AIM: to determine the incidence of accompanying cytomegalovirus infection (CMVI) in patients with moderate and severe ulcerative colitis, and also to determine the value of diagnosis and treatment of this infection in that category of patients.

PATIENTS AND METHODS: the study included 67 patients with severe or moderate ulcerative colitis. The colonoscopy with biopsy with definition of cytomegalovirus DNA by polymerase chain reaction (PCR) was done in all the patients. The patients without virus (CMV negative group) received therapy according to the current clinical recommendations. The patients with virus (CMV positive group) had antiviral therapy by ganciclovir in addition to the standard therapy. The viral load in colonic biopsy of those patients was evaluated before the treatment and on the 19-21 st therapy days. In case of patient state deterioration and inability to continue the conservative treatment, colectomy was done. The success of therapy in both groups was assessed by the colectomy rate during hospitalization.

RESULTS: the incidence of severe and moderate ulcerative colitis combination with cytomegalovirus infection was 43.2%. The previous treatment did not influence on the probability of virus detection. Acute attacks of ulcerative colitis were found significantly more often in the CMV-positive group than in the CMV-negative group (20% vs 2.6%, respectively) (р=0.02). The efficacy of the antiviral therapy was 69%. All the patients who responded to the antiviral therapy did not undergo surgery. Failure of the antiviral therapy in the patients with associated cytomegalovirus infection significantly increased the colectomy rate (0 – in the patients who responded to the antiviral therapy vs. 22.2% of those who did not respond).

CONCLUSION: the study showed 43% of cases moderate and ulcerative colitis goes with CMVI persistence. CMVI is the resistance factor for conservative treatment. The specific antiviral therapy in addition to the conservative treatment for this category of patients ameliorates the treatment results and prognosis.

AIM: to identify predictors of colectomy in patients with «extremely severe» ulcerative colitis.

PATIENTS AND METHODS: seventy-four patients with severe ulcerative colitis in 2017 were included in the study. The patients were divided into the groups of colectomy (54 pts) and conservative treatment (20 pts).
The predictors such as serum albumin, C-reactive protein, hemoglobin, endoscopic picture, and clinical data were analyzed.

RESULTS: the groups were homogeneous by gender, age and duration of the disease. Mean albumin and hemoglobin levels were significantly lower (28 g/l and 96 g/l) in the colectomy group.
The endoscopic picture of «extensive ulcer defects merging among themselves» was significantly more common in the operated patients – 78%, compared with 5% in the conservative treatment group (p<0.0001). The risk of colectomy in the presence of an endoscopic picture was 85%, and when combined with an albumin level of less than 31 g/l and hemoglobin of less than 107 g/l, the risk increased to 100%.

CONCLUSION: the endoscopic picture of «extensive, merging ulcerative defects» in combination with an albumin level of less than 31 g/l and hemoglobin less than 107 g/l are predictors of colectomy with high predictive value.

AIM: to compare multiparametric endorectal ultrasound (ERUS) and enhanced imaging colonoscopy in the diagnosis of early colorectal cancer.

PATIENTS AND METHODS: the study included 78 patients with epithelial rectal tumor. All the patients underwent multiparametric ERUS and colonoscopy with examination by narrow beam imaging (NBI) at optical magnification. All the patients were operated.

RESULTS: a morphological examination removed specimens revealed adenomas in 48 cases, in 19 specimens – adenocarcinomas in situ and T1, and in 11 specimens – adenocarcinomas with invasion of the muscle layer or deeper. When calculating the accuracy indicators of diagnostic methods for groups of patients with adenoma, Tis-T1 adenocarcinoma, and T2-T3 adenocarcinoma, the difference in the sensitivity and specificity of the methods in none of the presented groups did not reach the level of statistical significance (p>0.05).
ROC analysis showed that ultrasound has a prognostic value comparable to colonoscopy. The area difference was 0.013 (p=0.85).

CONCLUSION: endoscopy and ultrasound have similar value in the diagnosis of malignant transformation of rectal adenomas.

AIM: to assess the effectiveness and safety of sodium picosulfate for screening colonoscopy.

PATIENTS AND METHODS: the retrospective study included 299 patients at mean age of 54±14 years who had screening colonoscopy, . All patients received sodium pikosulfate for bowel cleansing. The quality of bowel cleansing was evaluated by the Boston international scale. Organoleptic and subjective sensations were also evaluated.

RESULTS: the quality of bowel cleansing was 8.5±1.0 point by Boston scale. As a result of screening colonoscopy in 96 (32.1%) patients, polyps of the rectum, sigmoid, colon and ileum were detected in 11%, 8%, 11% and 2% of cases respectively. Pathology showed that 78 (26%) patients had adenomatous polyps, 13 (4%) – adenocarcinoma. All patients reported comfortable use of the agent.

CONCLUSION: sodium picosulfate fully meets the requirements for the drug used for bowel cleansing for colonoscopy.

AIM: to work out a diagnostic program that allows to individualize approach in preoperative care and surgery for patients with colorectal cancer complicated by acute obstruction.

PATIENTS AND METHODS: the study included 442 patients with colorectal cancer complicated by acute obstruction, at whom were used special diagnostic methods for the purpose of precise diagnosis.

RESULTS: the most informative and safe methods for the diagnosis of tumor obstruction were abdominal X-ray, CT scan, colonoscopy (CS), barium enema (BE) and abdominal ultrasound. These methods allow to prove bowel obstruction and its stage, to detect the tumor site, depth of invasion, distant metastases, to control the efficacy of decompression and to make prognosis of the outcome in 87.2-96.4% patients.

CONCLUSION: the information obtained allows to plan individually the use of conservative, endoscopic and surgical methods of treatment for patients with colorectal cancer complicated by acute bowel obstruction.

AIM: to evaluate the early and long-term results of emergency two-stage surgical procedures in patients with sigmoid colon cancer complicated by decompensated bowel obstruction.

PATIENTS AND METHODS: the cohort study included 112 patients with sigmoid colon cancer complicated by bowel obstruction that underwent emergency two-stage surgical procedures in general surgical and coloproctological units in 2011-2017. The group 1 (n=60) included patients who, at the first stage, underwent Hartmann’s procedure, at the second stage – stoma reversal. The group 2 (n=52) included patients with a loop colostomy at the first stage and radical elective surgery as a second stage. The comparative analysis between the groups was carried out according to the following criteria: the type of surgery, the type of intestinal stoma, the rate and type of postoperative complications, postoperative mortality, resection status (R0/R1), the number of removed lymph nodes, the rate of adjuvant polychemotherapy (PChT).

RESULTS: postoperative mortality in the group 1 was 3.33% (n=2) and occurred after the first main stage (Hartmann’s procedure), there were no deaths in group 2 (p=0.28). The procedures in group 2 fully met the criteria of oncological radicalism based on the number of lymph nodes examined and resection status (p<0.0001 and p<0.0001, respectively). Three-year overall survival at stage IIB in group 1 was 44.4% vs 75.2% in group 2 (p<0.0001); with IIIB in the 1st group – 60.3% vs 68.2% in group 2 (p=0.034); at IIIС in the 1st group – 35.7% vs 60.7% in the 2nd group (p=0.009). The 3-year disease – free survival at stage IIB in the 1st group was 41.7% vs 68.8% in the 2nd group (p<0.0001); with IIIB in the 1st group – 53.6% vs 64.5% in group 2 (p=0.036); at IIIС in the 1st group – 33.2% vs 60.8% in the 2nd group (p=0.023).

CONCLUSION: for sigmoid colon cancer complicated by decompensated obstruction, in general hospitals the stage treatment with the colostomy at the first stage is preferable.

The article describes clinical case of a patient with two rectovaginal fistulas of high and low level. The first stage included diverting loop sigmostomia and latex seton for low fistula. Three months later, on the second stage, fistulectomy with invagination of the fistula to rectal lumen with compression of invaginated part by titanium nickelide clamp was done. The fistulectomy with sphincteroplasty was done for the lower fistula. No postoperative complications developed; the complete recovery was detected. Seven months later, on the third stage, the stoma closure was done. No complications and fistula recurrence were obtained in 2 months of follow-up.

Mesenchymal tumors of the colon and rectum are extremely rare and do not have specific clinical manifestations, their diagnosis and staging cause certain difficulties.

Different types of mesenchymal tumors differ in prognosis and choice of the treatment. It explains the importance of differential diagnosis of these neoplasms among themselves and tumors-derivatives of other embryonic structures.

The article describes the clinical case of a rare mesenchymal tumor and management of the patient.

In the review data concerning modern methods of endoscopic treatment of colonic strictures are presented.

Relevance of this problem, reasons for the development, clinical picture and methods of endoscopic procedures for strictures are presented in detail.

The analysis of Russian and foreign literature with an assessment of the effectiveness and feasibility of various methods of treatment of strictures has been done. Despite the variety of ways of existing methods of stricture’s treatment, there are still no evidence-based data on the efficiency and safety of various endoscopic approaches.

Thus, there are a number of unresolved topical issues that require further research.

AIM: to analyze basic medical care characteristics for hemorrhoidal disease (HD) in federal subjects of Russia in 2018.

MATERIALS AND METHODS: the study is based on the summary data of the annual statistical observation form «Report of the chief coloproctologist of the subject of the Russian Federation» for 2018, which includes the level of outpatient treatment for HD per 100,000 of the population, the number of outpatient coloproctologists, the number of hospitalized patients for HD, the rate of patients hospitalized for emergency indications and number of coloproctological beds.

RESULTS: in 2018 in Russia there were 304.9 outpatient visits per 100,000 thousand of the population for HD (Me=304.9; Q1=236.1; Q3=401.2). Number of coloproctologists was 0.23 per 100,000 (Me=0.23; Q1=0.13; Q3=0.32), and no correlation between these indicators was found (r=0.18; p=0.09). The hospitalization rate for HD was 36.8 (Me=36.8; Q1=30.5; Q3=44.7). There were 2.68 coloproctological beds per 100,000 (Me=2.68; Q1=1.95; Q3=3.35), and the percentage of patients with HD hospitalized in an emergency hospital was 34.0% (Me=34.0; Q1=24.0; Q3=45.0). There was no correlation between the number of patients treated in a hospital and the proportion of emergency hospitalizations in patients with hemorrhoids (r=0.1; p=0.38).

CONCLUSION: in 2018, at least half a million patients with HD have got an outpatient consultation of coloproctologist. A significant staff shortage in specialists remains, and unresolved organizational problems require further studies.