Peritonitis In Children Research Articles

Commentary on the article «Differential approach to preoperative preparations for diffuse purulent peritonitis in children»

Commentary on the article Zavyalkin VA, Barskaya MA, Yukhimets SN “Differential approach to preoperative preparations for diffuse purulent peritonitis in children” published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2024;14(1):57–68. (In Russ.) DOI: https://doi.org/10.17816/psaic1570

Erratum to “Differential approach to preoperative preparations for diffuse purulent peritonitis in children” (doi: 10.17816/psaic1570)

The editorial board regret that in the published abstract in Chinese, the hospital name V.D. Seredavin Samara Regional Hospital, Samara, containing proper names, is translated in hieroglyphs, not in Latin. The editorial board is confident that the error could not significantly affect the perception of the work and interpretation of information by readers. The error has been corrected online, and the file of the article and issue have been updated.

Diagnostic Scale for Acute Appendicitis to Prevent General Peritonitis in Children

This article presents the development and implementation of a diagnostic scale for acute appendicitis in children over 5 years of age with the aim of effectively preventing general peritonitis in children. The study is based on an extensive analysis of clinical cases and medical observation data. The proposed diagnostic scale, based on a comprehensive analysis of the disease history, clinical signs, and laboratory parameters, demonstrates high accuracy and reliability in determining acute appendicitis in children, which contributes to the timely initiation of treatment and reducing the risk of developing intra-abdominal complications including generalized peritonitis.

Incidence and Factors Associated with Peritoneal Dialysis-Related Peritonitis in Children

Background: Since the peritoneal dialysis (PD)-first policy in Thailand, the number of end-stage renal disease (ESRD) patients receiving PD has increased significantly. Although the overall intraperitoneal infection rate has been decreased in recent years, it remains the leading cause of death and requiring a change in renal replacement therapy methods. Objective: To study the incidence rate and factors associated with PD-related peritonitis in children at the authors’ center by retrospective study. Materials and Methods: Patients aged 18 years or younger from the onset of chronic PD were included in the present study. Medical records were reviewed between October 2008 and October 2020 and data were collected on peritonitis rates, baseline clinical characteristics, cause of ESRD, laboratory investigation, catheter type, antibiotic before catheter insertion, timing for starting continuous ambulatory peritoneal dialysis (CAPD), residual renal function, and immunosuppressive drug usage. Results: The present study included 68 patients. The incidence of peritonitis rate was 0.3 episode/patient year. The most common symptoms were fever, abdominal pain, and cloudy effluent. The most common pathogen was gram-positive. Culture-negative accounted for 24%. Factors associated with peritonitis in univariate analysis were single-cuff catheter type (IRR 2.982, 95% CI 1.29 to 6.895, p=0.011), serum potassium less than 3.5 mEq/dL (IRR 1.827, 95% CI 1.065 to 3.133, p=0.029), lower serum albumin (IRR 0.543, 95% CI 0.447 to 0.924, p=0.017), lower serum phosphorus (IRR 0.817, 95% CI 0.686 to 0.973, p=0.023), lower blood urea nitrogen (BUN) (IRR 0.986, 95% CI 0.976 to 0.996, p=0.007), and lower serum creatinine (IRR 0.940, 95% CI 0.885 to 0.998, p=0.042). Conclusion: The present study demonstrated a significant association between single-cuff catheter type, hypokalemia, lower serum albumin, hypophosphatemia, lower BUN, and lower serum creatinine and peritonitis, even though they did not show statistical significance in multivariate analysis. Controlling the associated factors, following standard guidelines may reduce the rate of peritonitis.

Clinical and Laboratory Indicators for Appendicular Peritonitis in Children

This study analyzed clinical and laboratory data in children with appendiceal peritonitis. The authors assessed common symptoms of this disease, such as abdominal pain, vomiting, fever, as well as laboratory test results, including white blood cell levels, C-reactive protein, procalcitonin, and others. The results showed that certain clinical symptoms and laboratory parameters can help in the early diagnosis and treatment of this condition in children, thereby preventing serious complications. Thus, the results obtained may be useful for improving diagnosis and optimizing treatment approaches for appendiceal peritonitis in children.

Perforated Appendicitis in Children: Management, Microbiology, and Antibiotic Stewardship.

Although appendicitis has been described for more than 300 years, its optimal management remains a topic of active investigation. Acute appendicitis is the most common cause of peritonitis in children, and rates of perforated appendicitis are much higher in children than in adults. Increased risk for perforated appendicitis in children is related to a delay in diagnosis due to age, size, access to care, and more. Surgical options include immediate appendectomy versus nonoperative management with intravenous antibiotics ± a drainage procedure, with a subsequent interval appendectomy. Microbiota of perforated appendicitis in children most often includes Escherichia coli, Bacteroides fragilis, Streptococcus, and more. Even though the most common organisms are known, there is a large variety of practice when it comes to postoperative antibiotic management in these patients. Studies discuss the benefits of mono- versus dual or triple therapy without a particular consensus regarding what to use. This is reflected across differing practices at various institutions. In this review, we aim to explore the implications of perforated appendicitis in pediatrics, common organisms seen, antibiotic regimen coverage, and the implications of variations of practice. Resistance to commonly used broad-spectrum antibiotics is evolving, therefore minimization of care variability is needed for improved patient outcomes and proper antibiotic stewardship.

Differential approach to preoperative preparations for diffuse purulent peritonitis in children

BACKGROUND: Diffuse purulent peritonitis is the most severe complication of abdominal surgical pathology accompanied by the development of serious metabolic disorders, and its elimination is a preoperative task.
 AIM: This study aimed to compare traditional preoperative preparations using a new scheme that provides a differential approach considering the stage of peritonitis, degree of endotoxicosis, child’s age, and succinate administration.
 MATERIALS AND METHODS: An analysis of the results of treatment of patients aged 1–14 years (average age 7.9 ± 3.9 years) with diffuse purulent peritonitis of various etiologies who were treated from 2006 to 2022 in the children’s surgical department of the V.D. Seredavin Samara Regional Hospital, Samara. The patients were divided into two groups. The main group included 237 patients who underwent preoperative preparation according to the proposed scheme (depending on age, peritonitis stage, and degree of endotoxemia) lasting at least 4–6 h. In addition, for intracorporeal detoxification, the antihypoxant meglumine sodium succinate was used. The control group comprised 102 children who received traditional therapy according to generally accepted approaches and national guidelines for pediatric surgery lasting 2–3 h. Changes in hemodynamic parameters, electrolytes, hematocrit, platelets, and blood gases were comprehensively examined.
 RESULTS: After preoperative preparation, a statistically significant improvement in hemodynamic parameters was observed in the main group compared with that in the control group; the indicators were close to normal values. The dynamics of hematological parameters indicated more pronounced hemodilution in patients of the main group of all ages, which proves a significant improvement in the rheological properties of blood. Electrolyte and blood gas indicators did not reach the indicators of healthy children in any groups; however, in the main group, they were closer to normal. Complications of varying severity in the main group occurred in 21 children (8.8% ± 1.4%; p 0.001), whereas in the control group, they were diagnosed in 47 patients (46.0% ± 4.6%). A statistically significant reduction in the length of stay of patients in the intensive care unit after surgery was noted in 80% of children in the main group.
 CONCLUSIONS: The proposed scheme of preoperative preparation based on a differential approach using the antihypoxant meglumine sodium demonstrated greater effectiveness than traditional treatment. The composition, volume, and duration of preoperative preparation are dependent on the state of homeostasis and the age of the patient.

Results of treatment of diffuse purulent peritonitis in children

BACKGROUND: Despite significant achievements in surgery and in antibiotic therapy, management of children with severe purulent complications of surgical diseases in the abdominal cavity remains an important issue. Due to the polyetiology of diffuse purulent peritonitis, sometimes not enough attention is paid to metabolism correction, especially in children. Optimization of comprehensive therapy in the diffuse purulent peritonitis promotes better outcomes in this group of patients. AIM: To assess results of the treatment of children with diffuse purulent peritonitis applying the optimized pathogenetic therapy which includes a differentiated approach to the preoperative preparation, active correction of dysmetabolic disorders in the postoperative period as well as selection of the criteria for abdominal cavity sanation bearing in mind the degree of intra-abdominal hypertension. METHODS: Outcomes of 339 patients, aged 1–14 years, with diffuse peritonitis of various etiology were analyzed. The patients were hospitalized to pediatric surgical departments in Samara in 2006–2022. The studied group included 237 children with diffuse purulent peritonitis who were prescribed the optimized comprehensive therapy. Control group included 102 children with diffuse purulent peritonitis who were prescribed traditional therapy according to the generally accepted standards. In the studied group, patients' therapeutic tactics included a therapeutic and diagnostic algorithm developed by the authors. Complex examination registered the dynamics of biochemical blood parameters: total protein, albumin, alanine transaminase, aspartate aminotransferase, as well as indicators of endotoxicosis (C-reactive protein and procalcitonin). RESULTS: After studying the dynamics of transaminases, we concluded that in children with widespread peritonitis in the main group, despite the initial severity of endotoxicosis, there was a faster decrease in the level of liver enzymes, indicating a more effective restoration of cell membranes. The dynamics of the level of total protein and albumin revealed a faster recovery of protein-synthetic liver function in children of the main group, including antitoxic, which was reflected in the improvement of the general condition of patients and stabilization of hemostasis indicators, a decrease in the levels of acute phase proteins. The analysis of the results of the complex treatment of children with advanced peritonitis revealed a statistically significant decrease in the main group: the duration of stay of patients in the intensive care unit after surgery, the timing of infusion therapy in the postoperative period, as well as the duration of hospitalization. CONCLUSION: Thus, less stay in the intensive care unit in the postoperative period, less terms of infusion therapy as well as less length of stay in children with diffuse peritonitis demonstrate better effectiveness of the proposed comprehensive management of children with the discussed pathology.

Best Practice of Peritoneal Dialysis-Associated Gram-Negative Peritonitis in Children: Insights From the International Pediatric Peritoneal Dialysis Network Registry

Gram-negative peritonitis (GNP) is associated with significant morbidity in children receiving long-term peritoneal dialysis (PD) and current treatment recommendations are based on limited data. Analysis of 379 GNP episodes in 308 children (median age 6.9 years, interquartile range [IQR]: 3.0-13.6) from 45 centers in 28 countries reported to the International Pediatric Peritoneal Dialysis Network registry between 2011 and2023. Overall, 74% of episodes responded well to empiric therapy and full functional recovery (FFR) was achieved in 82% of cases. Invitro bacterial susceptibility to empiric antibiotics and lack of severe abdominal pain at onset were associated with a good initial response. Risk factors for failure to achieve FFR included severe abdominal pain at onset and at 60 to 72 hours from treatment initiation (odds ratio [OR]: 3.81, 95% confidence interval [CI]: 2.01-7.2 and OR: 3.94, 95% CI: 1.06-14.67, respectively), Pseudomonas spp. etiology (OR: 1.73, 95% CI: 1.71-4.21]) and invitro bacterial resistance to empiric antibiotics (OR: 2.40, 95% CI: 1.21-4.79); the risk was lower with the use of monotherapy as definitive treatment (OR: 0.40, 95% CI: 0.21-0.77). Multivariate analysis showed no benefit of dual antibiotic therapy for treatment of Pseudomonas peritonitis after adjustment for age, presenting symptomatology, 60 to 72-hour treatment response, and treatment duration. Monotherapy with cefazolin in susceptible Enterobacterales peritonitis resulted in a similar FFR rate (91% vs. 93%) as treatment with ceftazidime or cefepime monotherapy. Detailed microbiological assessment, consisting of patient-specific and center-specific antimicrobial susceptibility data, should guide empiric treatment. Treatment "deescalation" with the use of monotherapy and narrow spectrum antibiotics according to susceptibility data is not associated with inferior outcomes and should be advocated in the context of emerging bacterial resistance.

Frequency and prognosis of peritoneal dialysis-associated peritonitis in children.

Peritonitis is the leading cause of peritoneal dialysis (PD) discontinuation. However, few data concern risk factors of peritonitis development and catheter removal caused by treatment failure in pediatric patients. This single-center, retrospective study analyzed data from pediatric patients who underwent chronic PD between March 2002 and June 2022. The incidence rates of peritonitis by the person-year method were calculated, and they were stratified by patient age groups. Risk factors for peritonitis development and catheter removal were also analyzed by multivariate analysis using logistic regression model. Ninety patients were enrolled, and 62 peritonitis episodes were observed in 41 (46%) patients. The incidence rate of peritonitis was 0.21 episodes per patient-year, which was the highest in children aged under 2years old (0.26 episodes per patient-year). Moreover, 44 (71%) cases were successfully cured by antibiotics alone, although 17 (27%) cases required catheter removal, and 4 (6%) cases transitioned to chronic hemodialysis because of peritoneal dysfunction. One patient died. The risk factor for peritonitis development and catheter removal caused by treatment failure was PD insertion at under 2years old (odds ratio = 2.5; P = 0.04) and Pseudomonas aeruginosa (odds ratio = 11.0; P = 0.04) in the multivariate analysis. P. aeruginosa was also a risk factor for difficulty in re-initiating PD (P = 0.004). The incidence rate of peritonitis was the highest in children under 2years old. P. aeruginosa peritonitis is a risk factor for catheter removal and peritoneal dysfunction.

Group A Streptococcus Primary Peritonitis in Children, New Zealand.

Group A Streptococcus (GAS) primary peritonitis is a rare cause of pediatric acute abdomen (sudden onset of severe abdominal pain); only 26 pediatric cases have been reported in the English language literature since 1980. We discuss 20 additional cases of pediatric primary peritonitis caused by GAS among patients at Starship Children's Hospital, Auckland, New Zealand, during 2010-2022. We compare identified cases of GAS primary peritonitis to cases described in the existing pediatric literature. As rates of rates of invasive GAS increase globally, clinicians should be aware of this cause of unexplained pediatric acute abdomen.

Differential approach to the diagnosis and treatment of appendicular peritonitis in children

The incidence of appendicular peritonitis (AP) is 3-4 % among all acute surgical diseases in children, and the structure of acute appendicitis in recent decades fluctuates within 10-15 %. Timeliness and informativeness of acute abdomen diagnostics remain important tasks of clinical practice. The use of laparoscopy with its possibility of diapeutic approach allows to diagnose and eliminate the cause of the disease. On the basis of the surgical department of the Children's City Clinical Hospital No. 1 in Nizhny Novgorod. In the period from 2018 to 2022, 126 (11.2%) patients with various types of AP were treated in Nizhny Novgorod. All children were examined with assessment of general and local status, laboratory tests were performed using unified methods developed for practical healthcare. In complicated or doubtful cases, ultrasound of the abdominal cavity organs was performed (Vivid-7 of expert class using high-frequency transducers: convex (frequency up to 5 MHz) and linear (frequency up to 10 MHz). Local forms of AP prevailed – 90 %, of which appendicular abscess was found in 35 % of observations. Data of anamnesis, examination of patients, assessment of purulent-inflammatory markers in complicated and controversial situations were resolved by ultrasound of abdominal cavity organs. Instrumental diagnostics allowed them to detect anechogenic contents (effusion), delimited areas of absceding between the intestinal loops, perforation defect of the appendix wall, periappendicular abscess forming. Within the framework of surgical correction the priority was given to laparoscopy (59.5 %), a modern therapeutic and diagnostic method with a diapeutic approach. Open interventions were used in 51 (49.5%) patients, of which: Sprengel's access was performed in 31 (61%) patients, Volkovich-Dyakonov was used in 19 (37%) cases, midline laparotomy was performed in 1 child. Analysis of the results of bacteriological studies allowed us to identify the leading pathological pathogens belonging to Gram-negative or Gram-positive flora. In the postoperative period, therapy corresponding to the treatment of patients with peritonitis was prescribed. Evaluation of bacteriological examination revealed that Enterobacteriaceae (87%), non-fermenting bacteria (72%) were susceptible to all antibiotics. However, the highest susceptibility (73 %) was noted to cephalosporins. All children were discharged home in satisfactory condition, with an average bed-day of 12.32 ± 2.4.

#6921 INFECTIOUS PERITONITIS DURING PEDIATRIC PERITONEAL DIALYSIS

Abstract Background and Aims Peritoneal dialysis (PD) is the dialysis treatment modality of choice used to treat pediatric patients with end-stage kidney disease (ESKD), thanks to its various benefits. However, infectious complications, mainly infectious peritonitis (IP), can occur, leading to morbidity, mortality and technique's failure. In this study, we aimed to describe the deferent infectious complications observed in children on PD and to investigate the risk factors for the occurrence of IP. Method In this study, we retrospectively collected the records of 99 patients who were treated with PD within the last eleven years (2010-2020) in the department of pediatrics of the University Hospital Charles Nicolle in Tunis. We adopted the terminology of the International Society of Peritoneal Dialysis (ISPD) to define peritonitis and its outcome. Analysis examining possible predictive factors of IP were performed using parametric and non-parametric tests and multivariate logistic regression in multivariate analysis. Results Ninety-nine patients were on PD during our study period, of which 65 patients had a total of 120 episodes of IP. The incidence of IP was 0.41 episodes per patient/year. The average time to onset of the first episode of IP was 1.2 years [3 days – 5.54 years]. Clinical signs of IP were dominated by abdominal pain (78.3%) and fever (50.4%). The PD effluent was cloudy in 78.3% of cases. Peritoneal dialysis fluid culture was positive in 33.3% of episodes with a predominance of gram-positive germs (62.8%). The evolution of this IP was favourable in 91.5% of cases with a response to antibiotics. 7% of episodes were relapsing of which five were during the first episode of IP. IP recurrence occurred in one patient. A catheter change was required over 16 episodes of IP, and hemodialysis sessions were necessary in 27 patients, temporary in 10 patients. The multivariate study identified the following predictive factors of IP: poor adherence to treatment (OR=3.851; 95%CI: 1.369-10.837; P = .011) and weight less than 15 Kg (OR=6.314; 95%CI: 1.333- 29.897; P = .02). Conclusion Considering the high risk of peritonitis in children on PD, it is imperative to establish a primary prevention based on training of the child's caregivers and families. Continous quality improvement program and PD technique must systematically reviewed in every peritonitis episode. Nutritional management of children prior to the start of PD is necessary to limit the risk of IP.

Diagnostic Accuracy of Leucocyte Esterase Dipstick Test for The Diagnosis of Spontaneous Bacterial Peritonitis in Children with Nephrotic Syndrome

Spontaneous bacterial peritonitis (SBP), which has a high fatality rate if antibiotics are not given promptly, is one of the most serious side effects of nephrotic syndrome and ascites. Therefore, it is essential for survival to diagnose and treat SBP early. A quick dipstick test for leukocyte esterase can identify the SBP. Objective: To determine the diagnostic accuracy in detection of SBP using leucocyte esterase dipstick test in children with nephrotic syndrome taking ascitic fluid neutrophil count as gold standard. Methods: A Cross Sectional Study was carried out Khyber teaching hospital and LRH Peshawar Pakistan. This research covered patients of either gender with nephrotic syndrome and ascites. On admission, diagnostic paracentesis was performed. The ascitic fluid collected at the bedside was examined immediately using a reagent strip. The PMN cell count in ascitic fluid was then determined. A positive +3 result on a leukocyte esterase dipstick was declared positive for SBP while absolute neutrophil count more than 250 cells per mm3 was considered confirmatory. Results: A total of 107 patients were enrolled. Age of the patients ranged from 4 to 14 years. Mean age of the patients was 6.68 ± 1.239 years. Male to female ratio was 1.7: 1. The sensitivity, specificity, positive and negative predictive value of leucocyte esterase dipstick test were 86.4%, 92.0%, 73.1% and 96.4% respectively. Conclusion: It is concluded that reagent strips are quick, practical, and low-cost diagnostics with good sensitivity and specificity for identifying SBP in children with nephrotic syndrome

Spontaneous Rupture of Choledochal Cyst: A Rare Presentation

AbstractCholedochal cyst (CDC) is a rare surgical cause of cholestatic jaundice in infants. Spontaneous rupture is an unusual presentation of a previously undiagnosed CDC and is also a rare cause of biliary peritonitis in children. Here, we report a case of a 1-year-old boy who was evaluated for progressive abdominal distension. Ultrasonogram showed gross ascites with echogenic particles, dilated common bile duct (CBD), common hepatic duct (CHD), and upstream intra hepatic biliary radicle dilatation (IHBRD). CECT sections of the abdomen showed gross ascites and IHBRD with disproportionate dilatation of CHD and CBD. At laparotomy, a type 1 CDC with rupture of the anterior wall was found. The cyst was excised followed by hepaticojejunostomy. In a sick child with abdominal pain, cholestatic jaundice and biliary ascites, a high index of suspicion during imaging will help in the correct diagnosis and surgery for a potentially fatal ruptured CDC.

Automated complete blood counter, urine analyzer and urine dipstick test results are correlated with thoma cell counting chamber counts in the diagnosis of dialysis related peritonitis in children

IntroductionPeritoneal dialysis is the treatment of choice for end-stage renal disease. Peritoneal dialysis related peritonitis is of great importance for patient and technical survival. The aim of our study was to evaluate the accuracy and the correlation between the three methods (complete blood count, urinalysis device, urine dipstick test) and with the reference manual method (Thoma Cell Counter Chamber). Materials and methodsWe retrospectively analyzed 167 peritoneal fluid samples taken from 25 patients receiving peritoneal dialysis treatment. Leukocyte counts were evaluated with Thoma Cell Counter Chamber, complete blood count, urinalysis device and urine dipstick test. ResultsThere was a significant positive correlation between Thoma Cell Counter Chamber and complete blood count results (Spearman's rho=0.70), between Thoma Cell Counter Chamber and urinalysis device (Spearman's rho=0.73), and between Thoma Cell Counter Chamber and urine dipstick test (Spearman's rho=0.71). Area under curve for complete blood count, urinalysis device and urine dipstick test were 0.93, 0.94 and 0.89 respectively, indicating good accuracy. Sensitivity and specificity were 89.7% and 86.7% in the complete blood count analysis (associated criterion: 130 cells/mm3). Sensitivity and specificity were 89.7% and 86.7% in the urinalysis device (associated criterion: 10 cells/HPF). Sensitivity and specificity were 79.6% and 91.4% when in the urine dipstick test analysis (associated criterion: +1 positivity). The Bland-Altman plot showed good agreement. ConclusionAutomatic complete blood count and urinalysis devices have good correlation and agreement with manual method in the diagnosis of peritonitis in the pediatric age group. Urine dipstick test in the home setting can be useful for screening patients with suspected peritonitis.

Study of Generalized Peritonitis in Children at the Hospital Fousseyni Daou of Kayes: Mali

Introduction: Peritonitis is an acute inflammation of the peritoneum; it is a surgical emergency in children, as in adults. It is still common in underdeveloped countries because of the delay in diagnosis. There are primary and secondary peritonitis. The main symptom is violent and sudden abdominal pain in children. The objectives were to determine the hospital frequency of peritonitis, to describe the clinical and therapeutic aspects, to evaluate the mortality of peritonitis. This was a retrospective study that took place in the pediatric surgery department from January 2019 to December 2021; using patient records. All patients operated for peritonitis from 0 to 15 years old were included in this study. Results: During this study, we performed 650 surgeries, including 23 cases of peritonitis, or 3.53% of the surgeries. The ages were between 4 and 15 years old, the male sex was predominant, i.e. 65.21%: 15 cases. The average consultation time was 7 days. The clinical signs were dominated by abdominal pain in 100% of cases, asthenia and deterioration in general condition. All the patients had benefited from a biological assessment, the widal was positive in 12 cases. Abdominal X-ray without preparation and abdominopelvic ultrasound were performed in all patients. Abdominal X-ray without preparation objectified 6 cases of pneumoperitoneum, water levels in 10 patients. Ultrasound showed 16 cases of appendicular peritonitis, i.e. 69.56%. All patients underwent laparotomy and we found 16 cases of appendicular peritonitis 69.56%, 5 ileal perforations i.e. 21.73%, 1 perforation of the gallbladder i.e. 4.34% and tuberculous peritonitis confirmed by pathology 4.34%. The postoperative course was simple in 65.21%, parietal suppuration was observed in 21.73% of patients. We had recorded 3 cases of death or 13.04%.

High C-reactive protein and number of previous episodes at diagnosis increase the risk of catheter removal in peritoneal dialysis-related peritonitis in children.

A minority of patients with peritonitis require removal of peritoneal dialysis (PD) catheters. We examined risk factors at diagnosis that could predict the removal of PD catheter before obtaining the results of treatment success in children with peritonitis. We analyzed 156 peritonitis episodes in 57 pediatric PD patients. The peritonitis rate was 0.68 peritonitis episode per patient year. Catheter removal was required in 22 of 156. C-reactive protein (CRP) ≥ ×10 of upper limit at diagnosis and increased previous episode number were found to be associated with catheter removal (OR [95% CI] 6.4 [2.3-18.1], p= 0.001 and 3.8 [1.4-10.6], p= 0.009). These findings supported that CRP could be an early marker in predicting catheter removal even before obtaining the results of treatment success. Furthermore, it should be kept in mind that the risk of catheter removal is high in patients with high number of previous episodes especially of three or more.

Clinical justification of small-intestine decompression in children with common appendicular peritonitis

The aim of this work: to evaluate the effectiveness of the developed methods of intestinal decompression in the treatment of spilled appendicular peritonitis in children. Materials and methods. The study was conducted on the basis of the 2nd SamMI clinic in the period from 1990 to 2014. Long-term decompression of the small intestine was carried out through appendicostomy or cecostomy, the technique of which was significantly different in the main group (79 patients) and the comparison group (34 patients). Results. The methods we developed for decompression of the small intestine in children with common appendicular peritonitis (WAP) contributed to an earlier restoration of intestinal motility and the appearance of the first independent stool (on day 4), normalization of body temperature by 4-5 days, and a reduction in the duration of the gastric tube (up to 3 days) and early activation of patients (2-3 days).

Sociodemographic features and outcomes of peritonitis episodes in children on peritoneal dialysis.

Peritoneal dialysis (PD) is one of the most preferred kidney replacement therapies in children. However, it has an important complication such as peritonitis. This study was planned to investigate the causes and frequency of peritonitis in children with PD. The demographic features, peritonitis episodes, and microbiological characteristics of PD patients followed up for 5 years. Overall, 50 pediatric PD patients who met the study criteria in a 5-year period were included in the study. Consanguineous marriage was 64% and 44% of the mothers was illiterate. A total of 19 patients had no peritonitis episode, and a total of 54 peritonitis episode were experienced. The overall peritonitis rate was one episode per 24.4 patient-months. Culture negativity rate was 44%. Even though factors such as the education level of the parents, the number of people or rooms in the house, dialysis modality were thought to influence peritonitis episodes, they could not be shown statistically.