AIM: to evaluate the effect of cytomegalovirus (CMV) infection on the course of moderate and severe flare ups of ulcerative colitis (UC).
PATIENTS AND METHODS: a prospective cohort single-center study was done in September 2018 — December 2020. The study included patients with moderate and severe flare ups of UC. All patients underwent colonoscopy with biopsy to quantify CMV DNA by polymerase chain reaction (PCR). Subsequently, the patients were divided into subgroups: with the presence of CMV (CMV+) and its absence (CMV–). In the CMV+ subgroup, antiviral therapy was carried out with an assessment of virological, clinical and endoscopic results on the 19th day of therapy, one month after its completion and after 6 months. In the CMV– subgroup these results were evaluated after 6 months only.
RESULTS: the study included 126 patients. CMV was detected in 51 (40.5%). At the same time, its presence was not influenced by gender, age, or previous therapy. Laboratory indicators in both subgroups were comparable, as well as the severity of UC. A significant increase in the risk of developing steroid resistance was revealed in CMV+ patients with severe UC attack (OR 1.33, 95% CI: 1.059–19.4). The effectiveness of antiviral therapy was 60.8%. All patients who did not respond to antiviral therapy underwent surgery. At the same time, among patients in whom antiviral therapy was effective (virus eradication was achieved), there was no need for surgery.
CONCLUSION: CMV infection significantly increases the likelihood of developing steroid resistance in patients with severe flare up of UC, while all patients who responded to antiviral therapy did not require surgery. Further multicenter randomized trials are needed.

AIM: to evaluate the genetic and clinical characteristics of Russian patients with Lynch syndrome.
PATIENTS AND METHODS: in the period from 2012 to 2019, patients with suspected Lynch syndrome were studied, according to the selection recommendations (Amsterdam II and original criteria). All patients underwent a microsatellite instability test in the tumor, and if it was detected, for germline mutations in the genes of MMR system. All patients underwent standard clinical procedures (colonoscopy, gastroscopy, CT, MRI, etc.).
RESULTS: Lynch syndrome was genetically confirmed in 60 unrelated patients (included 30 women and 30 men, ranging in age from 24 to 68 years). Germline mutations were found in the following genes: MLH1 — 30, MSH2 — 26, MSH6 — 2, PMS1 — 1, PMS2 — 1. For the first time in the world, 12 novel mutations have been described. Clinical features of Russian patients with Lynch syndrome include: the early average age of development of the first cancer — 39.0 years; frequent 45% localization in the left colon; high (55%) incidence of poorly differentiated adenocarcinomas. A total of 234 tumors were diagnosed in Russian patients with Lynch syndrome and their relatives. It is also important to note that the stomach cancer is the third most common cancer after colon cancer.
CONCLUSION: Russian patients with Lynch syndrome showed clinical and genetic and features, that distinguish them from European and North American population and should be taken into account when treating.

AIM: to evaluate the effectiveness of tofacitinib as a second line treatment.
PATIENTS AND METHODS: the study included 12 patients, 4 (33.34%) males and 8 (66.66%) females. The median age was 41 ± 5 years. All patients admitted to the hospital with a severe flare-up of ulcerative colitis, which was the inclusion criterion in this study. Clinical manifestations, laboratory parameters, and colonoscopy were done at the time of administration of tofacitinib, on days 3 and 7, and after 12 weeks.
RESULTS: a fast clinical response on 3 day of treatment, reduction in stool frequency, decrease blood in stool was noted in 10 (83.3%) patients. After 7 days from the start of TFCS therapy, all patients showed a decrease from severe activity to mild activity, as well as a decrease in inflammatory blood markers and hemoglobin levels. During the follow-up for 12 weeks, 100% of patients showed positive clinical and laboratory changes. In 10 (83.4%) patients, remission or maintenance of negligible minimal activity was noted.
CONCLUSION: the results obtained show that the use of TFTB in hormone-resistant patients can be effective as a second line of “rescue therapy”.

AIM: to improve the results of treatment in hemorrhoid Grade IV.
PATIENTS AND METHODS: the prospective randomized study included 101 patients with combined hemorrhoids Grade IV were divided in two groups. Both groups were homogenous in age and gender. All patients underwent open hemorrhoidectomy with monopolar coagulation. Low-temperature argon plasma application was implemented in postoperative period as an additional option in the main group at 2, 4, 6, 8, 14, 21, 30 days after surgery. Visual Analogue Scale (VAS, 0 to 10 points) was used to assess pain intensity. Bacteriological and cytological tests performed at 2, 8, 14, 21, 30 days and then every 7 days until the wounds were completely healed. The area of the postoperative wound and the rate of healing were calculated using a planimetric method. Quality of life was assessed before surgery, and on days 8 and 30 using the SF-36 questionnaire.
RESULTS: on the 30th day after surgery, cytology confirmed wound healing occurred in 38 (76.0%) patients of the main group and in 18(36.0%) patients in the control group, p = 0.0001. VAS score at day 8 after surgery was 3 (3; 4) and 4 (3; 5) points in main and control group, respectively, p = 0.00003. Quality of life measuring showed significant difference in the physical component between groups: 48 (44; 53) vs 42 (38; 48) points in the main and control group, respectively (p < 0.05). On the 30th day after the procedure, the physical component of the quality of life was 48 (44; 53) points in the patients of the main group, 42 (38; 48) — in the control group, p = 0.005. There was found significant difference in wound microbial content between groups: 104 vs 107 CFU on the 30th day after the surgery.
CONCLUSION: the low-temperature argon plasma accelerates wound healing, as well as reduces the pain intensity. A significant antimicrobial effect was detected.

AIM: to assess risk factors affecting the five-year overall survival in patients ≥ 70 years old who underwent emergency surgery for complicated colorectal cancer.
PATIENTS AND METHODS: a cohort retrospective study included 268 patients with complicated colorectal cancer for the period from January 10, 2010 to March 03, 2020, operated on in hospitals in Smolensk. Inclusion criteria: 1) patients underwent emergency surgery for decompensated bowel obstruction or tumor perforation with peritonitis; 2) histological type of tumor: adenocarcinoma, signet ring cell carcinoma, undifferentiated cancer; 3) age ≥ 70 years. Non-inclusion criteria: 1) subcompensated bowel obstruction, paratumoral inflammation, intestinal bleeding; 2) non-epithelial malignant tumors; 3) age < 70 years.
RESULTS: the significant differences were revealed in overall survival rates depending on the type of surgery. In complicated colon cancer, overall survival after one-stage surgeries was 15.35%, after tumor removal at the first stage — 21.51%, and after surgeries with tumor removal at the second stage — 46.59% (p < 0.00001). For complicated rectal cancer: 1.03%, 1.6%, and 16.49%, respectively (p = 0.00402). The main factors that had an unsatisfactory effect on overall survival: surgery type — one-stage and multi-stage with tumor removal at the first stage (risk ratio (RR) 1.34; 95% coincidence interval (CI) 1.17–1.56; p < 0.0001); tumor perforation (OR 1.46, 95% CI: 1.36–1.55; p < 0.0001); disease stage (OR 1.61, 95% CI: 1.45–1.69; p < 0.0001), tumor site (OR 1.24, 95% CI: 1.29–1.72; p = 0.004); tumor histological type — poorly differentiated adenocarcinoma (OR 1.5, 95% CI: 1.24–1.62; p < 0.0001), the number of lymph nodes examined < 12 (OR 0.69, 95% CI: 0.59–0.63; p < 0.0001), presence of positive resection margins (R1 and/or CRM+) (OR 1.29, 95% CI: 1.14–1.47; p < 0.0001); severe comorbidity (OR 1.95, 95% CI: 1.62–1.98; p = 0.003), no adjuvant treatment (OR 0.57, 95% CI: 0.49–0.63; p < 0.0001).
CONCLUSION: staged procedures with a minimal volume in an emergency and the second — main stage, performed in a specialized hospital, are the most appropriate in patients ≥ 70 years old.

INTRODUCTION: squamous cell metaplasia in the rectum is found in patients with longstanding inflammation or infectious lesions [1]. Colonoscopy plays a major role in the diagnostic of squamous cell metaplasia, especially with the use of Narrow Band Imaging (NBI) or Blue Light Imagining (BLI), which allows for targeted visualization of intraepithelial capillary loopspeculiar for the squamous epithelium [1,2]. The final conclusion cannot be reached without morphological diagnostics. We would like to show on two clinical cases of patients with a longstanding ulcerative colitis the occurrence of squamous cell metaplasia in the rectum. These areas of metaplasia may be the source of squamous cell cancer.
CLINICAL CASES: a clinical cases of squamous cell metaplasia in the rectum in two patients with a longstanding ulcerative colitis (9 and 14 years) are presented. The total ulcerative colitis was verified in both patients by colonoscopy. Against the background of endoscopic remission, flat whitish areas of irregular shape, up to 3 cm in size, in the form of “tongues” of metaplastic epithelium with clear boundaries were found in the low rectum. When examined in a Narrow Band Imaging (NBI) and Blue Light Imagining (BLI), the microvascular pattern in the detected areas was identical in structure to the microvascular pattern of the squamous epithelium. The biopsies confirmed the presence of squamous cell epithelium.
CONCLUSION: patients with a longstanding ulcerative colitis may have squamous cell metaplasia of the rectal mucosa, which can be detected by colonoscopy in white light. Using a Narrow Band Imaging (NBI) followed by a targeted biopsy allows the most accurate diagnosis to be established. Patients of this group require repeated colonoscopies using the above methods, since areas of metaplasia can be a source of squamous cell cancer of the rectum.

AIM: to demonstrate the first experience of extralevator abdominoperineal resection (ELAPR) with gluteoplasty.
PATIENTS AND METHODS: patient K., aged 71 years old, with a low rectal cancer cT3aN0M1a CRM– EMVI+ (IV st) after neoadjuvant chemoradiation therapy, underwent surgery. Laparoscopic extralevator abdominoperineal resection with gluteoplasty was performed.
RESULTS: the patient was mobilized on the next day after surgery, the drain tubes were removed on the 5th day. On the 7th day, the seroma of the perineal wound without signs of suppuration was drained. No discomfort or movement disorders were noted. The patient was discharged in satisfactory condition on the 17th day.
CONCLUSION: the presented clinical case allows us to consider gluteoplasty as a promising method for reconstruction of the pelvic floor defect after ELAPR.

AIM: to demonstrate the first experience of extralevator abdominoperineal resection of rectum (ELAPR) with gluteoplasty.

PATIENTS AND METHODS: Patient K., 71 years old, with a low rectal cancer cT_3aN₀M_1a CRM- EMVI + (IV st) after neoadjuvant chemoradiation therapy was underwent surgical treatment. Laparoscopic extralevator abdominoperineal resection of rectum with gluteoplasty of the pelvic floor was performed.

RESULTS: The first ELAPR with gluteoplasty was performed. The patient was activated on the 2nd day, the drain tubes were removed on the 5th day. On the 7th day, the seroma of the perineal wound was drained without signs of suppuration. No discomfort or movement disorders were noted. The patient was discharged in satisfactory condition on the 17th day.

CONCLUSION: the presented clinical case allows us to consider gluteoplasty as a promising method for reconstruction of the pelvic floor defect after ELAPR.

Massive gastrointestinal bleeding (GIB) is a rare complication of Crohn’s disease (CD). For the recent decades a number of medical and surgical methods to control the GIB have been introduced. However, the unified algorithm and approach to this subset of patients is still lacking, mostly due to the absence of adequately powered and wellconducted RCTs. Determining the optimal treatment approach to inflammatory bowel disease (IBD) in patients who develop a GIB is still a valid research target.