Endovascular Occlusion of Giant Posttraumatic Pseudo-Aneurysm of Superior Mesenteric Artery Connected to Mesenteric Arteriovenous Fistula.

The aim of the study was to show the capabilities of endovascular occlusion of giant posttraumatic pseudo-aneurysm of superior mesenteric artery (SMA) connected to a mesenteric arteriovenous fistula (AVF) under the conditions of portal hypertension and life-threatening esophageal variceal bleeding. MATERIALS AND METHODS: A 27-old male patient underwent endovascular occlusion; the patient being hospitalized with a clinical picture of gastrointestinal bleeding. The examinations: ultrasound, esophagogastroduodenoscopy, multispiral computed tomography with angiography - revealed the source of bleeding to be esophageal varices against the background of portal hypertension caused by massive arteriovenous shunt, its source being AVF with an aneurysmal component (32×35 mm in size) between SMA and superior mesenteric vein (SMV) dilated up to 50 mm in diameter. Patient's past medical history recorded that 4.5 years ago the patient had undergone the resection of a small intestine area due to a penetrating stab wound in the abdominal cavity. Taking into consideration an extremely high operative intervention risk due to the condition severity related to blood loss, portal hypertension, and ascites, it was decided to embolize AVF with a vascular occluder - Amplatzer Vascular Plug II (USA), 14×10 mm in size. RESULTS: A unique endovascular intervention - transcatheter occlusion of pseudo-aneurysm and AVF separation - was performed in life-threatening esophageal variceal bleeding under the condition of a giant post-traumatic aneurysm of SMA and mesenteric AVF. Due to an extremely large-sized SMV and an arterial pseudo-aneurysm, first ever we used the technique applied for transcatheter occlusion of a cardiac septum defect.Occluder implantation enabled to completely close the communication of aneurysmatic AVF with SMV, and occlude the aneurysm cavity. During an immediate postoperative period portal hypertension was arrested. No recurrent bleedings occurred within 4 postoperative months.

[Traumatic gunshot wounds of neck, thorax and abdomen].

Basing on the largest experience in the country, authors characterize the dynamics of growth, localizaton and severity of wounds from traumatic (nonlethal) weapon. Every third victim with neck wound had deep neck structures damage. Open wounds of thorax and abdomen, though performed from traumatic weapon, pose a certain life threat.

[Tracheobronchoscopy in injuries of the thorax and neck]. / Trakheobronkhoskopiia pri raneniiakh grudi i shei.

The results of examination and treatment of patients with penetrating wounds of the thorax and the neck are analysed. Diagnostic potential abilities of roentgenography and tracheobronchoscopy are evaluated comparatively. High diagnostic and curative effectiveness of tracheobronchoscopy is detected, which is indicated in diagnosis of the wounds of the larynx and the trachea as well as in cases of technical difficulties during endotracheal intubation. Besides, tracheobronchoscopy is indicated in postoperative period for sanation of the tracheobronchial tree under visual control for prevention of broncho-pulmonary complications.

[The diagnosis and treatment of neck wounds]. / Diagnostika i lechenie ranenii shei.

The largest in Russia experience of diagnostics and treatment victims with side-arms' wounds of the neck (492 patients) is represented. The authors subdivide allo wounds into superficial (170 cases without mortal outcomes) and profound ones (322 cases with total mortality rate as 6.8%). Classification of the injuries, their features, depending of the causes and the king of the weapon, are represented. Complex of diagnostic methods, which application depends on severity of the patients condition, is substantiated. The standard surgical approach in profound injuries of the neck is considered to be an anterior colotomy.

[Laparocentesis and laparoscopy in the diagnosis of abdominal injuries in patients with combined trauma]. / Laparotsentez i laparoskopiia v diagnostike povrezhdenii organov briushnoi polosti i postradavshikh s sochetannoi.

Experience in laparocentesis (152 cases) and laparoscopy (40 cases) in persons with concurrent trauma is discussed. Laparocentesis with lavage of the abdominal cavity is the method of choice in such patients because it ensures correct diagnosis in 98% of cases and does not distort the clinical picture on the abdomen during the subsequent surveillance.