Abstract:

Background: expansion of tourism business in countries of South and Southeast Asia, Africa, and South America led to the appearance of rare parasitic diseases in Russia, Europe, and the United Kingdom. In our country, more than 1.3 million patients with various parasitosis are officially registered annually, among which there is an increase in the incidence of intestinal protozoa.

Aim: was to show features of the diagnosis of acute manifestations of necrotic amebic colitis, which simulated severe intoxication with manifestation of clinics of acute surgical disease and intestinal bleeding

Material and methods: using the example of case report of a 70-year-old woman, the possibility of complex diagnostics using abdominal ultrasound, abdominal computed tomography, colonoscopy with biopsy of intestinal ulcers and parasitological research methods is shown. Results: detoxification, anti-inflammatory therapy in a surgical hospital and instrumental examination allowed us to objectively evaluate and conduct targeted therapy avoiding serious complications.

Discussion: primary lesions with acutely occurring both local and general body reactions lead to severe intoxication, which does not allow to exclude acute surgical pathology, and in some cases dictate the need for urgent surgical intervention.

Differential diagnosis of an amoeba with a colon cancer only on the basis of x-ray symptoms is almost impossible. Specific anti-ameba therapy leads to the disappearance of amoeba.

Conclusion: only on the basis of a complex of clinical and epidemiological data, ultrasound, CT, colonoscopy, histological analysis and parasitological methods of research, pathology can be correctly identified. 

References

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6.      Ozereczkovskaya N.N. Organ pathology in the acute stage of tissue helminthiases: the role of blood and tissue eosinophilia, immunoglobulinemia E, G4 and factors that induce an immune response. Medicinskaya parazitologiya iparazitarny'e bolezni. 2000; (3): 3-8 [In Russ.].

7.      Romanenko N.A. Modern tasks of sanitary parasitology. Medicinskaya parazitologiya i parazitarny'e bolezni. 2001; (4): 25-29 [In Russ.].

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14.    Guzeeva T.M. Status the incidence of parasitic diseases in the Russian Federation and tasks in terms of the reorganization of the service. Medicinskaya parazitologiya i parazitarny'e bolezni. 2008; (1): 3-11 [In Russ.].

15.    Weitzel T, Carbera J, Rosas R, et al. Enteric multiplex PCR panels: A new diagnostic tool for amoebic liver abscess? New Microbes New Infect. 2017; 18: 50-53. PMID: 28626584 DOI:10.1016/j.nmni.2017.05.002.

16.    Abbas М.А., Mulligan D.C., Ramzan N.N., et al. Colonic perforation in unsuspected amebic colitis. Dig Dis Sci. 2000; 45(9): 1836-1841. PMID: 11052328.

17.    Sinharay R., Atkin G.K., Mohamid W., Reay-Jones N. Caecal amoebic colitis mimicking a colorectal cance. J Surg Case Rep. 2011; (11): 1. PMID: 24972391 DOI:10.1093/jscr/2011.11.1.

18.    Delabroussea E., Ferreirab F., Badeta N., et al. Coping with the problems of diagnosis of acute colitis. Diagn Intervent Imaging. 2013; 94(7-8): 793—804. PMID: 23751227 DOI:10.1016/j.diii.2013.03.012. 

Abstract:

Background: the cause of the development of traumatic hernias of the diaphragm is its damage due to open or closed injury In modern conditions, the diaphragm injury is most common trauma in falling from height and car accidents (multiple trauma), and can be unnoticed in againts the background of other injuries.

The dislocation of abdominal organs into the pleural cavity occurs in various, sometimes long, time periods after trauma. This situation is determined by the gradual increase in the size of the defect due to the difference in pressure in the abdominal and pleural cavities.

Aim: was to study the importance of radiodiagnosis of traumatic hernias of the diaphragm.

Materials and methods: two rare clinical cases of traumatic diaphragmatic hernias are presented. In one observation - a woman of 81 years, in the second - a 66 years old man. Results: a woman with a history of trauma as a result of a car accident 10 years ago, basec on a comprehensive survey, revealed posttraumatic hernia of the right half of the diaphragm with a dislocation into the pleural cavity of the small and large intestine.

In the second case report (male), an old rupture of the left half of the diaphragm of unknowr prescription of injury was revealed with the dislocation of the greater part of the intestine and the left kidney

Conclusion. To diagnose traumatic hernias of the diaphragm, a comprehensive examination of patients is necessary. Plain radiography can detect the dislocation of abdominal organs into the pleural cavity, and examination of the gastrointestinal tract with a water-soluble contrast drug is a violation of the passage.

Multi-slice computed tomography (MSCT) in case of such pathology, has a greater importance, because thin sections give the highest resolving power. The construction of multiplanar reformation allows obtaining more complete information on the dislocation of organs, visualizing the defect of the diaphragm and determining its exact localization.

References

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2.      Korabelnikov I.D. Travmaticheskie diafragmalnye gryzhi [Traumatic diaphragmatic hernias] (Pod red. V.A. Chernavskogo). M.: Medgiz. 1951; 5-62 [ In Russ].

3.      Borisov A.E., Kubachev K.G., Kukushkin A.V. i dr. Diafragmalnye gryzhi. Diagnostika i khirurgicheskoe lechenie [Diaphragmatic hernias. Diagnosis and surgical treatment.] Vestnik khirurgii im. 1.1. Grekova. 2012; 171 (6): 38-42 [In Russ].

4.      Plekhanov A.N. Khirurgiia travmaticheskikh diafragmalnykh gryzh [Surgery of traumatic diaphragmatic hernias.] Vestnik khirurgii im 1.1. Grekova. 2012; 171(5): 107-110 [In Russ].

5.      Aliev S.A., Bairamov N.Iu., Aliev E.S. Osobennosti diagnostiki i taktiki khirurgicheskogo lecheniia razryvov diafragmy pri zakrytoi sochetannoi travme grudi i zhivota [Features of diagnosis and tactics of surgical treatment of diaphragm ruptures with closed combined injury of chest and abdomen.]. Vestnik khirurgii im. 1.1. Grekova. 2014; 173 (4): 66-72 [In Russ].

6.      Thiam O., Konate I., Gueye M.L. et al. Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects. Springer Plus. 2016; 5 (1): 1614. doi: 10.1186/s40064-016-3291-1.

7.      Al Skaini M.S., Sardar A., Haroon H. et al. Traumatic diaphragmatic hernia: delayed presentation with tension viscerothorax - lessons to learn. Ann R Coll Surg Engl. 2013; 95 (2): 27-29. doi: 10.1308/ 003588413X 13511609955337.

8.      Fischer N.J., Aiono S. Delayed presentation of a traumatic diaphragmatic hernia presenting as a large bowel obstruction: a case report. ANZ J Surg. 2016; 86 (1-2): 9798. doi: 10.1111/ans.125968.

9.      Kubachev K.G., Kukushkin A.V, Zaitsev D.A. Diagnostika i khirurgicheskoe lechenie ushchemlennykh diafragmalnykh gryzh [Diagnosis and surgical treatment of strangulated diaphragmatic hernias.]. Vestnik SPbGU. 2012; Ser. 11. Vyp. 1: 89-97 [In Russ].

10.    Chikinev Iu.V., Drobiazgin E.A. Posttravmaticheskie diafragmalnye gryzhi (diagnostika i lechenie) [Post-traumatic diaphragmatic hernia (diagnosis and treatment).]. Acta Biomedical Scientifica. 2017; 2 (6): 163-166. [In Russ].

11.    Aissa A., Hassine A., Hajji H. et al. Complication rare d'une hernie diaphragmatique gauche post-traumatique. Rev Pneumol Clin. 2013; 69(6): 331-335. doi: 10.1016/j.pneumo.2013.04.006.

12.    Hajong R., Baruah A. Post-traumatic diaphragmatic hernia. Indian J Surg. 2012; 74 (4): 334-335. doi: 10.1007/s12262-012-0418-7.

13.    Ercan M., Aziret M., Karaman K. et al. Dual mesh repair for a large diaphragmatic hernia defect: An unusual case report. Int J Surg Case Rep. 2016; 28: 266-269. doi: 10.1016/j.ijscr. 2016.10.015.

14.    Al-Koudmani I., Darwish B., Al-Kateb K., Taifour Y Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases. J Cardiothorac Surg. 2012; 7: 35. doi: 10.1186/1749-8090-7-35.

15.    Akar E., Kaya H. Traumatic rupture of the diaphragm: A 22-patient experience. Biomedical Research. 2017; 28 (20): 8706-8710.

16.    Mikheev A.V., Trushin S.N., Bazzaev T.M. i dr. Ushchemlennaia pravostoronniaia travmaticheskaia diafragmalnaia gryzha [Strangulated right-sided traumatic diaphragmatic hernia.]. Al'manakh instituta khirurgii im. A.V. Vishnevskogo. 2017; 2: 148-149 [In Russ].

17.    Plaksin S.A., Kotelnikova L.P Dvustoronnie posttravmaticheskie diafragmalnye gryzhi [Two-sided post-traumatic diaphragmatic hernia.]. Vestnik khirurgii im. 1.1. Grekova. 2015; 174 (1): 47-51 [In Russ].

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19.    Demuro J.P A delayed traumatic diaphragmatic hernia presenting with a bowel obstruction 20 years postinjury. J Clin Diagn Res. 2013; 7(4): 736-738. doi: 10.7860/JCDR/2013/4755.2898.

20.    De Nadai T.R., Lopes J.C., Inaco Cirino C.C. et al. Diaphragmatic hernia repair more than four years after severe trauma: Four case reports. Int J Surg Case Rep. 2015; 14: 72-76. doi: 10.1016/j.ijscr.2015.07.014.

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Abstract:

Aim. Was to study X-ray computer tomography (X-CT) semiotics of lungs injure in patients with closed thoracic trauma.

Materials and methods. For the period of 2008-2009 in Moscow Institute of Emergency First Aid we have examined 90 patients with different forms of pulmonary hemorrhage: aged 15-83 years (middle age 33,8); 71 men (78,9%) and 19 women (21,1%).The diagnosis was established due to X-CT

Results. All the patients had pulmonary bruise with different Intensity and prevalence on the 1st day In 67% patients it was combined with bleeding or/and gas in the depth of lungs - hematoma, hemopneumatocele, pneumatocele. Supervision in dynamics showed gradually regression of bruise lesions and traumatic caverns structure transformation

Conslution. X-CT in patients with closed thoracic trauma can specify the localization, characteristic and volume of pulmonary injure; it can also document pathologic process in dynamics.
 

References 

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Abstract:

Currently, the combination of acute cholecystitis complicated by choledocholithiasis is quite common.

Aim: was to improve the efficiency of diagnosis of complicated forms of gallstone disease (acute cholecystitis complicated by choledocholithiasis).

Materials and methods: study included 118 patients with acute cholecystitis complicated by choledocholithiasis. The age of patients ranged from 16 to 92 years (mean age 61,5 ± 2,5 years). Women were 86(78.5%), men - 32 (21.5%). All patients underwent ultrasound examination of the abdominal cavity, hepatobiliary scintigraphy (HBSG), MRI-cholangiography (MRHG), endoscopic retrograde cholangiopancreatography (ERCP) and biochemical blood tests with determination of total bilirubin, amylase, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), alkaline phosphatase (ALP), total protein and protein fractions.

Results: in the diagnosis of choledocholithiasis sensitivity of ultrasound was 86%; HBSG - 97% MRHG - 92%. Basing on these data of sensitivity of different diagnostic methods, we developed diagnostic algorithm of acute cholecystitis complicated by choledocholithiasis: US → HBSG (if inefficient US ir terms of visualization of the distal common bile duct) → MRHG (to clarify causes of focal disorders of transport of labeled bile, according to HBSG) → ERCP: endoscopic papillosphincterotomy (EPST) and lithoextraction (LE) (detected choledocholithiasis or lingering doubts in the diagnosis).

Conclusions: the use of the diagnostic algorithm for acute cholecystitis in many cases allows timely identification of choledocholithiasis, followed by the implementation of adequate endoscopic sanitation of biliary tract, before performing cholecystectomy . 

References

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2.    Gal'perin E.I. i Vetshev P.S. Rukovodstvo po khirurgii zhelchnykh putej [Guide for surgery of the biliary tract ]. M: Vidar. 2009; 568 S [In Russ].

3.     Аrdasenov T.B., Frejdovich DA., Pan'kov А.G., Brudzinskij SA., Orlova E.N. Dooperatsionnaya diagnostika skrytogo kholedokholitiaza [Preoperative diagnosis of latent choledocholithiasis]. Апп khir. gepatol. 2011; 2: 18-24 [In Russ].

4.    Dadvani S.А., Vetshev P.S., SHulutko АЖ., Prudkov M.I. ZHelchnokamennaya bolezn'. [Gallstone disease]. M. Izd. dom Vidar-M. 2000; 144S [In Russ].

5.     Ratnikov V.A., Cheremisin V.M., Shejko S.B. Sovremennye luchevye metody (ul'trazvukovoe issledovanie, rentgenovskaya komp'yuternaya i magnitno-rezonansnaya tomografiya) v diagnostike kholedokholitiaza (obzor literatury) [Modern radiation techniques (ultrasound, X-ray CT and MRI) in the diagnosis of choledocholithiasis (literature review)]. Meditsinskaya vizualizatsiya. 2002;3: 99-106 [In Russ].

6.     Popova I.E., SHarifullin FA. Primenenie magnitnorezonansnoj kholangiopankreatografii v diagnostike kholedokholitiaza. Moskva. [The use of magnetic resonance cholangiopancreatography in the diagnosis of choledocholithiasis ]. Materialy gorodskogo seminara «Aktualnie voprosy diagnostiki i lecheniya kholedokholitiaza, oslozhnennogo mekhanicheskoj zheltukhoj i kholangitom». 2009; 15-17 [In Russ].

7.     Аbdulamitov KH.K., Rogal' M.L., Moiseeva L.V. Popova I.E. SHavrina I.V. Kuprikov S.V. Rol' magnitnorezonansnoj kholangiografii v diagnostike patologii zhelchevyvodyashhikh protokov u bol'nykh v otdalennom periode posle videolaparoskopicheskoj kholetsistehktomii ["The role of magnetic resonance cholangiography in the diagnosis of biliary tract disease in patients in the late period after cholecystectomy videolaparoscopic ]. Rossijskij zhurnal Gastroehnterologii, Gepatologii, Koloproktobgii. 2008;18(5):111 [In Russ].

8.     Tham T.C., Lichtenstein D.R., Vandervoort J. et al. Role of endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis in patients undergoing laparoscopic cholecystectomy. Gastrointestinal Endoscopy. 1998; 47: 50-56.

9.     Sharma S.K., Larson K.A., Adler Z. et al. Role of endoscopic retrograde cholangiopancreatography in the management of suspected choledocholithiasis. Surgical Endoscopy. 2003; 17: 868-871.