Consilium Medicum

Background. Nutritional status impairments accompanying inflammatory bowel disease (IBD) adversely affect both the achievement and maintenance of remission and patients’ quality of life. Despite the potential utility of computed tomography (CT) as an adjunctive method for body composition assessment, its application in this context remains insufficiently explored.

Aim. To evaluate the applicability of CT-derived body composition parameters for the objective characterization of nutritional status in patients with IBD.

Materials and methods. A retrospective analysis was conducted using data from patients who underwent evaluation and treatment in a gastroenterology department. Outcomes included laboratory parameters (hemoglobin, total protein, albumin, serum iron, and total cholesterol concentrations) and body composition metrics assessed on CT using a computer vision algorithm: Visceral Fat Area (VFA), Subcutaneous Fat Area (SFA), Intramuscular Fat Area (IFA), VFA/SFA ratio, intramuscular fat fraction, Skeletal Muscle Area (SMA), Skeletal Muscle Index (SMI), SMA/VFA ratio, and CT-derived Skeletal Muscle Radiodensity (SMRD).

Results. The study included 142 patients with IBD: 45 (31.7%) with ulcerative colitis and 97 (68.3%) with Crohn’s disease. IBD exacerbation was associated with lower serum iron levels (odds ratio – 1.08, 95% confidence interval – 1.02–1.15; p=0.005). No associations were identified between clinical disease activity and body composition parameters. In analyses of laboratory markers and body composition, higher albumin and hemoglobin levels were associated with higher SMI and SMRD. Total protein was positively associated with SMA (β=0.024; p=0.003), SMI (β=0.028; p=0.003), and SMRD (β=0.024; p=0.020), and inversely associated with intramuscular fat fraction (β=-0.027; p=0.043).

Conclusion. Opportunistic CT analysis may enable objective assessment of protein nutritional status in patients with IBD without increasing radiation exposure. The robustness of muscle-related parameters as morphological markers is supported by their independence from disease activity phase and their correlation with biochemical indicators of protein metabolism.

Background. The key role in the pathogenesis of inflammatory bowel disease (IBD) is an imbalance between pro- and anti-inflammatory cytokines. Numerous studies confirm that serum levels of certain cytokines correlate with disease activity in ulcerative colitis (UC) and Crohn's disease (CD). Non-invasive assessment of fecal cytokine concentrations, which reflect the local inflammatory process, is an underexplored but promising diagnostic approach.

Aim. The aim of the study is to determine the diagnostic significance of cytokine profile for disease activity assessing in pediatric IBD.

Materials and methods. This clinical, bidirectional, observational study included 143 children with a verified diagnosis of UC (n=75) and CD (n=68). Disease activity was assessed using the pediatric activity indices for UC and CD, the UC Endoscopic Index of Severity, and the Simple Endoscopic Score for CD. Clinical and biochemical blood tests were performed, and fecal calprotectin levels were measured. Concentrations of cytokines Interleukin IL-1α, 1RA, 7, 9, 10, 15, 17A, 21, 22, 23, 27, 31, Interferon α and Tumor Necrosis Factor β in aqueous-salt coprofiltrates were determined using a multiplex immunoassay panel.

Results. Pro-inflammatory cytokines IL-1α, 17A, 23, 31, TNF-β in UC, and IL-1α, 23, 31, TNF-β in CD, reflect clinical disease activity. In both UC and CD cytokines IL-1α, 23, TNF-β reflect the severity of the endoscopic picture. Anti-inflammatory cytokines IL-10 and IL-22 reflect reparative processes in the intestinal mucosa in CD, whereas in UC, only IL-22 does. A decrease in endoscopic activity is reflected by IL-10 and IL-22 levels in UC and by IL-22 in CD. No association was found between cytokine concentration in coprofiltrate and the extent of UC or the localization of CD.

Conclusion. From the spectrum of cytokines we studied, a number of pro- and anti-inflammatory fecal cytokines reflect local inflammatory activity in UC and CD. Their use may be promising as non-invasive biomarkers of IBD activity

Modern diagnostics of intestinal diseases rely on a wide range of imaging methods, each with its own advantages and significant limitations. Abdominal radiography, despite its accessibility, has low sensitivity. Ultrasound examination is safe and applicable for dynamic monitoring, but its accuracy is operator-dependent and can be affected by artifacts. Computed tomography, being the gold standard in emergency diagnostics, involves radiation exposure. Magnetic resonance enterography provides excellent visualization without radiation but requires complex preparation and is static. Endoscopic methods, including capsule endoscopy, allow direct assessment of the mucosa but are invasive, costly, and do not provide real-time information on motor function. A key problem remains the lack of a non-invasive, safe, and accessible method for long-term monitoring of intestinal functional activity – its peristalsis. In this context, digital phonoenterography – the recording and analysis of bowel sounds – appears to be a promising direction. This article presents a detailed analytical review of modern diagnostic methods (radiological, ultrasound, tomographic, endoscopic) with a critical assessment of their capabilities and limitations in light of assessing intestinal function. Based on the identified diagnostic gaps, the relevance of developing new approaches to functional monitoring is substantiated. As a solution, the authors present an original development – a compact wireless device for long-term recording of peristaltic sounds. The device is attached to the anterior abdominal wall, equipped with a highly sensitive microphone, battery, and transceiver for Bluetooth data transmission to a smartphone or tablet. Its design, including a specially shaped sound-conducting channel and an adhesive ring, ensures effective audio recording with minimal external interference. The conclusion is drawn that the proposed technology has significant scientific and practical potential for transitioning from episodic assessment of morphology to continuous, objective monitoring of intestinal motor function. The phonoenterography method using this device could occupy a complementary niche in diagnostic algorithms, especially for patients requiring long-term monitoring (postoperative period, functional disorders) and in cohorts vulnerable to radiation and invasive interventions. For implementation into clinical practice, a series of studies to validate the method and develop standards for interpreting acoustic data is planned.

External intestinal fistulas after intraperitoneal placement of a mesh implant (IPOM) are rare but among the most severe complications of hernioplasty. The literature emphasizes that contact between the mesh and the intestine creates a fundamentally different class of complications compared to retromuscular techniques, including erosion of the bowel wall, chronic implant infection, and the formation of an external intestinal fistula. The treatment strategy consists of resection of the bowel loop bearing the fistula with the formation of an interintestinal anastomosis. However, the choice of the operative completion method remains debatable, especially when complete removal of the mesh prosthesis is not possible. A clinical case of a 61-year-old patient who had previously undergone IPOM hernioplasty and developed an external small bowel fistula 10 years later was analyzed. Intraoperative tactics, the extent of bowel resection and partial mesh removal, the decision to withhold antibiotic therapy, and postoperative monitoring (APACHE II, laboratory and instrumental parameters) were evaluated. The patient underwent resection of the small bowel loop bearing the fistula with the formation of a single-row end-to-end interintestinal anastomosis and partial removal of the mesh implant. Due to the absence of signs of systemic infectious process, antibiotic therapy was not administered. The postoperative period was uneventful; the patient was discharged on postoperative day 10, and at 6-month follow-up there were no signs of recurrent intestinal fistula or soft tissue infection at the surgical site. This case demonstrates that complete implant removal is not mandatory in the absence of pronounced infection or systemic inflammation. The results highlight the feasibility of an individualized surgical strategy based on intraoperative findings, patient comorbidity, and careful postoperative surveillance. The findings emphasize the need for comprehensive risk assessment when selecting surgical management strategies. The chosen strategy of partial mesh removal and withholding antibiotic therapy under controlled conditions may be safe with careful patient monitoring. The presented case may serve as a model for decision-making in similar clinical situations.

Background. Acute leukemias (AL) represent the most prevalent oncological pathology in the pediatric population. Despite the progress achieved in treatment, primarily through chemotherapy (CT) and hematopoietic stem cell transplantation, the management of this disease is associated with various complications, such as mucositis, febrile neutropenia, systemic infections, and graft-versus-host disease (GVHD). The gut microbiota (GM) plays a crucial role in modulating both the efficacy of CT and the development of its toxicity. CT-induced dysbiosis is associated with worsened treatment outcomes, underscoring the relevance of exploring strategies for its correction.

Aim. To systematize current data on the role of GM in the pathogenesis of complications and the efficacy of AL therapy in children, and to analyze promising strategies for its targeted modulation aimed at improving treatment outcomes.

Materials and methods. A systematic literature review was conducted in accordance with the PRISMA guidelines. The search for publications was performed in the PubMed/MEDLINE, Google Scholar, and eLIBRARY databases for the period from 2014 to 2025. Out of 5628 identified publications, after excluding duplicates and applying inclusion/exclusion criteria, 63 relevant sources were included in the analysis.

Results. It was demonstrated that CT-induced dysbiosis leads to reduced alpha-diversity, characterized by a decreased abundance of commensal genera (e.g., Faecalibacterium, Lachnospiraceae) and dominance of opportunistic pathogens (e.g., Enterobacteriaceae). These alterations contribute to the development of severe mucositis, febrile neutropenia, systemic infections, and GVHD. The GM also influences the metabolism of cytostatic drugs (e.g., gemcitabine inactivation), intestinal barrier integrity (via the production of short-chain fatty acids), and the systemic immune response. Promising methods for dysbiosis correction include fecal microbiota transplantation, which has shown efficacy in steroid-refractory acute GVHD, as well as the use of probiotics, prebiotics, personalized high-fiber diets, synthetic microbial consortia, and live biotherapeutic products.

Conclusion. The integration of GM modulation strategies into standard AL treatment protocols for children represents a promising approach to enhance the efficacy of CT. However, further randomized controlled trials are required to validate and standardize these strategies, focusing on the assessment of their long-term safety and efficacy.

Background. Postoperative intra-abdominal complications (POIACs) remain one of the most challenging problems in modern abdominal surgery, associated with high morbidity, significant mortality, and substantial socio-economic burden. To date, there are no systematic, clinically validated decision-making algorithms for choosing the surgical approach in the management of PIACs in the world literature. Existing recommendations are primarily descriptive, based on expert opinion, and do not offer quantitative criteria for choosing between relaparoscopy and relaparotomy.

Aim. To develop a clinical algorithm for selecting the surgical approach (laparoscopic or open) in reoperations for patients with postoperative intra-abdominal complications (POIACs).

Materials and methods. The study included 253 patients with POIACs requiring reintervention. Infectious complications (peritonitis) were diagnosed in 141 (55.7%) patients, non-infectious complications – in 112 (44.3%). An assessment was performed of demographic parameters, physical status (ASA), prognostic scores (SAPS II, SOFA, APACHE II), specialized peritonitis indices (Mannheim Peritonitis Index – MPI, Peritonitis Strategy Scale – PSS, WSES SSS scale), and laboratory markers (procalcitonin, C-reactive protein, lactate). Independent predictors for selecting an open approach and their threshold values were determined using logistic regression and ROC analysis.

Results. Independent predictors for choosing laparotomy were: age ≥60 years, ASA≥IV, SAPS II≥28 (area under the curve – AUC 0.820), SOFA≥4 (AUC 0.781), APACHE II≥17 (AUC 0.776). In patients with peritonitis, additional significant criteria were Mannheim Peritonitis Index ≥21 (AUC 0.813), Peritonitis Strategy Scale ≥4 (AUC 0.841), and WSES SSS ≥6 (AUC 0.833). The combined criterion " procalcitonin ≥7 ng/mL and lactate ≥2 mmol/L" had 85% specificity for predicting an open approach. In patients with non-infectious complications, a body mass index ≥30.6 kg/m² (AUC 0.747) was a significant predictor. Based on the obtained data, a three-level risk stratification algorithm ("green", "yellow", and "red" zones) was developed to guide intervention strategy. The use of a laparoscopic approach in accordance with the algorithm reduced 90-day mortality in infectious complications from 15.1 to 1.1% (p< 0.001), shortened hospitalization duration by 17–29%, and reduced intensive care unit length of stay by 2–5 times. In 48.7% of cases with infectious complications and 63.5% with non-infectious complications, laparoscopic management was successfully performed after primary laparotomy (a "minimally invasive step").

Conclusion. The proposed algorithm, based on the integration of objective prognostic criteria, allows for standardization of surgical approach selection in reoperations, minimization of subjectivity, and significant improvement in treatment outcomes for patients with POIACs.