Year 2022 Vol. 30 No 3




State Budgetary Health Institution, City Clinical Hospital
named after V.V. Veresaev of the Department of Health of Moscow 1,
"National Medical Research Center for Therapy and Preventive Medicine"
of the Ministry of Health of Russian Federation 2,
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
of the Ministry of Health of Russian Federation 3,
National Medical Research Center for Cardiovascular Surgery named after A.N. Bakulev
of the Ministry of Health of Russian Federation 4, Moscow,
Russian Federation

Objective. This paper specifically focuses on the study of determination of the predictors associated with the development of postoperative atrial fibrillation (POAF) and mortality rate after major abdominal non-cardiac surgical interventions.
Methods. The methodology Case-control study has been used. The study included 226 patients: 83 - with a fatal outcome (cases) and 143 without a fatal outcome (control group).
Results. Independent predictors increasing risk of POAF developing were considered to be the followings: myocardial infarction in the anamnesis (MI) (OR 4.7, CI 2.2-10.1), cardiac arrhythmias (OR 5.0, CI 2.5-10.3), chronic kidney disease (CKD) (OR 8.7, CI 4.6-16.5), congestive heart failure (CHF) (OR 9.9, CI 5.2-19.1), diabetes (OR 4.0, CI 2-8), chronic obstructive pulmonary disease (COPD) (OR 8.6, CI 1.7-42.3), intraoperative infusion of more than 3 liters (OR 3.4, CI 1.6-7,4). Independent predictors increasing the risk of mortality rate were the followings: cardiac arrhythmias in the anamnesis (OR 3,4, CI 1.7-6,9), CKD (OR 248, CI 80-764), CHF 2-3 class (OR 6,8, CI 3,7-12,6), diabetes (OR 4.9, CI 2.3-9,6), COPD (OR CI 6,5, 1,3-32), intraoperative infusion of more than 3 liters (OR 2.9, CI 1.46-5.7), post-surgery fluid therapy of 3-5 liters (OR 2,9 1,6-5,0), POAF (OR 14,8, CI 7,4-29,4), thromboembolic complications (OR 37,9, CI 8,7-164). Age (>72 years) was statistically significant (p<0.001) was associated with POAF and with mortality rate.
Conclusion. In abdominal non-cardiac surgical interventions. the development of POAF is a common complication of cardiac surgery. In patients with POAF, the risk of in-hospital mortality is significantly higher. Independent factors that increase the risk of mortality rate and POAF are largely similar and in this study were the followings: myocardial infarction in the anamnesis, heart rate variabily, chronic heart failure, chronic renal failure, diabetes, chronic obstructive pulmonary disease, as well as relaporotomy, inflammation and pneumonia. The quantitative component of the extra volume of infusion therapy associated with perioperative complications was also recorded.

Keywords: postoperative atrial fibrillation, new onset atrial fibrillation, non-cardiac surgery, cardiovascular complications, mortality, surgery, inflammation
p. 245-254 of the original issue
  1. Devereaux PJ, Chan M, Eikelboom J. Major vascular complications in patients undergoing noncardiac surgery: The magnitude of the problem, risk prediction, surveillance, and prevention. In: DPhil SY, Cairns JA, Camm AJ, Fallen EL, Gershl BJ, editors. Evidence?Based Cardiology. 3-rd ed. Blackwell Publishing Ltd; 2010. . 47-62. doi: 10.1002/9781444309768
  2. Bhave PD, Goldman LE, Vittinghoff E, Maselli J, Auerbach A. Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery. Am Heart J. 2012 Dec;164(6):918-24. doi: 10.1016/j.ahj.2012.09.004
  3. Danelich IM, Lose JM, Wright SS, Asirvatham SJ, Ballinger BA, Larson DW, Lovely JK. Practical management of postoperative atrial fibrillation after noncardiac surgery. J Am Coll Surg. 2014 Oct;219(4):831-41. doi: 10.1016/j.jamcollsurg.2014.02.038
  4. Gialdini G, Nearing K, Bhave PD, Bonuccelli U, Iadecola C, Healey JS, Kamel H. Perioperative atrial fibrillation and the long-term risk of ischemic stroke. JAMA. 2014 Aug 13;312(6):616-22. doi: 10.1001/jama.2014.9143
  5. Park SJ, Choi JH, Cho SJ, Chang SA, Choi JO, Lee SC, Park SW, Oh JK, Kim DK, Jeon ES. Comparison of transthoracic echocardiography with N-terminal pro-brain natriuretic Peptide as a tool for risk stratification of patients undergoing major noncardiac surgery. Korean Circ J. 2011 Sep;41(9):505-11. doi: 10.4070/kcj.2011.41.9.505
  6. Liu MH, Chiou AF, Wang CH, Yu WP, Lin MH. Relationship of symptom stress, care needs, social support, and meaning in life to quality of life in patients with heart failure from the acute to chronic stages: a longitudinal study. Health Qual Life Outcomes. 2021 Nov 6;19(1):252. doi: 10.1186/s12955-021-01885-8
  7. Lowres N, Mulcahy G, Jin K, Gallagher R, Neubeck L, Freedman B. Incidence of postoperative atrial fibrillation recurrence in patients discharged in sinus rhythm after cardiac surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2018 Mar 1;26(3):504-11. doi: 10.1093/icvts/ivx348
  8. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, Ford I, Gonzalez-Juanatey JR, Gorenek B, Heyndrickx GR, Hoeft A, Huber K, Iung B, Kjeldsen KP, Longrois D, Lüscher TF, Pierard L, Pocock S, Price S, Roffi M, Sirnes PA, Sousa-Uva M, Voudris V, Funck-Brentano C; Authors/Task Force Members. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014 Sep 14;35(35):2383-431. doi: 10.1093/eurheartj/ehu282
  9. Dobrev D, Aguilar M, Heijman J, Guichard JB, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol. 2019 Jul;16(7):417-36. doi: 10.1038/s41569-019-0166-5
  10. Walkey AJ, Benjamin EJ, Lubitz SA. New-onset atrial fibrillation during hospitalization. J Am Coll Cardiol. 2014 Dec 9;64(22):2432-33. doi: 10.1016/j.jacc.2014.09.034
  11. Christians KK, Wu B, Quebbeman EJ, Brasel KJ. Postoperative atrial fibrillation in noncardiothoracic surgical patients. Am J Surg. 2001 Dec;182(6):713-15. doi: 10.1016/s0002-9610(01)00799-1
  12. Sohn GH, Shin DH, Byun KM, Han HJ, Cho SJ, Song YB, Kim JH, On YK, Kim JS. The incidence and predictors of postoperative atrial fibrillation after noncardiothoracic surgery. Korean Circ J. 2009 Mar;39(3):100-4. doi: 10.4070/kcj.2009.39.3.100
  13. Polanczyk CA, Goldman L, Marcantonio ER, Orav EJ, Lee TH. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay. Ann Intern Med. 1998 Aug 15;129(4):279-85. doi: 10.7326/0003-4819-129-4-199808150-00003
  14. Butt JH, Olesen JB, Havers-Borgersen E, Gundlund A, Andersson C, Gislason GH, Torp-Pedersen C, Køber L, Fosbøl EL. Risk of Thromboembolism Associated With Atrial Fibrillation Following Noncardiac Surgery. J Am Coll Cardiol. 2018 Oct 23;72(17):2027-36. doi: 10.1016/j.jacc.2018.07.088
  15. Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005 Jul;103(1):25-32. doi: 10.1097/00000542-200507000-00008
  16. Cecconi M, Hofer C, Teboul JL, Pettila V, Wilkman E, Molnar Z, Della Rocca G, Aldecoa C, Artigas A, Jog S, Sander M, Spies C, Lefrant JY, De Backer D; FENICE Investigators; ESICM Trial Group. Fluid challenges in intensive care: the FENICE study: A global inception cohort study. Intensive Care Med. 2015 Sep;41(9):1529-37. doi: 10.1007/s00134-015-3850-x
  17. Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, Rasmussen MS, Lanng C, Wallin L, Iversen LH, Gramkow CS, Okholm M, Blemmer T, Svendsen PE, Rottensten HH, Thage B, Riis J, Jeppesen IS, Teilum D, Christensen AM, Graungaard B, Pott F. Danish Study Group on Perioperative Fluid Therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003 Nov;238(5):641-48. doi: 10.1097/01.sla.0000094387.50865.23
  18. Curry FR. Atrial natriuretic peptide: an essential physiological regulator of transvascular fluid, protein transport, and plasma volume. J Clin Invest. 2005 Jun;115(6):1458-61. doi: 10.1172/JCI25417
Address for correspondence:
Russian Federation, Moscow,
Rublevskoe highway 135,
Federal State Budgetary Institution National Medical
Research Center for Cardiovascular Surgery named
after N.N. A.N. Bakulev of the Ministry of Health
of Russian Federation.. Department of Surgical
Treatment of Interactive Pathology,
Tel. +79032619292
Shvartz Vladimir A.
Information about the authors:
Abdurozikov Eldor E., Physician of Functional Diagnostics, State Budgetary Health Institution, City Clinical Hospita named after V.V. Veresaev of the Department of Health of Moscow, Moscow, Russian Federation
Dzhioeva Olga N., MD, Senior Researcher, Department of Fundamental and Applied Aspects of Obesity, Federal State Budgetary Institution National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia; Associate Professor, Department of Therapy and Preventive Medicine, Federal State Budgetary Institution of Higher Education, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov of the Ministry of Health of Russian Federation, Moscow, Russian Federation
Shvartz Vladimir A., MD, Researcher at the Department of Surgical Treatment of Interactive Pathology, Associate Professor of the Department of Cardiovascular Surgery with a Course in Arrhythmology and Clinical Electrophysiology, Federal State Budgetary Institution National Medical Research Center for Cardiovascular Surgery named after A.N. Bakulev of the Ministry of Health of Russian Federation,. Moscow, Russian Federation
Kiselev Anton R., MD, Head of the Center for the Coordination of Fundamental Scientific Activities, Federal State Budgetary Institution National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia, Moscow, Russian Federation
Rogozhkina Elizaveta A., Trainee Physician, City Clinical Hospital Named after V.V. Veresaev of the Department of Health of Moscow, Moscow, Russian Federation.
Drapkina Oksana M., Corresponding Member RAS, MD, Professor, Director Federal State Budgetary Institution National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russian Federation, Head of the Department of Therapy and Preventive Medicine of Federal State Budgetary Institution of Higher Education, Moscow State University of Medicine and Dentistry Named after A.I. Evdokimov of the Ministry of Health of Russian Federaration, Moscow, Russian Federation.



Ryazan State Medical University, Ryazan,
Russian Federation

Objective. To assess dynamics of primary hemostasis markers in patients with pacemakers (PM) in the early postoperative period. Methods. The study included 94 patients (49 men) with an average age of 72 (67-81) years with indications for pacemaker implantation. 43 patients (45.7%) were underwent management of antiplatelet agents (acetylsalicylic acid in a standard dosage) and 51 (54.3%) patients anticoagulants due to the presence of atrial fibrillation. Before implantation, after 7 days and after 1 month, samples of blood were taken to determine the number of platelets, thrombocrit, platelet distribution width, mean platelet volume, von Willebrand factor (vWF) activity, and the level of soluble P-selectin (sP-selectin). Results. The number of platelets decreased 7 days after the pacemaker implantation (p<0.001), recovering to the initial values after 1 month (p=0.002). Thrombocrit significantly decreased 7 days after surgery (p=0.003). The mean platelet volume decreased after 1 month compared to baseline values (p=0.016) and 7 days values after implantation (p=0.01). The level of sP-selectin increased on the 7th day of the postoperative period (p=0.006). The mean values of the platelet distribution width, vWF, and other changes not described above were statistically hegligibl (p>0.05). The number of platelets 7 days after implantation of a pacemaker requiring puncture of the subclavian vein was lower than in the case of using the cephalic vein (p=0.02). When analyzing subgroups, these changes were noted primarily in patients underwent antiplatelet therapy. Conclusion. The changes in the investigated parameters after implantation of the pacemaker may indicate the activation of the primary hemostasis in patients underwent antiplatelet therapy, but not anticoagulant therapy. A more pronounced activation of the primary hemostasis has occurred in the case of subclavian vein puncture. The mean platelet volume decreases 1 month after pacemaker implantation, which may be associated with the relief of bradyarrhythmia and the elimination of its role in the pathogenesis of heart failure.

Keywords: cardiac implantable electronic devices, pacemaker, hemostasis system, primary hemostasis, platelets
p. 255-263 of the original issue
  1. Hoffman M, Monroe DM. Coagulation 2006: a modern view of hemostasis. Hematol Oncol Clin North Am. 2007;21(1):1-11. doi: 10.1016/j.hoc.2006.11.004
  2. Kalinin Kt, bucnkov IA, Mzhavanadze NU, Kovarov vu Hemostatic system in patients witn cardiovascular implantable electronic devices. Kardiologiya i Serdechno-Sosudistaya Khirurgiya. 2021;14(4):292-99. doi: 10.17116/kardio2021l4041292 (In Russ.).
  3. Kondjurova EV, Vlasova TI, Trofimov VA, Vlasov AP, Adamchik RA, Akimov VV, Tashina EA. Sostojanie trombocitarnogo zvena sistemy gemostaza v patogeneze progressirovanija hronicheskogo parodontita. Ross Med-Biol Vestn Im Akad I.P. Pavlova. 2019; 27(2):209-18. doi: 10.23888/PAVLOVJ2019272209-218 (In Russ.)
  4. Skeith L, Baumann Kreuziger L, Crowther MA, Warkentin TE. A practical approach to evaluating postoperative thrombocytopenia. Blood Adv. 2020;4(4):776-783. doi: 10.1182/bloodadvances.2019001414
  5. Kalinin RE, Suchkov IA, Mzhavanadze ND, Povarov VO. Dynamics of Coagulation Parameters and Their Relationship with Venous Thromboembolic Events in Patients with Cardiac Implantable Electronic Devices. Flebologiya. 2019;13(1):21-26. (In Russ.). doi: 10.17116/ flebo20191301121
  6. Greinacher A, Selleng K. Thrombocytopenia in the intensive care unit patient. Hematology Am Soc Hematol Educ Program. 2010;2010:135-143. doi: 10.1182/asheducation-2010.1.135
  7. Selleng S, Malowsky B, Strobel U, Wessel A, Ittermann T, Wollert HG, Warkentin TE, Greinacher A. Early-onset and persisting thrombocytopenia in post-cardiac surgery patients is rarely due to heparin-induced thrombocytopenia, even when antibody tests are positive. J Thromb Haemost. 2010;8(1):30-36. doi: 10.1111/j.1538-7836.2009.03626.x
  8. Arnold DM, Warkentin TE. Thrombocytopenia and thrombocytosis In: Wilson WC, Grande CM, Hoyt DB, eds. Trauma: Critical Care, New York, NY: Informa; 2007:983-1005.
  9. Burri H, Starck C. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace. 2021;23(7):983-1008. doi: 10.1093/europace/euaa367
  10. Yıldırım I, Tütüncü AÇ, Bademler S, Özgür I, Demiray M, Karanlık H. Does the real-time ultrasound guidance provide safer venipuncture in implantable venous port implantation? J Vasc Access. 2018;19(3):297-302. doi: 10.1177/1129729817752606
  11. Costa R, Da Silva KR, Rached R, Martinelli Filho M, Carnevale FC, Moreira LF, Stolf NA. Prevention of venous thrombosis by warfarin after permanent transvenous leads implantation in high-risk patients. Pacing Clin Electrophysiol. 2009;32 (Suppl) 1:S247-S251. doi: 10.1111/j.1540-8159.2008.02295.x
  12. Abu-El-Haija B, Bhave PD, Campbell DN, Mazur A, Hodgson-Zingman DM, Cotarlan V, Giudici MC. Venous Stenosis After Transvenous Lead Placement: A Study of Outcomes and Risk Factors in 212 Consecutive Patients. J Am Heart Assoc. 2015;4(8):e001878. doi: 10.1161/JAHA.115.001878
  13. Safi M, Akbarzadeh MA, Azinfar A, Namazi MH, Khaheshi I. Upper extremity deep venous thrombosis and stenosis after implantation of pacemakers and defibrillators; A prospective study. Rom J Intern Med. 2017;55(3):139-44. doi: 10.1515/rjim-2017-0018
  14. Gjesdal G, Hansen AB, Brandes A. Does bipolar pacemaker current activate blood platelets? Pacing Clin Electrophysiol. 2009;32(5):627-31. doi: 10.1111/j.1540-8159.2009.02336.x
  15. Palatianos GM, Dewanjee MK, Panoutsopoulos G, Kapadvanjwala M, Novak S, Sfakianakis GN. Comparative thrombogenicity of pacemaker leads. Pacing Clin Electrophysiol. 1994;17(2):141-45. doi: 10.1111/j.1540-8159.1994.tb01364.x van Rooden CJ, Molhoek SG, Rosendaal FR, Schalij MJ, Meinders AE, Huisman MV. Incidence and risk factors of early venous thrombosis associated with permanent pacemaker leads. J Cardiovasc Electrophysiol. 2004;15(11):1258-62. doi: 10.1046/j.1540-8167.2004.04081.x
  16. Haghjoo M, Nikoo MH, Fazelifar AF, Alizadeh A, Emkanjoo Z, Sadr-Ameli MA. Predictors of venous obstruction following pacemaker or implantable cardioverter-defibrillator implantation: a contrast venographic study on 100 patients admitted for generator change, lead revision, or device upgrade. Europace. 2007;9(5):328-32. doi: 10.1093/europace/eum019
  17. Alper AT, Akyol A, Hasdemir H, Yildirim A, Nurkalem Z, GüvenÇ TS, Cakmak N, Oğuz E, Erdinler IC, Gürkan K. Effect of cardiac resynchronization therapy on mean platelet volume. Acta Cardiol. 2008;63(6):735-39. doi: 10.2143/AC.63.6.2033391
  18. Kaya H, Kutay Yıldırımlı M, Kurt R, Beton O, Birhan Yilmaz M. Mean Platelet Volume as a Predictor of Heart Failure-Related Hospitalizations in Stable Heart Failure Outpatients with Sinus Rhythm. Acta Cardiol Sin. 2017;33(3):292-300. doi: 10.6515/acs20160930a
  19. . Kanagala P, Arnold JR, Khan JN, Singh A, Gulsin GS, Squire IB, McCann GP, Ng LL. Plasma P-selectin is a predictor of mortality in heart failure with preserved ejection fraction. ESC Heart Fail. 2021;8(3):2328-33. doi: 10.1002/ehf2.13280
  20. Xia ZY, Yang H, Qu HQ, Cheng WD, Wang LX. Expression of P-selectin, von Willebrand and endothelin-1 after carotid artery stenting. Vasa. 2011;40(3):199-204. doi: 10.1024/0301-1526/a000094
Address for correspondence:
390026, Russian Federation,
Ryazan, st. Vysokovoltnaya, 9,
Ryazan State Medical
University Named by Acad. I.P. Pavlov,
Department of Cardiovascular,
X-ray Endovascular Surgery
with a Course of Radiation Diagnostics,
phone: +7-903-836-24-17,
Suchkov Igor A.
Information about the authors:
Kalinin Roman E., MD, Professor, Head of the Department of Cardiovascular, Endovascular Surgery and Radiology, Ryazan State Medical University Named by Acad. I.P. Pavlova, Ryazan, Russian Federation.
Suchkov Igor A., MD, Professor, Professor of the Department of Cardiovascular, Endovascular Surgery and Radiology, Ryazan State Medical University Named by Acad. I.P. Pavlova, Ryazan, Russian Federation.
Povarov Vladislav O., PhD., Junior Researcher of the Scientific and Educational Center, Ryazan State Medical University Named by Acad. I.P. Pavlova, Ryazan, Russian Federation.
Mzhavanadze Nina D., PhD., Assistant Professor of the Department of Cardiovascular, Endovascular Surgery and Radiology, Ryazan State Medical University Named by Acad. I.P. Pavlova, Ryazan, Russian Federation.
Zhurina Olga N., Researcher of the Department of Clinical Laboratory Diagnostics, Ryazan State Medical University Named by Acad. I.P. Pavlova, Ryazan, Russian Federation.




Tyumen State Medical University 1,
Regional Clinical Hospital 2 2, Tyumen,
Russian Federation

Esophageal atresia is a malformation with an incidence of 1: 2500-1: 3000 newborns. Duodenal obstruction occurs in 1: 7000-10000 neonates. The combination of congenital esophageal atresia and duodenal obstruction is less frequent than 1-6% of all cases of esophageal atresia. The article is devoted to the choice of treatment tactics of a neonate with a rare combination of gastrointestinal malformations: esophageae without associated tracheoesophageae fistula atresia of type A (R. Gross classification) and duodenal obstruction caused by a violation of intestinal rotation and fixation. The variability of surgical approaches is shown and the technique of intrathoracic thoracoscopic tractional elongation of the esophagus is demonstrated, which allowed perfoming esophago-esophagoanastomosis in 10 days thoracoscopically and preserve the childs esophagus. The uniqueness of the case is that laparoscopy was performed simultaneously with the primary esophageal surgery, aimed at eliminating the midgut volvulus which caused high intestinal obstruction. Gastrointestinal passage was fully restored 14 days after the second stage of esophageal plastic surgery. Subsequently, stenosis was recorded in the place of esophageal anastomosis, resolved by esophageal bougienage conducted by string-guide under esophagoscopy control. The chosen endoscopic treatment of the correction of combined malformations of the gastrointestinal tract allowed saving the childs esophagus and discharging him to out-patient observation in a satisfactory condition.

Keywords: esophageal atresia, duodenal obstruction, Ledds syndrome, intestinal malrotation, thoracoscopy, laparoscopy, malformations, anastomosis, internal traction, long-gap
p. 264-269 of the original issue
  1. Harris J, Kallen B, Robert E. Descriptive epidemiology of alimentary tract atresia. Teratology. 1995;52:1529. doi: 10.1002/tera.1420520104
  2. van Bokhoven H, Celli J, van Reeuwijk J, Rinne T, Glaudemans B, van Beusekom E, Rieu P, Newbury-Ecob RA, Chiang C, Brunner HG. MYCN haploinsufficiency is associated with reduced brain size and intestinal atresias in Feingold syndrome. Nat Genet. 2005;37(5):465-467. doi: 10.1038/ng1546
  3. Mukhametshin RF, Toropov NV. Kabdrakhmanova O.T. Esophageal atresia: predicting outcomes and decreasing mortality. Ros Vestn Det Khirurgii Anesteziologii i Reanimatologii. 2020:10(3):315-26. http: doi: 10.17816/psaic572 (In Russ.)
  4. Hanverdiev RA, Razumovskii Aiu. Sravnitelnyi obzor metodov plastiki pishchevoda u detei s atreziei pishchevoda. Det Khiurgiia. 2012;2):47-50 (In Russ.)
    5.Kozlov YA, Rasputin AA, Baradieva PJh, Ochirov CB, Cheremnov VS. Staged thoracoscopic treatment of long-gap esophageal atresia without the need for a gastrostomy. Ros Vestn Det Khirurgii Anesteziologii i Reanimatologii. 2019:9(4):43-49. doi: 10.30946/2219-4061-2019-9-4-43-49 (In Russ.)
  5. Cao ZP, Li QF, Liu SQ, Niu JH, Zhao JR, Chen YJ, Wang DY, Li XS. Surgical management of newborns with combined tracheoesophageal fistula, esophageal atresia, and duodenal obstruction. Chin Med J (Engl). 2019 Mar 20;132(6):726-30. doi: 10.1097/CM9.0000000000000102
  6. Rothenberg SS, Flake AW. Experience with thoracoscopic repair of long gap esophageal atresia in neonates. J Laparoendosc Adv Surg Tech A. 2015 Nov;25(11):932-35. doi: 10.1089/lap.2015.0124
  7. Akselrov M, Emeljanova V, Minaev S, Suprunec S, Sergienko T, Kiseleva N, Karlova M, Stolyar A. Successful application toracoskopy (elongation by Focker and formation deferred anastomosis ) in a child with multiple malformations, including esophageal atresia with irresistible diastase. Med Vestn Sever Kavkaza. 2017;12(2):138-41 doi: 10.14300/mnnc.2017.12039 (In Russ.)
  8. Tainaka T, Uchida H, Tanano A, Shirota C, Hinoki A, Murase N, Yokota K, Oshima K, Shirotsuki R, Chiba K, Amano H, Kawashima H, Tanaka Y. Two-Stage Thoracoscopic repair of long-gap esophageal atresia using internal traction is safe and feasible. J Laparoendosc Adv Surg Tech A. 2017 Jan;27(1):71-75. doi: 10.1089/lap.2016.0207
  9. Hayden CK Jr, Schwartz MZ, Davis M, Swischuk LE. Combined esophageal and duodenal atresia: sonographic findings. AJR Am J Roentgenol. 1983 Feb;140(2):225-26. doi: 10.2214/ajr.140.2.225
Address for correspondence:
625039, Russian Federation,
Tyumen, st. Melnikayte, 75 bldg. 2,
Regional Clinical Hospital No. 2,
Department of Anesthesiology,
Resuscitation and Intensive Care,
Tel. +7 912 997 01 82,
Sudareva Daniela I.
Information about the authors:
Akselrov Mikhail A., MD, Head of the Department of Pediatric Surgery, Tyumen State Medical University, Head of the Surgical Department No. 1, Regional Clinical Hospital No. 2, Tyumen, Russian Federation.
Suprunets Svetlana N., PhD, Associate Professor of the Department of Childrens Diseases, Tyumen State Medical University, Head of the Department of Anesthesiology, Resuscitation and Intensive Care of Newborns, Regional Clinical Hospital No. 2, Tyumen, Russian Federation.
Sergienko Tatyana V., Pediatric Surgeon, Regional Clinical Hospital No. 2, Tyumen, Russian Federation.
Sudareva Daniela I., Neonatologist, Department of Anesthesiology, Resuscitation and Intensive Care of Newborns, Regional Clinical Hospital No. 2, Tyumen, Russian Federation.
Tanzybaev Anton V., Anesthesiologist, Department of Anesthesiology, Resuscitation and Intensive Care of Newborns, Regional Clinical Hospital No. 2, Tyumen, Russian Federation.
Emelyanova Victoria Alexandrovna, Head of the Medical Care Service for Children Regional Clinical Hospital No. 2, Assistant of the Department of Pediatric Surgery, Tyumen State Medical University, Tyumen, Russian Federation.



Belarusian State Medical University 1, Minsk, Belarus
N. N. Alexandrov National Nancer Centre of Belarus 2, Minsk,
Republic of Belarus

Objective. To find out the reasons of the ineffectiveness of dilatation therapy for post-burn stricture of the esophagus in children on the basis of pathohistological examination of esophageal samples after its subtotal resection or extirpation
Methods. The article comprises five clinical cases of children aged 1 year 3 months to 2 years 10 months with a chemical burn of the esophagus as a result of accidental swallowing of caustic materials. In all children a complication of a caustic burn resulted in refractory esophageal stricture (a length of 3.0 to 9.0 cm). The method of treatment of stricture dilatation were the followings: balloon dilatation, suture bougienage, laser recanalization, and esophageal stent insertion. Due to balloon dilation is largely ineffective in the treatment of corrosive strictures, the children underwent a surgical operation esophageal subtotal resection in 2 children and esophageal extirpation - in 3 children. The operation was performed in the period from 2 years 20 months to 4 years 7 months from onset disease. Esophageal surgical specimens were examined histologically with hematoxylin-eosin staining and Massons method.
Results. Sodium (potassium) hydroxide and sodium hypochlorite are considered to be the most common aggressive caustic substances of household cleaning agents, that cause refractory esophageal burns in children. A severe caustic burn of the esophagus results in an extended severe esophageal stricture resistant to dilatation therapy. Pathohistological examination of esophageal tissue samples after subtotal resection or extirpation of the esophagus in children with extended post-burn esophageal stricture detected displacement of the muscle layer of the esophageal wall by connective tissue, glands atrophy, epithelial necrosis, mucosal atrophy, and diffuse sclerosis with increased wall thickness of entire organ.
Conclusion. Sclerosis of the esophageal wall due to caustic burn is considered to be the reason of failed dilatation in patients with acid-induced corrosive esophageal stricture and is associated with significant morphological, anatomical and functional disorders of the esophagus.

Keywords: caustic, stricture, endoscopy, esophagoplasty, children
p. 270-280 of the original issue
  1. Hoffman RS, Burns MM, Gosselin S. Ingestion of Caustic Substances. N Engl J Med. 2020 Apr 30;382(18):1739-48. doi: 10.1056/NEJMra1810769
  2. Franklin RL, Rodgers GB. Unintentional child poisonings treated in United States hospital emergency departments: national estimates of incident cases, population-based poisoning rates, and product involvement. Pediatrics. 2008 Dec;122(6):1244-51. doi: 10.1542/peds.2007-3551.
  3. Gummin DD, Mowry JB, Spyker DA, Brooks DE, Beuhler MC, Rivers LJ, Hashem HA, Ryan ML. 2018 Annual Report of the American Association of Poison Control Centers National Poison Data System (NPDS): 36th Annual Report. Clin Toxicol (Phila). 2019 Dec;57(12):1220-1413. doi: 10.1080/15563650.2019.1677022.
  4. Sabzevari A, Maamouri G, Kiani MA, Saeidi M, Kianifar H, Jafari SA, Ahanchian H, Jarahi L, Roudi E, Sharafkhani M. Clinical and endoscopic findings of children hospitalized in Qaem Hospital of Mashhad due to caustic ingestion (2011-2013). Electron Physician. 2017 Apr 25;9(4):4248-50. doi: 10.19082/4248. eCollection 2017 Apr.
  5. Tannuri ACA, Tannuri U. Total esophageal substitution for combined hypopharyngeal and esophageal strictures after corrosive injury in children. J Pediatr Surg. 2017 Nov;52(11):1742-46. doi: 10.1016/j.jpedsurg.2017.02.003
  6. Niedzielski A, Schwartz SG, Partycka-Pietrzyk K, Mielnik-Niedzielska G. Caustic Agents Ingestion in Children: A 51-Year Retrospective Cohort Study. Ear Nose Throat J. 2020 Jan;99(1):52-57. doi: 10.1177/0145561319843109
  7. Razumovskii AIu, Geraskin AV, Obydennova RV, Kulikova NV. Lechenie khimicheskikh ozhogov pishchevoda u detei. Khirurgiia. Zhurn im NI. Pirogova. 2012;(1):43-48. (In Russ.)
  8. Di Nardo G, Betalli P, Illiceto MT, Giulia G, Martemucci L, Caruso F, Lisi G, Romano G, Villa MP, Ziparo C, Pensabene L, Vassallo F, Quitadamo P. Caustic Ingestion in Children: 1 Year Experience in 3 Italian Referral Centers. J Pediatr Gastroenterol Nutr. 2020 Jul;71(1):19-22. doi: 10.1097/MPG.0000000000002685
  9. Riffat F, Cheng A. Pediatric caustic ingestion: 50 consecutive cases and a review of the literature. Dis Esophagus. 2009;22(1):89-94. doi: 10.1111/j.1442-2050.2008.00867.x
  10. Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991 Mar-Apr;37(2):165-69. doi: 10.1016/s0016-5107(91)70678-0
  11. Cheng HT, Cheng CL, Lin CH, Tang JH, Chu YY, Liu NJ, Chen PC. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol. 2008 Jul 25;8:31. doi: 10.1186/1471-230X-8-31
  12. Keh SM, Onyekwelu N, McManus K, McGuigan J. Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma. World J Gastroenterol. 2006 Aug 28;12(32):5223-28. doi: 10.3748/wjg.v12.i32.5223
  13. Chirica M, Resche-Rigon M, Bongrand NM, Zohar S, Halimi B, Gornet JM, Sarfati E, Cattan P. Surgery for caustic injuries of the upper gastrointestinal tract. Ann Surg. 2012 Dec;256(6):994-1001. doi: 10.1097/SLA.0b013e3182583fb2
  14. Reinberg O. Esophageal replacements in children. Ann N Y Acad Sci. 2016 Oct;1381(1):104-12. doi: 10.1111/nyas.13101
  15. El-Asmar KM, Allam AM. Predictors of successful endoscopic management of caustic esophageal strictures in children: When to stop the dilatations? J Pediatr Surg. 2021 Sep;56(9):1596-99. doi: 10.1016/j.jpedsurg.2020.08.017
Address for correspondence:
220116, Republic of Belarus, Minsk,
Dzerzhinsky Ave., 83,
Belarusian State Medical University,
Department of Pediatric Surgery,
tel. mob.: +375 029 32-902-32,
Voronetsky Alexander N.
Information about the authors:
Voronetsky Alexandr N., PhD, Associate Professor of the Department of Pediatric Surgery, Belarusian State Medical University, Minsk, Republic of Belarus
Hulenka Aleh V., Pathologist, Department of Pathology, Republican Scientific and Practical Center of Oncology and Medical Radiology named after A.I. N.N. Aleksandrova, Minsk, Republic of Belarus




Federal State Budgetary Institution "Scientific Research Center Named after Academician G. Ilizarova Ministry of Health of the Russian Federation, Kurgan,
Russian Federation

Objective. To analyze the incidence of various disorders of carbohydrate metabolism (aseptic and septic) in patients with primary and revision hip arthroplasty.
Methods. The paper analyzes the data of anamnesis, morphometry and basic indicators of carbohydrate metabolism in the blood of patients prior the revision hip surgery. The first group (n=236) included patients with revision hip arthroplasty without infectious complications after primary arthroplasty. The second group (n=141) included the patients with serologically confirmed periprosthetic infection. The comparison group (n=188) included patients examined prior primary hip arthroplasty. Statistical methods were used to assess the incidence of type 1 and type 2 diabetes mellitus, impaired glucose tolerance and obesity - a preclinical form of impaired carbohydrate metabolism.
Results. The highest incidence of carbohydrate metabolism disorders was found in patients with periprosthetic hip joint infection. In patients with revision hip arthroplasty, the incidence of carbohydrate metabolism disorders is higher than in patients with primary arthroplasty.
Conclusion. Incidence evaluation of carbohydrate metabolism disorders in patients with revision hip arthroplasty showed the need to develop the additional laboratory criteria for preoperative preparation, examination and postoperative management in patients with periprosthetic infection. Since it is a known fact that in patients with disorders of carbohydrate metabolism, infections join faster, and infectious diseases are more severe to reduce the risk of developing instability of the hip joint endoprosthesis for this category of patients; a set of measures is required that involve the use of routine laboratory tests (glycemic monitoring) as well as the development of new approaches in protocols and clinical guidelines.

Keywords: revision hip arthroplasty, periprosthetic infection, diabetes mellitus, impaired glucose tolerance, body mass index
p. 281-287 of the original issue
  1. Koenig K, Huddleston JI 3rd, Huddleston H, Maloney WJ, Goodman SB. Advanced age and comorbidity increase the risk for adverse events after revision total hip arthroplasty. J Arthroplasty. 2012 Aug;27(7):1402-07.e1. doi: 10.1016/j.arth.2011.11.013
  2. Tikhilov RM, Shubnyakov MI, Boyarov AA, Riahi A, Shubnyakov II. The impact of the acetabular component position on the rate of the polyethylene liner wear and periprosthetic osteolysis: a clinical case. Genii Ortopedii. 2020;26(2):238-43. doi: 10.18019/1028-4427-2020-26-2-238-24 (In Russ.)
  3. Havelin LI, Fenstad AM, Salomonsson R, Mehnert F, Furnes O, Overgaard S, Pedersen AB, Herberts P, Kärrholm J, Garellick G. The Nordic Arthroplasty Register Association: a unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs. Acta Orthop. 2009 Aug;80(4):393-401. doi: 10.3109/17453670903039544
  4. Khan M, Della Valle CJ, Jacofsky DJ, Meneghini RM, Haddad FS. Early postoperative complications after total hip arthroplasty: current strategies for prevention and treatment. Instr Course Lect. 2015;64:337-46.
  5. Huang Z, Sun C. Causes of failure after total knee arthroplasty. Zhonghua Yi Xue Za Zhi. 2015;95(20):1606-608.
  6. Iamthanaporn K, Chareancholvanich K, Pornrattanamaneewong C. Revision primary total hip replacement: causes and risk factors. J Med Assoc Thai. 2015 Jan;98(1):93-99.
  7. Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today--has anything changed after 10 years? J Arthroplasty. 2014 Sep;29(9):1774-78. doi: 10.1016/j.arth.2013.07.024
  8. Zhang T, Zheng C, Ma H, Sun C. Causes of early failure after total hip arthroplasty. Zhonghua Yi Xue Za Zhi. 2014 Dec 30;94(48):3836-38. [Article in Chinese]
  9. Chirkov NN, Nikolaev NS, Kaminskii AV. Ways to prevent adverse outcomes and complications of total shoulder arthroplasty . Genii Ortopedii. 2019;25(3):312-17. doi: 10.18019/1028-4427-2019-25-3-312-317 (In Russ.)
  10. Eka A, Chen AF. Patient-related medical risk factors for periprosthetic joint infection of the hip and knee. Ann Transl Med. 2015 Sep;3(16):233. doi: 10.3978/j.issn.2305-5839.2015.09.26
  11. Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA. Periprosthetic joint infection. Lancet. 2016 Jan 23;387(10016):386-94. doi: 10.1016/S0140-6736(14)61798-0
  12. Maoz G, Phillips M, Bosco J, Slover J, Stachel A, Inneh I, Iorio R. The Otto Aufranc Award: Modifiable versus nonmodifiable risk factors for infection after hip arthroplasty. Clin Orthop Relat Res. 2015 Feb;473(2):453-59. doi: 10.1007/s11999-014-3780-x
  13. Jaxybayev MN, Alhodzhaev SS, Kilybayev AK, Orazkhan Zh, Bekmuratov AI, Bikonurov ND, Safiollaeva AK, Beiseyeva ZhE, Zhanykulova GM. Replacement of large joints in patients with diabetes Vestn KazNMU. 2015;(2)285-87. (In Russ.)
  14. Ivchenko DV, Ivchenko AV, Shvets AI, Antonova TS. Totalnoe endoprotezirovanie tazobedrennogo sustava u bolnykh sakharnym diabetom. Travma. 2014;15(3):132-33. (In Russ.)
  15. Allen DC, Jedrzynski NA, Michelson JD, Blankstein M, Nelms NJ. The effect of dexamethasone on postoperative blood glucose in patients with type 2 diabetes mellitus undergoing total joint arthroplasty. J Arthroplasty. 2020 Mar;35(3):671-74. doi: 10.1016/j.arth.2019.10.030
  16. Galbraith AS, Sanz-Nogués C, Glynn S, Coleman CM, Murphy C. Diabetes mellitus and gender have a negative impact on the outcome of hip fracture surgery-a pilot study. J Orthop Res. 2020 Apr;38(4):834-42. doi: 10.1002/jor.24517
  17. Wang SH, Xu C, Tan TL, Goswami K, Cooper AM, Parvizi J. Increased Postoperative Glucose Variability Is Associated With Adverse Outcome Following Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection. J Arthroplasty. 2020 May;35(5):1368-73. doi: 10.1016/j.arth.2019.11.046
  18. Dedov II (red), Shestakova MV (red), Galstyan GR, Grigoryan OR, Esayan RM, Kalashnikov VYu, Kuraeva TL, Lipatov DV, Mayorov AYu, Peterkova VA, Smirnova OM, Starostina EG, Surkova EV, Sukhareva OYu, Tokmakova AYu, Shamkhalova MS, Jarek-Martynowa IR. Standards of specialized diabetes care. Diabetes Mellitus. (7th ed.). 2015;18(1S):1-112. doi: 10.14341/DM7078 (In Russ.)
Address for correspondence:
640014, Russian Federation,
Kurgan. M.Ulyanova Street, 6,
Federal State Budgetary Institution Scientific Research Center named after Academician G.A.Ilizarov of the Ministry of Health
of the Russian Federation,
tel. 8 (3522) 45-05-38,
Gasanova Anna G.
Information about the authors:
Matveeva Elena L., MD (Biol.), Leading Researcher of the Department of Preclinical and Laboratory Reseach of the Federal State Budgetary Institution Scientific Research Center Named after Academician G.A. Ilizarov of the Ministry of Health of the Russian Federation, Kurgan, Russian Federation.
Gasanova Anna G., Junior Researcher of the Department of Preclinicla and Laboratory Reseach of the Federal State Budgetary Institution Scientific Research Center Named after Academician G.A. Ilizarov of the Ministry of Health of the Russian Federation, Kurgan, Russian Federation.
Luneva Svetlana N., MD (Biol.), Professor, Leading Reseacher of the Department of Preclinicla and Laboratory Reseach of the Federal State Budgetary Institution Scientific Research Center Named after Academician G.A. Ilizarov of the Ministry of Health of the Russian Federation, Kurgan, Russian Federation.
Ermakov Artem M., PhD, Researcher of the Laboratory of the Clinic of Purulent Osteology, Physician of the Purulent Traumatology and Orthopedic Department No 1 of the Federal State Budgetary Institution National Medical Research Center for Traumatology and Orthopedics Named after Academician G.A. Ilizarov of the Ministry of Health of the Russian Federation, Kurgan, Russian Federation.




Voronezh state medical University named after N. N. Burdenko, Voronezh,
Russian Federation

Throughout the world cancer of unknown primary origin occures the 7th place according to morbidity, which is 2.3-5% of all malignant neoplasms and ranks the 4th according to mortality. In a certain proportion of patients, these metastases are determined independently, without identifying the primary focus. This nosological form of cancer is a heterogeneous disease and usually manifests a pronounced aggressive character in case of progression of the process in the absence of a primary tumor focus. The search for the primary focus and further tactics of treating patients is an embarrassing and under-researched problem that requires numerous studies in future. In addition to standard diagnostic methods, immunohistochemical and virological examinations are used to examine such patients. Most often, patients with metastases in the cervical lymph nodes without a primary identified focus, associated with human papillomavirus (HPV) and Epstein-Barr virus (EBV), which in turn helps to predict the primary localization of cancer. Also diagnostic bilateral tonsillectomy and panendoscopy play the important role. In most cases cancer of unknown primary origin is located in the head and neck. Currently, a search is underway for new diagnostic methods to eliminate delays in treatment and increase the life expectancy of patients. This issue is in demand among researchers around the world. Therefore, further studies are necessary to advance the knowledge of this area.

Keywords: squamous cell carcinoma, metastases without identified primary focus, lymph nodes of the neck, positron emission tomography, human papillomavirus
p. 288-297 of the original issue
  1. Wagland R, Bracher M, Drosdowsky A, Richardson A, Symons J, Mileshkin L, Schofield P. Differences in experiences of care between patients diagnosed with metastatic cancer of known and unknown primaries: mixed-method findings from the 2013 cancer patient experience survey in England. BMJ Open. 2017 Sep 27;7(9):e017881. doi: 10.1136/bmjopen-2017-017881
  2. Choi J, Nahm JH, Kim SK. Prognostic clinicopathologic factors in carcinoma of unknown primary origin: a study of 106 consecutive cases. Oncotarget. 2017 Mar 8;8(37):62630-640. doi: 10.18632/oncotarget.16021. eCollection 2017 Sep 22.
  3. Vagner RI, Podviaznikov SO, Choinzonov EL, Kropotov MA, Komarov IG, Paches AI, Mudunov AM, Mikhnin AE, Olshanskii VO, Kozhanov LG, Pustynskii IN, Saprina OA Examination and treatment of patients with neck lymph nodes metastases without detectable primary tumor. clinical recommendations. Siberian Journal of Oncology. 2014;(1):60-63. (In Russ.)
  4. Saprina O.A. Squamous cell carcinoma metastases to the cervical lymph nodes without a primary focus being detected. Head and Neck Tumors (HNT). 2012;(4):53-58 doi: 10.17650/2222-1468-2012-0-4-53-58. (In Russ.)
  5. Chen YH, Yang XM, Li SS, Wang YH, He JJ, Yang YD, Wang S, Liu JJ, Zhang XL. Value of fused positron emission tomography CT in detecting primaries in patients with primary unknown cervical lymph node metastasis. J Med Imaging Radiat Oncol. 2012 Feb;56(1):66-74. doi: 10.1111/j.1754-9485.2011.02331.x
  6. Fülöp M, Kásler M, Remenár E, Lengyel Z, Borbély K. The role of PET-CT in detecting unknown primary tumour in patients with cervical lymph node metastases. Magy Onkol. 2012 May;56(2):84-92. [Article in Hungarian]
  7. Komarov IG, Karseladze DA, Senderovich AI, Karseladze AI, Smirnova KV, rylovetskaya MA. Metastases of squamous cell carcinoma in the lymph nodes of the neck without the revealed primary focus. Head and Neck Tumors (HNT). 2018;8(1):38-47. doi: 10.17650/2222-1468-2018-8-1-38-47 (In Russ.)
  8. Axelsson L, Nyman J, Haugen-Cange H, Bove M, Johansson L, De Lara S, Kovács A, Hammerlid E. Prognostic factors for head and neck cancer of unknown primary including the impact of human papilloma virus infection. J Otolaryngol Head Neck Surg. 2017 Jun 10;46(1):45. doi: 10.1186/s40463-017-0223-1
  9. Schroeder L, Boscolo-Rizzo P, Dal Cin E, Romeo S, Baboci L, Dyckhoff G, Hess J, Lucena-Porcel C, Byl A, Becker N, Alemany L, Castellsagué X, Quer M, León X, Wiesenfarth M, Pawlita M, Holzinger D. Human papillomavirus as prognostic marker with rising prevalence in neck squamous cell carcinoma of unknown primary: A retrospective multicentre study. Eur J Cancer. 2017 Mar;74:73-81. doi: 10.1016/j.ejca.2016.12.020
  10. Ren J, Yang W, Su J, Ren X, Fazelzad R, Albert T, Habbous S, Goldstein DP, de Almeida JR, Hansen A, Jang R, Bratman SV, Hope A, Chen R, Wang J, Xu Y, Cheng D, Zhao Y, Xu W, Liu G. Human papillomavirus and p16 immunostaining, prevalence and prognosis of squamous carcinoma of unknown primary in the head and neck region. Int J Cancer. 2019 Sep 15;145(6):1465-74. doi: 10.1002/ijc.32164
  11. Straetmans J, Vent J, Lacko M, Speel EJ, Huebbers C, Semrau R, Hoebers F, Mujagic Z, Klussmann JP, Preuss SF, Kremer B. Management of neck metastases of unknown primary origin united in two European centers. Eur Arch Otorhinolaryngol. 2015 Jan;272(1):195-205. doi: 10.1007/s00405-014-2934-5
  12. Du C, Ying H, Zhang Y, Huang Y, Zhai R, Hu C. Treatment for retropharyngeal metastatic undifferentiated squamous cell carcinoma from an unknown primary site: results of a prospective study with irradiation to nasopharyngeal mucosa plus bilateral neck. Oncotarget. 2017 Jun 27;8(26):42372-81. doi: 10.18632/oncotarget.16344
  13. McDowell LJ, Young RJ, Johnston ML, Tan TJ, Kleid S, Liu CS, Bressel M, Estall V, Rischin D, Solomon B, Corry J. p16-positive lymph node metastases from cutaneous head and neck squamous cell carcinoma: No association with high-risk human papillomavirus or prognosis and implications for the workup of the unknown primary. Cancer. 2016 Apr 15;122(8):1201-8. doi: 10.1002/cncr.29901
  14. Chernock RD, Lewis JS. Approach to metastatic carcinoma of unknown primary in the head and neck: squamous cell carcinoma and beyond. Head Neck Pathol. 2015 Mar;9(1):6-15. doi: 10.1007/s12105-015-0616-2
  15. Cheol Park G, Roh JL, Cho KJ, Seung Kim J, Hyeon Jin M, Choi SH, Yuhl Nam S, Yoon Kim S. 18 F-FDG PET/CT vs. human papillomavirus, p16 and Epstein-Barr virus detection in cervical metastatic lymph nodes for identifying primary tumors. Int J Cancer. 2017 Mar 15;140(6):1405-12. doi: 10.1002/ijc.30550
  16. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more personalized approach to cancer staging. CA Cancer J Clin. 2017 Mar;67(2):93-99. doi: 10.3322/caac.21388
  17. Bertero L, Massa F, Metovic J, Zanetti R, Castellano I, Ricardi U, Papotti M, Cassoni P. Eighth Edition of the UICC Classification of Malignant Tumours: an overview of the changes in the pathological TNM classification criteria-What has changed and why? Virchows Arch. 2018 Apr;472(4):519-31. doi: 10.1007/s00428-017-2276-y
  18. Du C, Ying H, Zhang Y, Huang Y, Zhai R, Hu C. Treatment for retropharyngeal metastatic undifferentiated squamous cell carcinoma from an unknown primary site: results of a prospective study with irradiation to nasopharyngeal mucosa plus bilateral neck. Oncotarget. 2017 Jun 27;8(26):42372-81. doi: 10.18632/oncotarget.16344
  19. Rassy E, Nicolai P, Pavlidis N. Comprehensive management of HPV-related squamous cell carcinoma of the head and neck of unknown primary. Head Neck. 2019 Oct;41(10):3700-11. doi: 10.1002/hed.25858
  20. Švajdler M Jr, Kašpírková J, Hadravský L, Laco J, Dubinský P, StrakaL, Ondič O, Michal M, Skálová A. Origin of cystic squamous cell carcinoma metastases in head and neck lymph nodes: Addition of EBV testing improves diagnostic accuracy. Pathol Res Pract. 2016 Jun;212(6):524-31. doi: 10.1016/j.prp.2016.03.002
  21. Keller LM, Galloway TJ, Holdbrook T, Ruth K, Yang D, Dubyk C, Flieder D, Lango MN, Mehra R, Burtness B, Ridge JA. p16 status, pathologic and clinical characteristics, biomolecular signature, and long-term outcomes in head and neck squamous cell carcinomas of unknown primary. Head Neck. 2014 Dec;36(12):1677-84. doi: 10.1002/hed.23514
  22. Piazza C, Incandela F, Giannini L. Unknown primary of the head and neck: a new entry in the TNM staging system with old dilemmas for everyday practice. Curr Opin Otolaryngol Head Neck Surg. 2019 Apr;27(2):73-79. doi: 10.1097/MOO.0000000000000528
  23. Boscolo-Rizzo P, Schroeder L, Romeo S, Pawlita M. The prevalence of human papillomavirus in squamous cell carcinoma of unknown primary site metastatic to neck lymph nodes: a systematic review. Clin Exp Metastasis. 2015 Dec;32(8):835-45. doi: 10.1007/s10585-015-9744-z
  24. Luo WJ, Feng YF, Guo R, Tang LL, Chen L, Zhou GQ, Li WF, Liu X, Sun Y, Lin AH, Ma J, Mao YP. Patterns of EBV-positive cervical lymph node involvement in head and neck cancer and implications for the management of nasopharyngeal carcinoma T0 classification. Oral Oncol. 2019 Apr;91:7-12. doi: 10.1016/j.oraloncology.2019.01.012
  25. Rohde M, Dyrvig AK, Johansen J, Sørensen JA, Gerke O, Nielsen AL, Høilund-Carlsen PF, Godballe C. 18F-fluoro-deoxy-glucose-positron emission tomo-graphy/computed tomography in diagnosis of head and neck squamous cell carcinoma: a systematic review and meta-analysis. Eur J Cancer. 2014 Sep;50(13):2271-79. doi: 10.1016/j.ejca.2014.05.015
  26. Martell K, Mackenzie J, Kerney W, Lau HY. Management delays in patients with squamous cell cancer of neck node(s) and unknown primary site: a retrospective cohort study. J Otolaryngol Head Neck Surg. 2017 May 8;46(1):39. doi: 10.1186/s40463-017-0217-z
  27. Takes RP, Kaanders JH, van Herpen CM, Merkx MA, Slootweg PJ, Melchers WJ. Human papillomavirus detection in fine needle aspiration cytology of lymph node metastasis of head and neck squamous cell cancer. J Clin Virol. 2016 Dec;85:22-26. doi: 10.1016/j.jcv.2016.10.008
  28. Qaseem A, Usman N, Jayaraj JS, Janapala RN, Kashif T. Cancer of Unknown Primary: A Review on Clinical Guidelines in the Development and Targeted Management of Patients with the Unknown Primary Site. Cureus. 2019 Sep 2;11(9):e5552. doi: 10.7759/cureus.5552
  29. Zhuang SM, Wu XF, Li JJ, Zhang GH. Management of lymph node metastases from an unknown primary site to the head and neck (Review). Mol Clin Oncol. 2014 Nov;2(6):917-22. doi: 10.3892/mco.2014.361
  30. Barbora U, Marcela N, Vladimír Č, Andrej H. Carcinoma of Unknown Primary in Head and Neck Region. Klin Onkol. 2018 Summer;31(4):277-81. doi: 10.14735/amko2018277
  31. López F, Rodrigo JP, Silver CE, Haigentz M Jr, Bishop JA, Strojan P, Hartl DM, Bradley PJ, Mendenhall WM, Suárez C, Takes RP, Hamoir M, Robbins KT, Shaha AR, Werner JA, Rinaldo A, Ferlito A. Cervical lymph node metastases from remote primary tumor sites. Head Neck. 2016 Apr;38 Suppl 1(Suppl 1):E2374-85. doi: 10.1002/hed.24344
  32. Golusinski P, Di Maio P, Pehlivan B, Colley S, Nankivell P, Kong A, Hartley A, Mehanna H. Evidence for the approach to the diagnostic evaluation of squamous cell carcinoma occult primary tumors of the head and neck. Oral Oncol. 2019 Jan;88:145-52. doi: 10.1016/j.oraloncology.2018.11.020
  33. García-Curdi F, Lois-Ortega Y, Muniesa-Del Campo A, McGee-Laso A, Sebastián-Cortés JM, Vallés-Varela H, Lambea-Sorrosal JJ. Correlation between PET/CT and CT in the staging prior to the treatment of head and neck squamous cell carcinoma. Braz J Otorhinolaryngol. 2021 Jan-Feb;87(1):11-18. doi: 10.1016/j.bjorl.2019.06.004
  34. Noij DP, Martens RM, Zwezerijnen B, Koopman T, de Bree R, Hoekstra OS, de Graaf P, Castelijns JA. Diagnostic value of diffusion-weighted imaging and 18F-FDG-PET/CT for the detection of unknown primary head and neck cancer in patients presenting with cervical metastasis. Eur J Radiol. 2018 Oct;107:20-25. doi: 10.1016/j.ejrad.2018.08.009
  35. Aro K, Bäck L, Mäkitie A, Tapiovaara L. An evaluation of the diagnostic methods in head and neck cancer of unknown primary site. Acta Otolaryngol. 2018 Oct;138(10):930-36. doi: 10.1080/00016489.2018.1484567
  36. Waltonen JD, Ozer E, Schuller DE, Agrawal A. Tonsillectomy vs. deep tonsil biopsies in detecting occult tonsil tumors. Laryngoscope. 2009 Jan;119(1):102-6. doi: 10.1002/lary.20017
  37. Di Maio P, Iocca O, De Virgilio A, Ferreli F, Cristalli G, Pellini R, Golusinski P, Ricci G, Spriano G. Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta-analysis. Head Neck. 2019 Apr;41(4):1112-21. doi: 10.1002/hed.25522
  38. Durmus K, Rangarajan SV, Old MO, Agrawal A, Teknos TN, Ozer E. Transoral robotic approach to carcinoma of unknown primary. Head Neck. 2014 Jun;36(6):848-52. doi: 10.1002/hed.23385
  39. Sokoya M, Chowdhury F, Kadakia S, Ducic Y. Combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma. Laryngoscope. 2018 Nov;128(11):2573-75. doi: 10.1002/lary.27268
  40. Sharma A. In reference to combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma. Laryngoscope. 2019 Apr;129(4):E122. doi: 10.1002/lary.27692
  41. Ghazali N, Flashburg A, Ord RA. Extensive Regional Metastasis of High-Grade Mucoepidermoid Carcinoma of an Unknown Primary Tumor. J Oral Maxillofac Surg. 2017 Apr;75(4):874.e1-874.e7. doi: 10.1016/j.joms.2016.12.012
  42. Mackenzie K, Watson M, Jankowska P, Bhide S, Simo R. Investigation and management of the unknown primary with metastatic neck disease: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016 May;130(S2):S170-S175. doi: 10.1017/S0022215116000591
Address for correspondence:
394036, Russian Federation,
Voronezh, Kalyaev Street, 2,
Voronezh State Medical University
Named after N. N. Burdenko,
the Oncology Department.
tel.: +7 9066082061,
Sorokina Margarita V.
Information about the authors:
Redkin Alexander N., MD, Professor of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.
Sorokina Margarita V., Post-Graduate Student of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.
Ustinova Elena Yu., MD, Professor of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.
Manukovskaya Olga V., PhD, Associate Professor of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.
Konoplina Juliya S., PhD, Associate of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.
Popov Sergey S., PhD, Associate Professor of the Oncology Department of Voronezh State Medical University Named after N. N. Burdenko, Voronezh, Russian Federation.

M.D. LEVIN 1, 2, V.I. AVERIN 1, 3, YU.G. DEGTYAREV 1, 3


State Institution "Republican Scientific and Practical Center for Pediatric Surgery" ¹, Minsk,
Republic of Belarus
Dorot. State Geriatric Center, Netanya, Israel ²,
EE "Belarusian State Medical University" ³, Minsk,
Republic of Belarus

Objective. Until 1982, pediatric surgeons came to the consensus that in patients with anorectal malformations (ARM), the intestine located caudal to the pubococcygeal line is the anal canal and must be preserved to achieve the best functional result. Simultaneously with the publication of the posterior sagittal anorectoplasty, it was stated that most patients with ARM do not have anal canal. The part of the intestine that is located caudal to the pubococcygeal line began to be called the rectal sac or fistula, which was recommended to be removed, since it was believed that it was not functioning well. Analysis of the literature to determine the anatomy and physiology of ARM without visible fistulas.
Methods. The authors analyzed 32 articles, including 4 of own studies, which reflect the entire palette of ideas about the pathological anatomy and physiology of ARM without visible fistula (boys and girls without fistula, and boys with urethral fistula).
Results. During histological examination of the so-called fistula, the internal anal sphincter and the mucous membrane characteristic of the anal canal are determined. In a manometric study, the normal basal pressure and the rectoanal inhibitory reflex are determined. In radiological studies, in most patients at rest, the distal colon is constantly in a contracted state and opens wide at high pressure in the rectum, which is characteristic of a normally functioning anal canal.
Conclusion This literature review proves that most ARM patients without visible fistula have a functioning anal canal that must be preserved to support normal anorectal function.

Keywords: anorectal malformations; anorectal physiology; pathophysiology anorectum; urethral fistula; without fistula
p. 298-305 of the original issue
  1. Stephens FD. Imperforate rectum; a new surgical technique. Med J Aust. 1953 Feb 7;1(6):202-3.
  2. Holschneider A, Hutson J, Peña A, Beket E, Chatterjee S, Coran A, Davies M, Georgeson K, Grosfeld J, Gupta D, Iwai N, Kluth D, Martucciello G, Moore S, Rintala R, Smith ED, Sripathi DV, Stephens D, Sen S, Ure B, Grasshoff S, Boemers T, Murphy F, Söylet Y, Dübbers M, Kunst M. Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations. J Pediatr Surg. 2005 Oct;40(10):1521-26. doi: 10.1016/j.jpedsurg.2005.08.002
  3. Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE. Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants: A Critically Appraised Topic. Acad Radiol. 2016 May;23(5):559-68. doi: 10.1016/j.acra.2015.12.014
  4. Horsirimanont S, Sangkhathat S, Utamakul P, Chetphaopan J, Patrapinyokul S. An appraisal of invertograms and distal colostograms in the management of anorectal malformations. J Med Assoc Thai. 2004 May;87(5):497-502.
  5. Levitt MA, Peña A. Anorectal malformations. Orphanet J Rare Dis. 2007 Jul 26;2:33. doi: 10.1186/1750-1172-2-33
  6. Cremin RJ, Cywes S, Louw JH. A rational radiological approach to the surgical correction of anorectal anomalies. Surgery. 1972 Jun;71(6):801-6.
  7. Holschneider AM, Ure BM, Pfrommer W, Meier-Ruge W. Innervation patterns of the rectal pouch and fistula in anorectal malformations: a preliminary report. J Pediatr Surg. 1996 Mar;31(3):357-62. doi: 10.1016/s0022-3468(96)90738-1
  8. Gangopadhyay AN, Upadhyaya VD, Gupta DK, Agarwal DK, Sharma SP, Arya NC. Histology of the terminal end of the distal rectal pouch and fistula region in anorectal malformations. Asian J Surg. 2008 Oct;31(4):211-15. doi: 10.1016/S1015-9584(08)60089-5
  9. Xiao H, Huang R, Cui DX, Xiao P, Diao M, Li L. Histopathologic and immunohistochemical findings in congenital anorectal malformations. Medicine (Baltimore). 2018 Aug;97(31):e11675. doi: 10.1097/MD.0000000000011675
  10. Duhamel B. Physio-pathology of the internal anal sphincter. Arch Dis Child. 1969 Jun;44(235):377-81. doi: 10.1136/adc.44.235.377
  11. Lambrecht W, Lierse W. The internal sphincter in anorectal malformations: morphologic investigations in neonatal pigs. J Pediatr Surg. 1987 Dec;22(12):1160-68. doi: 10.1016/s0022-3468(87)80728-5
  12. Ohama K, Asano S, Nanbu K, Kajimoto T. The internal anal sphincter in anorectal malformation. Z Kinderchir. 1990 Jun;45(3):167-77. doi: 10.1055/s-2008-1042575
  13. Misharev OS, Levin MD, Nikiforov AN.. Teoreticheskoe obosnovanie khirurgicheskoi taktiki pri atrezii priamoi kishki so svishchami na promezhnost ili preddverie vlagalishcha u detei. Vestn. Khirurgii, 1983;130:(4):9297.
  14. Levin MD. Pathological physiology of the anorectal defects, from the new concept to to the new treatment. Eksp Klin Gastroenterol. 2013; (11): 3848.
  15. Levin MD, Degtyarov IG, Averin VI, Abu-Varda QF, Degtyarov IG. The standardization of X-rays study of the colon and anorectal area. Novosti Khirurgii. 2013;21(4): 90-8.
  16. Levin MD, Averin VI, Nikiforov AN, Abu-Varda QF, Degtyarov IG. Substantiation of surgical tactics in newborns with anorectal malformations without visible fistula. Khirurgia. Vostochnaya Evropa. 2013;3(07): 12-35.
  17. Ruttenstock EM, Zani A, Huber-Zeyringer A, Höllwarth ME. Pre- and postoperative rectal manometric assessment of patients with anorectal malformations: should we preserve the fistula? Dis Colon Rectum. 2013 Apr;56(4):499-504. doi: 10.1097/DCR.0b013e31826e4a38
  18. Hosokawa T, Yamada Y, Sato Y, Tanami Y, Tanaka Y, Kawashima H, Oguma E. Changes in the Distance Between the Distal Rectal Pouch and Perineum From the Birth Day to the Next Day in Neonates With an Imperforate Anus. J Ultrasound Med. 2017 Mar;36(3):601-606. doi: 10.7863/ultra
  19. Levin MD. Anatomy and physiology of anorectum: the hypothesis of fecal retention, and defecation. Pelviperineology. 2021;40(1):50-57. doi: 10.34057/PPj.2021.40.01.008
  20. Nagdeve NG, Bhingare PD, Naik HR. Neonatal posterior sagittal anorectoplasty for a subset of males with high anorectal malformations. J Indian Assoc Pediatr Surg. 2011 Oct;16(4):126-28. doi: 10.4103/0971-9261.86863
  21. Bharucha AE. Pelvic floor: anatomy and function. Neurogastroenterol Motil. 2006 Jul;18(7):507-19. doi: 10.1111/j.1365-2982.2006.00803.x
  22. Koga H, Kato Y, Shimotakahara A, Miyano G, Lane GJ, Okazaki T, Yamataka A. Intraoperative measurement of rectourethral fistula: prevention of incomplete excision in male patients with high-/intermediate-type imperforate anus. J Pediatr Surg. 2010 Feb;45(2):397-400. doi: 10.1016/j.jpedsurg.2009.10.085
  23. Zbar AP, Khaikin M. Should we care about the internal anal sphincter? Dis Colon Rectum. 2012 Jan;55(1):105-8. doi: 10.1097/DCR.0b013e318235b645
  24. Kraus SJ, Levitt MA, Peña A. Augmented-pressure distal colostogram: the most important diagnostic tool for planning definitive surgical repair of anorectal malformations in boys. Pediatr Radiol. 2018 Feb;48(2):258-69. doi: 10.1007/s00247-017-3962-2
  25. Madhusmita, Ghasi RG, Mittal MK, Bagga D. Anorectal malformations: Role of MRI in preoperative evaluation. Indian J Radiol Imaging. 2018 Apr-Jun;28(2):187-94. doi: 10.4103/ijri.IJRI_113_1
  26. Zhan Y, Wang J, Guo WL. Comparative effectiveness of imaging modalities for preoperative assessment of anorectal malformation in the pediatric population. J Pediatr Surg. 2019 Dec;54(12):2550-53. doi: 10.1016/j.jpedsurg.2019.08.037
  27. Midrio P, van Rooij IALM, Brisighelli G, Garcia A, Fanjul M, Broens P, Iacobelli BD, Giné C, Lisi G, Sloots CEJ, Fascetti Leon F, Morandi A, van der Steeg H, Giuliani S, Grasshoff-Derr S, Lacher M, de Blaauw I, Jenetzky E. Inter- and Intraobserver Variation in the Assessment of Preoperative Colostograms in Male Anorectal Malformations: An ARM-Net Consortium Survey. Front Pediatr. 2020 Sep 18;8:571. doi: 10.3389/fped.2020.00571. eCollection 2020.
  28. Tang ST, Cao GQ, Mao YZ, Wang Y, Li SW, Yang Y, Tong QS. Clinical value of pelvic 3-dimensional magnetic resonance image reconstruction in anorectal malformations. J Pediatr Surg. 2009 Dec;44(12):2369-74. doi: 10.1016/j.jpedsurg.2009.07.074
  29. Gans SL, Friedman NB, David JS. Congenital anorectal anomalies: changing concepts in management. Clin Pediatr (Phila). 1963 Nov;2:605-13. doi: 10.1177/000992286300201105
  30. Fatahi Bandpey ML, Moreno Flores A, Palacios Moya P. Augmented-pressure colostogram in the radiological assessment of anorectal malformations. Cir Pediatr. 2014 Apr 15;27(2):62-67.
  31. Wang C, Lin J, Lim K. The use of augmented-pressure colostography in imperforate anus. Pediatr Surg Int. 1997 Jul;12(5-6):383-85. doi: 10.1007/BF01076945
  32. Kakizaki H, Moriya K, Ameda K, Shibata T, Tanaka H, Koyanagi T. Diameter of the external urethral sphincter as a predictor of detrusor-sphincter incoordination in children: comparative study of voiding cystourethrography. J Urol. 2003 Feb;169(2):655-58. doi: 10.1097/
Address for correspondence:
4220200, Dorot.
State Geriatric Center, Netanya,
Amnon ve-Tamar 1, Israel.
. 972-53-8281393,
Levin Michael
Information about the authors:
Levin Mikhail D., MD, Radiologist, State Geriatric Center (Dorot), Netanya, Israel.
Averin Vasily I., MD, Professor, Head of the Department of Pediatric Surgery, Belarusian State Medical University, Minsk, Republic of Belarus,
Degtyarev Yury G., MD, Professor of the Department of Pediatric Surgery Belarusian State Medical University, Minsk, Republic of Belarus



Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University
Krasnoyarsk, Russian Federation

The failed outcomes of infected necrotizing pancreatitis treatment make the prevention of infectious complications particularly relevance. Despite the objective benefits of non-surgical management in patients with sterile pancreatic necrosis, pharmacologic therapies facilities in the early period of the disease remain limited. Concordantly to available evidence the efficiency of fluid resuscitation, anticoagulants, antioxidants, epidural blockade, hyperbaric oxygen therapy, antisecretory agents, protease inhibitors, antibiotics, immunomodulators, enteral nutrition and minimally invasive surgical approaches to prevent infectious complications in predicted severe acute pancreatitis is considered in this review. Preventive strategies for septic complications of acute necrotizing pancreatitis such as intravenous fluid resuscitation, use of anticoagulants, epidural analgesia and early enteral feeding the evidence is strong. Advantages of enteral nutrition cannot be overemphasized from the standpoint of the trigger role of intestinal contents in the pathogenesis of pancreatogenic infection, as well as the level of evidence of relevant clinical studies.

Keywords: acute severe pancreatitis, infected necrotizing pancreatitis, early enteral nutrition, epidural blockade, antibiotics
p. 306-316 of the original issue
  1. Lubyansky VG, Zharikov AN, Arutyunyan GA, Nasonov VV, Bykov VM, Ustinov DN, Aliev AR. modern approaches to surgical treatment of pancreatic necrosis. Bulletin of Medical Science. 2017. 2. . 38-46. doi: 10.31684/2541-8475.2017.2(6).43-52 (In Russ.)
  2. Bensman VM, Savchenko YUP, Shcherba SN, Malyshko VV. Gnipel AS, Golikov IV. Surgical resolutions determining outcomes of infected pancreatic necrosis. Khirurgiia. Zhurn im NI Pirogova. 2018;(8):12-18. doi: 10.17116/hirurgia2018812(In Russ.)
  3. Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, Ball CG, Parry N, Sartelli M, Wolbrink D, van Goor H, Baiocchi G, Ansaloni L, Biffl W, Coccolini F, Di Saverio S, Kluger Y, Moore E, Catena F. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019 Jun 13;14:27. doi: 10.1186/s13017-019-0247-0. eCollection 2019.
  4. Ning C, Huang G, Shen D, Bonsu AAFK, Ji L, Lin C, Cao X, Li J. Adverse clinical outcomes associated with multidrug-resistant organisms in patients with infected pancreatic necrosis. Pancreatology. 2019 Oct;19(7):935-40. doi: 10.1016/j.pan.2019.09.008
  5. Chen HZ, Ji L, Li L, Wang G, Bai XW, Cheng CD, Sun B. Early prediction of infected pancreatic necrosis secondary to necrotizing pancreatitis. Medicine (Baltimore). 2017 Jul;96(30):e7487. doi: 10.1097/MD.0000000000007487
  6. Zheng Z, Ding YX, Qu YX, Cao F, Li F. A narrative review of the mechanism of acute pancreatitis and recent advances in its clinical management. Am J Transl Res. 2021 Mar 15;13(3):833-52. eCollection 2021.
  7. Baron TH, DiMaio CJ, Wang AY, Morgan KA. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology. 2020 Jan;158(1):67-75.e1. doi: 10.1053/j.gastro.2019.07.064
  8. Moggia E, Koti R, Belgaumkar AP, Fazio F, Pereira SP, Davidson BR, Gurusamy KS. Pharmacological interventions for acute pancreatitis. Cochrane Database Syst Rev. 2017 Apr 21;4(4):CD011384. doi: 10.1002/14651858.CD011384.pub2
  9. Vlasov AP, Mitroshin AN, Nikolskiy VI, Cuslov AV, Muratova TA. Basics of antioxidant therapy in acute pancreatitis (experimental study). Vestn Anesteziologii i Reanimatologii. 2016;13(3):14-18. doi: 10.21292/2078-5658-2016-13-3-14-18 (In Russ.)
  10. Vinnik IuS, Perianova OV, Iakimov SV, Anishina OV, Petrushko SI. Primenenie ozonirovannogo fiziologicheskogo rastvora v kompleksnom lechenii gnoinykh oslozhnenii ostrogo pankreatita. Annaly Khirurg Gepatologii. 2002;7(1):59-62. (In Russ.)
  11. Tozlu M, Kayar Y, Ince AT, Baysal B, Şentürk H. Low molecular weight heparin treatment of acute moderate and severe pancreatitis: A randomized, controlled,open-label study. Turk J Gastroenterol. 2019 Jan;30(1):81-87. doi: 10.5152/tjg.2018.18583
  12. Jeurnink SM, Nijs MM, Prins HA, Greving JP, Siersema PD. Antioxidants as a treatment for acute pancreatitis: A meta-analysis. Pancreatology. 2015 May-Jun;15(3):203-8. doi: 10.1016/j.pan.2015.03.009
  13. Vinnik IuS, Tepliakova OV. Znachenie intraabdominalnoi gipertenzii u bolnykh s ostrym pankreatitom. Vestn Khirurgii im II Grekova. 2016;175(5):110-13. (In Russ.)
  14. Jabaudon M, Belhadj-Tahar N, Rimmelé T, Joannes-Boyau O, Bulyez S, Lefrant JY, Malledant Y, Leone M, Abback PS, Tamion F, Dupont H, Lortat-Jacob B, Guerci P, Kerforne T, Cinotti R, Jacob L, Verdier P, Dugernier T, Pereira B, Constantin JM; Azurea Network. Thoracic Epidural Analgesia and Mortality in Acute Pancreatitis: A Multicenter Propensity Analysis. Crit Care Med. 2018 Mar;46(3):e198-e205. doi: 10.1097/CCM.0000000000002874
  15. Butkevich ATs, Istratov VG, Brovkin AE, Nalivaiskii AA, Riabkov MG, Klychnikova EV. Kompleksnaia otsenka tiazhesti i effektivnosti intensivnoi terapii pankreonekroza. Moskov Khirurg Zhurn. 2014;(3):28-32. (In Russ.) 16.Kolotushkin IA, Balnykov SI, Trohanov MJ, Polytov Syu.. Evaluation effect of octreotide on mortality pationts with necrotizing pancreatitis. Nauka Molodykh (Eruditio Juvenium). 2014;(4):88-94 (In Russ.)
  16. Dibirov MD. Domarev LV. Shitikov EA, Isayev AI,. KarsotiyaN GS. Principles cliff pancreatic necrosis in a first-aid hospital. Khirurgiia Zhurn im NI Pirogova. 2017;(1):73-77. doi: 10.17116/hirurgia2017173-77(In Russ.) 18.Sun C, Li Z, Shi Z, Li G. Current diagnosis and treatment of acute pancreatitis in China: a real-world, multicenter study. BMC Gastroenterol. 2021 May 8;21(1):210. doi: 10.1186/s12876-021-01799-1
  17. Firsova VG, Parshikov VV, Kukosh MV, Mukhin AS. Antibacterial and antifungal therapy for patients with acute pancreatitis at high risk of pancreatogenic sepsis (Review) Sovrem Tekhnologii v Meditsine. 2020;12(1):126-38. doi: 10.17691/stm2020.12.1.15 (In Russ.)
  18. Andriushchenko VP, Andriushchenko DV, Mahlovahyi VV. Clinical Evaluation of the Features of Current Pancreatic Infection as a Component of the Multidisciplinary Principle of Treatment Tactics in Acute Pancreatitis. Novosti Khirurgii. 2021;29(6):671-79. doi: 10.18484/2305-0047.2021.6.671 (In Russ.)
  19. Fomin AV, Okulich VK, Ovsianik DM. Antibiotic prophylaxis and therapy of infected pancreatic necrosis adjusted for gastric microbial indicators . 2014;19(3):99-105. (In Russ.)
  20. Alekseev S, Tarasenko A, Hevsky P, Dudko A, Alekseev V. Method of prevention of purulent-septic complications of acute destructive pancreatitis. Surgery. Eastern Europe. 2017;6(3):400-10. (In Russ.)
  21. Lim CL, Lee W, Liew YX, Tang SS, Chlebicki MP, Kwa AL. Role of antibiotic prophylaxis in necrotizing pancreatitis: a meta-analysis. J Gastrointest Surg. 2015 Mar;19(3):480-91. doi: 10.1007/s11605-014-2662-6
  22. Schwender BJ, Gordon SR, Gardner TB. Risk factors for the development of intra-abdominal fungal infections in acute pancreatitis. Pancreas. 2015 Jul;44(5):805-7. doi: 10.1097/MPA.0000000000000334
  23. Trikudanathan G, Munigala S. Impact of Clostridium difficile infection in patients hospitalized with acute pancreatitis- a population based cohort study. Pancreatology. 2017 Mar-Apr;17(2):201-202. doi: 10.1016/j.pan.2017.02.012
  24. Vinnik IuS, Miller SV, Karapetian GE, Sychev AG, Iakimov SV, Tepliakova OV. Drenirovanie v khirurgii. Krasnoiarsk, RF; 2007. 184 p. (In Russ.)
  25. Vlasov AP, Salahov EK, Shibitov VA,. Vlasov PA, Bolotskih VA. Integrated approach to correction enteral insufficiency in early postoperative period. Khirurgiia. Zhurn im. N. I. Pirogova. 2016;(5):52-58. doi: 10.17116/hirurgia2016552-58 (In Russ.)
  26. Khalidov OK, Fomin VS, Gudkov AN, Zayratyants GO, Dmitrienko GP, Svitina KA. Percutaneous resonance stimulation in complex correction of intraabdominal hypertension and dynamic intestinal obstruction in patients with severe acute pancreatitis. Annaly Khirurgicheskoy Gepatologii = Annals of HPB Surgery. 2018;23(3):23-30 doi: 10.16931/1995-5464.2018323-30. (In Russ.)
  27. Andriushchenko VP, Andriushchenko DV, Kunovskyi VV, Lysiuk YS. Efficiency of Nutritional Support in Surgical Treatment of Patients with Acute Pancreatitis. Novosti Khirurgii. 2019;27(5):515-21. doi: 10.18484/2305-0047.2019.5.515. (In Russ.)
  28. Wu P, Li L, Sun W. Efficacy comparisons of enteral nutrition and parenteral nutrition in patients with severe acute pancreatitis: a meta-analysis from randomized controlled trials. Biosci Rep. 2018 Nov 15;38(6):BSR20181515. doi: 10.1042/BSR20181515
  29. Li W, Liu J, Zhao S, Li J. Safety and efficacy of total parenteral nutrition versus total enteral nutrition for patients with severe acute pancreatitis: a meta-analysis. J Int Med Res. 2018 Sep;46(9):3948-58. doi: 10.1177/0300060518782070
  30. Qi D, Yu B, Huang J, Peng M. Meta-Analysis of Early Enteral Nutrition Provided Within 24 Hours of Admission on Clinical Outcomes in Acute Pancreatitis. JPEN J Parenter Enteral Nutr. 2018 Sep;42(7):1139-47. doi: 10.1002/jpen.1139
  31. Achkasov EE , Pugaev AV, Nabieva ZhG, Kalachev SV. Effect of different nutritional support on pancreatic secretion in acute pancreatitis. Khirurgiia. Zhurn im NI Pirogova. 2018;(1):14-20. doi: 10.17116/hirurgia2018114-20. (In Russ.)
  32. Singh N, Sharma B, Sharma M, Sachdev V, Bhardwaj P, Mani K, Joshi YK, Saraya A. Evaluation of early enteral feeding through nasogastric and nasojejunal tube in severe acute pancreatitis: a noninferiority randomized controlled trial. Pancreas. 2012 Jan;41(1):153-59. doi: 10.1097/MPA.0b013e318221c4a8
  33. Poropat G, Giljaca V, Hauser G, Štimac D. Enteral nutrition formulations for acute pancreatitis. Cochrane Database Syst Rev. 2015 Mar 23;(3):CD010605. doi: 10.1002/14651858.CD010605.pub2
  34. Lakananurak N, Gramlich L. Nutrition management in acute pancreatitis: Clinical practice consideration. World J Clin Cases. 2020 May 6;8(9):1561-73. doi: 10.12998/wjcc.v8.i9.1561
  35. Tian X, Pi YP, Liu XL, Chen H, Chen WQ. Supplemented Use of Pre-, Pro-, and Synbiotics in Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis of 13 Randomized Controlled Trials. Front Pharmacol. 2018 Jun 28;9:690. doi: 10.3389/fphar.2018.00690. eCollection 2018
  36. Ponomar SA, Boldin BD. Key intracellular mechanisms in the pathogenesis of acute pancreatitis. . 2021;(1):106-12. doi: 10.24412/2071-5315-2021-12298 (In Russ.)
  37. Lin R, Chen F, Wen S, Teng T, Pan Y, Huang H. Interleukin-10 attenuates impairment of the blood-brain barrier in a severe acute pancreatitis rat model. J Inflamm (Lond). 2018 Feb 27;15:4. doi: 10.1186/s12950-018-0180-0
  38. Akinosoglou K, Gogos C. Immune-modulating therapy in acute pancreatitis: fact or fiction. World J Gastroenterol. 2014 Nov 7;20(41):15200-15. doi: 10.3748/wjg.v20.i41.15200
  39. Li J, Yang WJ, Huang LM, Tang CW. Immunomodulatory therapies for acute pancreatitis. World J Gastroenterol. 2014 Dec 7;20(45):16935-47. doi: 10.3748/wjg.v20.i45.16935
  40. Safarov SS. Immunokorrektsiia v lechenii ostrogo pankreatita [Elektronnyi resurs]. Novyi Den v Meditsine. 2020;(1):394-97. [data obrashcheniia: 2022 Ianv 27]. Available from: (In Russ.)
  41. Munir F, Jamshed MB, Shahid N, Hussain HM, Muhammad SA, Mamun AA, Zhang Q. Advances in immunomodulatory therapy for severe acute pancreatitis. Immunol Lett. 2020 Jan;217:72-76. doi: 10.1016/j.imlet.2019.11.002
  42. Belorusets VN, Karpitskij AS, Golubeva NN. Morphological changes in the retroperitoneal fat tissue in the early phase of acute necrotizing pancreatitis. Novosti Khirurgii. 2018;26(1):34-41. doi: 10.18484/2305-0047.2018.1.34 (In Russ.)
  43. Grekova NM, Shisfamencev NB, Naimushina YV, Buhvalov AG. Acute pancreatitis: Modem concepts of surgical treatment. Novosti Khirurgii. 2020;28(2):197-206. doi: 10.18484/2305-0047.2020.2.197 (In Russ.)
  44. Galperin EI, Dyuzheva TG, Shefer AV, Kotovskiy AE, Semenenko IA, Mudryak DL. Early interventions for disconnected pancreatic duct syndrome in acute pancreatitis. Annaly Khirurgicheskoy Gepatologii = Annals of HPB Surgery. 2021;26(2):25-31. doi: 10.16931/1995-5464.2021-2-25-31 (In Russ.)
  45. Korolkov AYu, Smirnov AA, Popov DN, Saadylaeva MM, Nikitina TO., Bagnenko SF. Surgical treatment of acute biliary pancreatitis. Grekovs Bulletin of Surgery. 2021;180(1):40-44. doi: 10.24884/0042-4625-2021-180-1-40-44 (In Russ.)
  46. Karjula H, Nordblad Schmidt P, Mäkelä J, Liisanantti JH, Ohtonen P, Saarela A. Prophylactic pancreatic duct stenting in severe acute necrotizing pancreatitis: a prospective randomized study. Endoscopy. 2019 Nov;51(11):1027-34. doi: 10.1055/a-0865-1960
  47. Van Wanrooij RLJ, van Hooft JE. Bridging the gap or paving the way for uninvited guests? Endoscopy. 2019;51(11):1015-16. doi: 10.1055/a-0901-749148.
  48. Malkov IS, Zainutdinov AM, Khamzin II, Makarov DV, Khalilov KhM, Gubaev RF. Improvement of acute destructive pancreatitis management. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnatim. N.I. Pirogova. 2021;(4):34-38. doi: 10.17116/hirurgia202-104134 (In Russ.)
Address for correspondence:
660022, Russian Federation,
Krasnoyarsk, Partizan Zheleznyan st.,1,
Krasnoyarsk State Medical University
named after Professor V.F. Voyno-Yasenetsky,
tel. +7 (391) 220-19-09,
Teplyakova Olga V.
Information about the authors:
Vinnik Yurii S., MD, Professor, Head of the Department of General Surgery Named Professor M. I. Gulman, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation.
Teplyakova Olga V., MD, Associate Professor, Professor of the Department of General Surgery Named Professor M. I. Gulman, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation.
Erguleeva Anna D., Resident of the Department of General Surgery Named Professor M. I. Gulman, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation.



FGBOU VO South Ural State Medical University 1,
FGBU Federal Center for Cardiovascular Surgery 2, Chelyabinsk,
Russian Federation

Although abdominal drainage is a routine method of completing abdominal surgery, the feasibility and validity of this approach are widely discussed. The opponents of using drainages argue that they have low efficiency and may cause negative consequences, thereby prolonging the hospitalization period and increasing the risk of complications. In most cases, these complications do not pose any danger, but sometimes they may pose an immediate threat to the patients life and require repeated interventions. It is believed that abdominal drainage should be performed according to strict indications and if necessary in compliance with techniques that exclude the occurrence of adverse events. The care of drainages in the postoperative period is equally important. The presented rare case of herniation gallbladder reminds us that such hernias may form at the sites of abdominal drainage. According to the literature their frequency does not exceed 3.4%. These hernias are often subject to insidious and diagnostically difficult strangulation because of the narrow gates. Ultrasound is consided as a good help highly, but the informative method of choice in the diaguosis is multispiral computed tomography (multigpiral CT) of the abdominal organs.

Keywords: gallbladder, drainage, incisional hernia, complications
p. 317-321 of the original issue
  1. Memon MA, Memon MI, Donohue JH. Abdominal drains: a brief historical review. Ir Med J. 2001 Jun;94(6):164-66.
  2. Vedat B, Aziz S, Cetin K. Evisceration of gallbladder at the site of a Pezzer drain: a case report. Cases J. 2009 Jul 31;2:8601. doi: 10.4076/1757-1626-2-8601
  3. Gurusamy KS, Samraj K, Mullerat P, Davidson BR. Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD006004. doi: 10.1002/14651858.CD006004.pub2
  4. Kumar M, Yang SB, Jaiswal VK, Shah JN, Shreshtha M, Gongal R. Is prophylactic placement of drains necessary after subtotal gastrectomy? World J Gastroenterol. 2007 Jul 21;13(27):3738-41. doi: 10.3748/wjg.v13.i27.3738
  5. Franchi M, Trimbos JB, Zanaboni F, v d Velden J, Reed N, Coens C, Teodorovic I, Vergote I. Randomised trial of drains versus no drains following radical hysterectomy and pelvic lymph node dissection: a European Organisation for Research and Treatment of Cancer-Gynaecological Cancer Group (EORTC-GCG) study in 234 patients. Eur J Cancer. 2007 May;43(8):1265-68. doi: 10.1016/j.ejca.2007.03.011
  6. Falidas E, Mathioulakis S, Vlachos K, Pavlakis E, Villias C. Strangulated intestinal hernia through a drain site. Int J Surg Case Rep. 2012;3(1):1-2. doi: 10.1016/j.ijscr.2011.06.002
  7. Samarawickrama MB, Senavirathna RW, HapuarachchiI UI. Drain site abdominal hernia: known but rare complication of abdominal drains, a case report and a review of drain site complications. IOSR Journal of Pharmacy (IOSRPHR). 2017 Apr;7(4):10-14. doi: 10.9790/3013-0704011014
  8. Kumarprasad PR. Drain site hernias a rare but recognized complication of surgical drainage. A study of their risk factors, management and prevention. University Journal of Surgery and Surgical Specialties (UJSS). 2017;3(5):153-58.
  9. Bhoir LN, Jagne NY, Murali D. Is using peritoneal drains in bowel surgeries beneficial? Int Surg J. 2017 Feb;4(2):650-5. doi: 10.18203/2349-2902.isj20170208
  10. Kadian YS, Verma A, Verma V. Appendicular evisceration via drain site - an unusual complication in a child. Int J Contemp Med Res. 2016 Sep;3(9):2720-21.
  11. Dulskas A, Lunevičius R, Stanaitis J. A case report of incisional hernia through a 5 mm lateral port site following laparoscopic cholecystectomy. J Minim Access Surg. 2011 Jul;7(3):187-89. doi: 10.4103/0972-9941.83512
  12. Splinter KL, Cook CL. Inferior epigastric artery pseudoaneurysm following trocar injury. J Minim Invasive Gynecol. 2012 May-Jun;19(3):393-95. doi: 10.1016/j.jmig.2012.01.013
  13. Sahu S, Bahl D, Husain M, Sachan P. Drain erosion into bowel: an unsual complication. Internet J Surg. 2007;16(2):1-4.
  14. Salati S, Lone N. Abdominal Drain-Associated Early Postoperative Small Bowel Obstruction. Journal of Pakistan Medical Students (JPMS). 2015 Apr-Jun;5(2):60-62.
  15. Frankl J, Michailidou M, Maegawa F. Parastomal gallbladder hernia in a septic patient. Radiol Case Rep. 2017 Jun 22;12(3):508-10. doi: 10.1016/j.radcr.2017.05.009. eCollection 2017 Sep.
  16. Makama JG, Ameh EA, Garba ES. Drain Site Hernia: A Review of the Incidence and Prevalence. West Afr J Med. 2015 Jan-Mar;34(1):62-68.
  17. Sharma R, Guleria K, Suneja A, Bhartiya V. Post-caesarean drain placement minor procedure leading to major complication. J Clin Diagn Res. 2017 Jan;11(1):QD03-QD04. doi: 10.7860/JCDR/2017/22505.9139
  18. Sharma L, Singh A, Bhaskaran S, Radhika AG, Radhakrishnan G. Fallopian tube herniation: an unusual complication of surgical drain. Case Rep Obstet Gynecol. 2012;2012:194350. doi: 10.1155/2012/194350
Address for correspondence:
454033, Russian Federation,
Chelyabinsk pr. Geroi
Rossii Y. Rodionov, 2,
Federal Center for Cardiovascular
Surgery (Chelyabinsk),
Cardiac Surgery Department N 1,
Tel. +7 908 576 84 55,
Belov Dmitry Vladimirovich
Information about the authors:
Garbuzenko Dmitry V., MD, Professor, Professor of the Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
Belov Dmitry V., PhD, Associate Professor of the Department of Hospital Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation, Cardiovascular Surgeon, Federal Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Chelyabinsk, Russian Federation.
Kosharnova Anastasia L., Department of Hospital Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
Anufrieva Svetlana S., MD, Associate Professor, Head of the Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation.
Danko Natalya A., PhD, Radiologist, Federal Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Chelyabinsk, Russian Federation.
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