.V., Osipkin V.G., Pogorelko V.G., Yushmanova A.B. Embodiments stay magnetic foreign objects in the gastrointestinal tract of children. Rossiyskiy vestnik detskoy khirurgii, anesteziologii i reanimatologii = Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2014;IV(4):36–42. (In Russ.) Available at: https://www.rps-journal.ru/jour/article/viewFile/79/80.

3. Bocharov R.V. Sepsis in a Child with Foreign Magnetic Bodies: Clinical Case. Obshchaya reanimatologiya = General Reanimatology. 2018;14(4):15–20. (In Russ.) https://doi.org/10.15360/1813-9779-2018-4-15-20.

4. Zaitseva T.V., Zolotaryova A.V., Ignatiev R.O., Rosinov V.M. Acute obturation intestinal obstruction caused by a foreign object in a 1.5-year-old. Rossiyskiy vestnik detskoy khirurgii, anesteziologii i reanimatologii = Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2017;7(1):55–58. (In Russ.) Available at: https://rps-journal.ru/jour/article/view/316

5. Karaseva O.V., Timofeeva A.V., Bryantsev A.V, Granikov O.D., Maksumov A.A. Application of laparoscopy for complications of foreign bodies of the gastrointestinal tract. In: XV Moscow International Congress on Endoscopic Surgery. Мoscow; 2011, pp. 131–133. (In Russ.)

6. Razumovskii A.Yu., Smirnov A.N., Ignat’ev R.O., Khalafov R.V., Tikhomirova L.Iu., Kholostova V.V. The magnetic foreign bodies of the gastrointestinal tract in children. Khirurgiya. Zhurnal im. N.I. Pirogova. = Khirurgiya. 2012;(9): 64–69. (In Russ.) Available at: https://www.mediasphera.ru/issues/khirurgiyazhurnal-im-n-i-pirogova/2012/9/030023-12072012912.

7. Donskoy D.V., Ionov D.V., Korovin S.A., Vorob’ev V.V., Solovova V.L., Tumanyan G.Т., Sokolov Yu.Yu. Classification and treatment of foreign bodies in the gastrointestinal tract. Detskaya khirurgiya = Russian Journal of Pediatric Surgery. 2017;21(3):127–130. (In Russ.) Available at: https://cyberleninka.ru/article/n/klassifikatsiya-i-lechebnayataktika-priinorodnyhtelah-zheludochnokishechnogo-trakta-u-detey.

8. Bauman B., McEachron K., Goldman D., Louiselle A., Zheng E., Mills D. et al. Emergency Management of the Ingested Magnet: An Algorithmic Approach. Pediatr Emerg Care. 2019;35(8):e141–e144. https://doi.org/10.1097/PEC.0000000000001168.

9. Sola R. Jr., Rosenfeld E.H., Yu Y.R., St. Peter S.D., Shah S.R. Magnet foreign body ingestion: rare occurrence but big consequences. J Pediatr Surg. 2018;53(9):1815–1819. https://doi.org/10.1016/j.jpedsurg.2017.08.013.

10. George A.T., Motiwale S. Magnets, children and the bowel: a dangerous attraction? World J Gastroenterol. 2012;18(38):5324–5328. https://doi.org/10.3748/wjg.v18.i38.5324.

11. Dutta S., Barzin A. Multiple magnet ingestion as a source of severe gastrointestinal complications requiring surgical intervention. Arch Pediatr Adolesc Med. 2008;162(2):123–125. https://doi.org/10.1001/archpediatrics.2007.35.