Surgical Tactics in Perforations of Stomach and Small Intestine in Children (Literature Review)

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Abstract

INTRODUCTION: Currently, the number of pediatric patients urgently hospitalized with different variants of gastrointestinal perforations complicated with peritonitis, remains high. In the given work, the variants of the surgical treatment depending on the location of the perforation defect (stomach, duodenum, small intestine) are presented, and the most common causes of such conditions encountered in clinical practice, are described (perforation of Meckel’s diverticulum, spontaneous perforation of small intestine and stomach in children with extremely low body mass, patients with Ehlers–Danlos syndrome).

AIM: To determine the most relevant variants of surgical tactics in children with perforations of different parts of the gastrointestinal tract (in particular, stomach, small intestine) in conditions of peritonitis.

MATERIALS AND METHODS: In the process of studying the literature, 142 scientific publications were analyzed on Google Academy, PubMed, eLIBRARY information resources, published from 2002 to 2022. With this, works describing intestinal perforation with the underlying necrotic enterocolitis, were excluded from the study, since this category of patients requires a separate discussion and description of approaches to treatment.

CONCLUSION: According to the results of the analysis of scientific literature, variants of surgical tactics used in perforations of the gastric wall include (in the order from the most commonly used to the least common): laparotomy and suturing with excision of the edges of the defect; suturing in conditions of laparoscopy; atypical resection with the formation of a gastric ‘tube’ on the probe; resection of stomach. In duodenal perforations, the following methods are used: rhomboid duodeno-duodenoanastomosis according to Kimura, intracorporeal suture with endovideosurgical access; laparotomy and suturing of the defect in extensive necrosis. In spontaneous perforation in the small intestine, resection of the part of the intestine is advisable — anastomosis according to Santulli in combination with terminal ileostomy, simultaneous end-to-end anastomosis or application of intestinal stomas.

About the authors

Vasiliy P. Gavrilyuk

Kursk State Medical University

Email: wvas@mail.ru
ORCID iD: 0000-0003-4792-1862
SPIN-code: 2730-4515

MD, Dr. Sci. (Med.), Associate Professor

Russian Federation, Kursk

Dmitriy A. Severinov

Kursk State Medical University

Author for correspondence.
Email: dmitriy.severinov.93@mail.ru
ORCID iD: 0000-0003-4460-1353
SPIN-code: 1966-0239

MD, Cand. Sci. (Med.)

Russian Federation, Kursk

Anatoliy M. Ovcharenko

Kursk State Medical University

Email: anatoly_franc98@vk.com
ORCID iD: 0000-0002-8301-6803
SPIN-code: 8624-8928
Russian Federation, Kursk

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Supplementary files

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2. Fig. 1. Variants of surgical tactics in gastric perforations in children.

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3. Fig. 2. Variants of surgical tactics in duodenal perforation in children.

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4. Fig. 3. Variants of surgical tactics in perforations of different parts of small intestine in children.

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5. Fig. 1. Variants of surgical tactics in gastric perforations in children.

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6. Fig. 2. Variants of surgical tactics in duodenal perforation in children.

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7. Fig. 3. Variants of surgical tactics in perforations of different parts of small intestine in children.

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