Peritonitis In Children Research Articles

PROGRAMMED LAPAROSCOPY IN THE OF DIFFUSE APPENDICULAR PERITONITIS TREATMENT OF CHILDREN.

The aim: To analyze the implementation of programmed laparoscopy with the criteria definition for its termination in the treatment of diffuse appendicular peritonitis in children. Materials and methods: Since 2017, the programmed laparoscopy in the treatment of diffuse appendicular peritonitis has been used in 28 children aged 1 to 16 years. Results: The programmed laparoscopy allows assessing the dynamics of the intra-abdominal infectious-inflammatory process and monitoring the treatment effectiveness. The modified abdominal index (AI) was determined based on integrated assessment of degree and nature of abdominal organs` damage during the first and repeated surgeries, the modified abdominal index (AI) was determined. AI identified during the primary laparoscopic intervention ranged from 14 up to 22 points and on average it was 17.5 ± 1.3 points, during the programmed laparoscopy AI was from 3 to 11 points, on average it was 9.15 ± 1.48 points. Conclusions: The programmed laparoscopy for diffuse peritonitis in children allows controlling the pathological process in the abdominal cavity and promptly eliminate intra-abdominal complications. Determination of AI allows objectifying the nature of the lesion and the dynamics of changes in the abdominal cavity.

Antibacterial therapy for secondary peritonitis at different ages

The review is devoted to antibiotic therapy for secondary community-acquired and postoperative peritonitis in children and adults. The authors analyze the features of pathogenic microflora in secondary peritonitis at different ages, sensitivity of microorganisms to various antibacterial drugs. Particular emphasis is placed on the choice of antimicrobial drugs and various antibiotic regimens, especially when initial empiric treatment is prescribed.

Early diagnosis of postoperative intraperitoneal purulent complications in peritonitis in children

Early diagnosis of postoperative complications leads to timely surgical interventions, on which the outcome of the disease depends. This also applies to postoperative intra-abdominal complications, especially in childhood, when the progression of peritonitis is fleeting, and many defense mechanisms are immature and depressed. Timely evacuation of pus from the abdominal cavity leads to a decrease in endotoxicosis, the main component in the pathogenesis of the toxic-septic process, and to a significant improvement in the results of treatment of the disease.

Closure of Abdominal Incisions Following Laparotomy for Peritonitis in Children: Primary Closure or Delayed Primary Closure?

Background: There is need to determine the optimal management strategy for dirty abdominal surgical wounds. The aim of this study was to evaluate the post-operative wound complications in children whose dirty surgical wounds were closed primarily, in relation to those closed by delayed primary closure. Materials and Methods: This was a prospective evaluation of children, aged 15 years and younger, who had laparotomy for peritonitis in a teaching hospital in Enugu, Nigeria. This study covered a 5-year period. The following data were evaluated: patients’ age, gender, presenting symptoms, laboratory results at presentation, duration of symptoms before presentation, time interval between presentation and intervention, intra-operative finding, definitive operative procedure performed, complications of treatment, and outcome of treatment of the 2 groups of patients. Results: A total of 204 cases of peritonitis in children were operated upon during the study period. The incisions were closed by primary closure (Group A) in 104 (51%) while 100 (49%) surgical wounds were closed by delayed primary closure (Group B). More males were involved. All the patients had abdominal pain and about half the patients were anemic and had electrolyte imbalance at presentation. Typhoid intestinal perforation was the most common cause of peritonitis and closure of ileal perforation was the most frequent performed surgical procedure. Comparing the 2 groups of patients, surgical site infection and stitch related were less common in group B patients whose surgical incisions were closed by delayed primary closure. Conclusion: Delayed primary closure of dirty laparotomy incisions has less complication in terms of surgical site infection and stitch related complications. Therefore, delayed primary closure of dirty laparotomy wounds is advocated in pediatric population.

Прогнозування ризику розвитку післяопераційної злукової кишкової непрохідності в дітей

Прогнозування ризику розвитку післяопераційної злукової кишкової непрохідності в дітей

Accuracy of ultrasonography for the diagnosis of acute generalized peritonitis in children: A two-year review

In atypical presentations, ultrasonography may be helpful to confirm the diagnosis of acute generalized peritonitis. Our study aimed to evaluate its accuracy at Albert Royer National Children’s Hospital Centre of Dakar, in Senegal. We conducted a two-year (2018-2020) retrospective cross-sectional study, with an analytical aspect. Fifty-one patients were included in our study. In 56.7% of cases, a radiologist realized the ultrasonography. The sensibility and specificity of ultrasonography for the diagnosis of acute generalized peritonitis were 70 and 75% respectively. Accuracy of diagnosis was reduced proportionally to the operator's experience, ranging from 82% for radiologists, 66% for interns in radiology to 46% for trainees in radiology (p=0,0145). In our environment, the accuracy of ultrasonography for the diagnosis of acute generalized peritonitis is poor, and largely influenced by the operator's experience, which relegates this investigation to the second line, behind clinical suspicion.

РЕЗУЛЬТАТЫ ВОЗДЕЙСТВИЯ АНТИПРОТЕИНАЗНОГО ГЕМОСОРБЕНТА НА ДИНАМИКУ КЛИНИКО-ЛАБОРАТОРНЫХ ПОКАЗАТЕЛЕЙ У ДЕТЕЙ С РАСПРОСТРАНЕННЫМ ПЕРИТОНИТОМ

Background. Despite the undoubted success of modern medicine, peritonitis in children remains not only a surgical, but also a general pathological problem, the relevance of which is not decreasing. The use of efferent therapy methods, in particular hemosorption, imitating the natural mechanisms of detoxification of the body, are promising in the complex therapy of children with peritonitis. The aim of the study was to establish the effectiveness of the antiproteinase hemosorbent "Hemo-proteazsorb" in the complex intensive care of children with generalized peritonitis. Material and methods. A prospective randomized study of 60 children with generalized peritonitis was conducted. In the main group, there were 30 patients who underwent hemosorption in complex intensive therapy. The comparison group also included 30 patients who underwent traditional treatment. The examined groups were comparable in terms of the nature of the pathology and the severity of the condition. Results. During hemoperfusion, a significant increase in blood saturation was established – from 95.1 (93.2; 97.1)% to 97.3 (95.5; 98.7)%, with an improvement in oxygen transport (ctO2, mmol/l) from 6.9 (6.4; 7.9) to 8.8 (1.5; 9.7) and a decrease in lactate level (mmol/l) from 1.7 (1.5;2.1) to 1.1 (0.9;1.3), which indicated normalization of blood oxygenation and improvement of microcirculation. After 24 hours, there was a significant decrease in the sum of points on the pSOFA scale, from 4.5 (3.0; 6.0) to 0.5 (0; 2.0), p<0.001. Normalization of body temperature and restoration of intestinal function in 15 (50.0% СI 32.1-67.9) children were also noted, which indicated a decrease in multiple organ dysfunction and improvement of the condition. In the comparison group, the studied indicators changed much more slowly. Conclusions. The data on the positive dynamics of clinical and laboratory parameters, obtained as a result of the study, prove the high effectiveness of the Belarusian hemosorbent "Hemo-proteazsorb" in the complex intensive care for generalized peritonitis.

Clinical Features and Risk Factors of Fungal Peritonitis in Children on Peritoneal Dialysis.

Objective: To analyse the clinical manifestations, aetiology, prognosis, and risk factors of fungal peritonitis (FP) in children on peritoneal dialysis (PD).Methods: Among 322 children undergoing PD at Children's Hospital of Fudan University, between January 2001 and December 2019, FP cases were retrospectively analysed and compared with those of bacterial peritonitis (BP) to analyse the risk factors of FP.Results: A total of 124 cases of peritonitis were treated, including 11 FP cases in 11 children (0.0019 episodes/patient*month) and 113 BP cases in 64 children (0.02 episodes/patient*month). Among the 11 FP cases, 7 cases (63.64%) were caused by Candida and Candida parapsilosis (5/7) was the most common pathogen of Candida. All FP patients were converted to haemodialysis (HD) and did not resume PD during follow-up. Two patients (18.2%) died after 6 months of HD due to heart failure, 2 patients underwent kidney transplant after 2 years of infection, and the other 7 patients were still on HD. The univariate analysis showed the usage rate of antibiotics in the month before the onset of peritonitis was higher (45.45 vs. 15.93%) and the mean serum albumin was lower (31.4 vs. 34.4 g/L) in the FP group when compared with BP group (P < 0.05), while multivariate analysis showed that serum albumin ≤ 30 g/L was an independent risk factor for FP (odds ratio 4.896, 95% confidence interval 1.335–17.961).Conclusion: FP is a rare complication of PD in children, but it is associated with high technique failure. Attention should be paid to hypoproteinaemia and antibiotic use in children on PD.

Clinical And Experimental Substantiation Of The Effectiveness Of Ozone In The Surgical Treatment Of Appendicular Peritonitis In Children

The article examines the use of ozone in the surgical treatment of common appendicular peritonitis in children. The use of ozone in clinical medicine is based on its oxidative, antioxidant, disinfectant, bactericidal, detoxifying, immunocorrecting, antihypoxic. An experimental model of peritonitis was created on 41 white Wistar rats of both sexes. Morphological studies of the effect of ozone therapy on the course of peritonitis in experimental animals allowed us to establish the high effectiveness of this method in the treatment of purulent-inflammatory processes in the abdominal cavity and the prevention of the formation of adhesions, which was the basis for the use of ozone in clinical practice.

Clinical justification for reducing pressure in the small intestine in common appendicular peritonitis in children

Clinical justification for reducing pressure in the small intestine in common appendicular peritonitis in children

Spontaneous duodenal perforation

Duodenal perforation is a rare cause of peritonitis in children; we present here a rare case of an 8-year-old boy who was admitted to emergency room for diffuse abdominal pain. On exam he was anxious with evidence signs of peritonitis. The frontal thoraco-abdominal x-ray showed the presence of pneumoperitoneum. The laparotomy revealed a duodenal perforation, treated by direct suturing and omental patch.

Results of the impact of antiproteinase hemosorbent on the dynamics of clinical and laboratory indicators in children with generalized peritonitis

Introduction. Despite the undoubted success of modern medicine, peritonitis in children remains not only a surgical, but also a general pathological problem, the relevance of which does not decrease. The use of efferent therapy methods, in particular hemosorption, imitating the natural mechanisms of detoxification of the body, are promising in the complex therapy of children with peritonitis. Aim. The aim of the study was to establish the effectiveness of the antiproteinase hemosorbent „Hemo-proteazsorb” in the complex intensive care of children with generalized peritonitis. Material and methods. A prospective randomized study of 60 children with generalized peritonitis was conducted. In the main group, there were 30 patients who underwent hemosorption in complex intensive care, and the comparison group also included 30 patients who underwent traditional treatment. The examined groups were comparable in terms of the nature of the pathology and the severity of the condition. Results. During hemoperfusion, a significant increase in blood saturation was established from 95.1 (93.2; 97.1)% to 97.3 (95.5; 98.7)%, with an improvement in oxygen transport (ctO2, mmol/l) from 6.9 (6.4; 7.9) to 8.8 (1.5; 9.7) and a decrease in lactate level (mmol/l) from 1.7 (1.5;2.1) to 1.1 (0.9;1.3), which indicates normalization of blood oxygenation and improvement of microcirculation. After 24 hours, there was a significant decrease in the amount of points on the pSOFA scale, from 4.5 (3.0; 6.0) to 0.5 (0; 2.0), p &lt; 0.001, normalization of body temperature, restoration of intestinal function was noted in 15 (50.0% CI: 32.1-67.9) children, which indicates a decrease in multiple organ dysfunction and improvement of the condition. When compared in the second group, the studied indicators changed much more slowly. Conclusions. The data obtained as a result of the study on the positive dynamics of clinical and laboratory parameters prove the high effectiveness of the use of the Belarusian hemosorbent ?Hemo-proteazsorb? in the complex of intensive care of generalized peritonitis.

Eosinophilic peritonitis in children on chronic peritoneal dialysis.

Eosinophilic peritonitis (EP) is sometimes difficult to distinguish from bacterial peritonitis (BP) at onset, as they are often overlapping. Previous reports show EP occurs more frequently in infants, although the reason is unknown. The study population was 77 pediatric patients receiving chronic peritoneal dialysis (PD) in our center. We compared clinical and laboratory data at onset of EP with those of BP. We also investigated age distribution at onset of EP and PD-related surgery. Eleven patients developed EP (18 episodes) and 19 patients developed BP (38 episodes). EP patients showed lower rate of cloudy dialysate (44.4% vs. 74.4%; p = 0.04), lower rate of fever (38.9% vs. 56.4%), lower frequency of abdominal pain (16.7% vs. 38.5%), higher peripheral blood eosinophil counts (/μL) (514 vs. 160; p < 0.001), and lower serum C-reactive protein level (mg/dL) (0.4 vs. 4.7; p < 0.001) than BP patients. Thirteen EP events were observed after 169 surgical interventions. Age at surgery-related EP was similar to age at surgery without EP (2.6 vs. 2.1; p = 0.65). There was no significant difference in postoperative EP occurrence between groups <2 years and ≥ 2 years (6.2% vs. 9.1%; p = 0.48). However, infants received more operations than older children. Clinical symptoms in children and laboratory data of EP in children were less severe than those of BP. As incidence of postoperative EP did not differ by age, we speculate that higher incidence of EP in infants might be associated with higher incidence of surgery, although further validation is necessary.

Dressing &lt;em&gt;versus&lt;/em&gt; non-dressing technique for long-term exit-site care in children on continuous ambulatory peritoneal dialysis: a single-center retrospective cohort study

BACKGROUND There is no consensus on the optimal long-term exit-site care strategy in children on long-term peritoneal dialysis (PD) worldwide. Thus, this study aimed to compared the dressing versus non-dressing technique for long-term exit-site care to prevent PD-related infection.&#x0D; METHODS This retrospective cohort study involved patients aged &lt;18 years with end-stage kidney disease who were on continuous ambulatory PD at the Cipto Mangunkusumo Hospital between March 2014 and March 2019. Long-term exit-site care was initiated within 3 months after the insertion of Tenckhoff catheter. The patients and caregivers can choose to either maintain the dressing method or change to the non-dressing method for the subsequent long-term exit-site care. The follow-up was performed until the following 6 months.&#x0D; RESULTS Out of 34 patients, 18 were treated without dressing and 16 with dressing technique. The peritonitis rates were 0.17 and 0.06 episodes per year at risk in the non-dressing and dressing groups; the adjusted incidence rate ratio was 0.4 (95% confidence interval = 0.04–3.25; p = 0.4). Allergic contact dermatitis occurred in 15/18 (83%) patients in the non-dressing group and 11/16 (69%) in the dressing group before long-term exit-site care was applied. Ultimately, no patient in the non-dressing group developed allergic contact dermatitis, whereas 11 (69%) had allergic contact dermatitis in the dressing group at the end of follow-up.&#x0D; CONCLUSIONS Non-dressing technique may increase the risk of peritonitis in children on long-term PD; however, it is beneficial for children vulnerable to allergic contact dermatitis.

Peritonitis in Children: Experience in a Tertiary Hospital in Enugu, Nigeria

Background: Peritonitis may be associated with significant morbidity and mortality. The aim of this study was to evaluate our experience with the management of secondary peritonitis in children. Methods: This was a retrospective study of children who had undergone laparotomy for peritonitis in the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) in Enugu, Nigeria over a five-year period. Results: There were 52 cases of laparotomies for peritonitis, with an age range of two weeks to 14 years (median: nine years) and a male to female ratio of 3.3:1. The etiologies of peritonitis were typhoid intestinal perforation in 25 cases (48%), ruptured appendix in nine cases (17.3%), perforated intussusception in eight cases (15.4%), perforated external hernia in three cases (5.8%), perforation due to adhesive intestinal obstruction in three cases (5.8%), perforated necrotizing enterocolitis in three cases (5.8%), and bowel perforation due to trauma in one case (1.9%). The following definitive surgical procedures were performed: closure of bowel perforation in 26 cases (50%), appendectomy plus abscess drainage in nine cases (17.3%), right hemicolectomy with ileotransverse anastomosis in eight cases (15.4%), segmental bowel resection in six cases (11.5%), and insertion of peritoneal drains in three cases (5.8%). The median duration of symptoms prior to presentation and the median duration from presentation to surgery were four days and two days, respectively. Twenty-four patients (46.2%) developed complications that included surgical site infection in 12 cases (23.1%), enterocutanous fistula in five cases (9.6%), intra-abdominal abscess in four cases (7.7%), and wound dehiscence in three cases (5.8%). There were seven deaths, accounting for 13.5% of the patients. Conclusion: Typhoid intestinal perforation was the most common cause of peritonitis in the present study. Keywords: Children; peritonitis; developing country; single center

Peritonitis in children on peritoneal dialysis: 12 years of tertiary center experience.

Background and ObjectivePeritoneal dialysis (PD) associated peritonitis is the most common cause of morbidity, mortality, and treatment failure in patients undergoing PD. We aimed to identify the incidence, pathogens, antibiotic susceptibility, and the outcome of peritoneal dialysis (PD)-associated peritonitis in children.MethodsData from medical records of children who underwent PD between 2007 and 2018 in King Fahad Medical City were retrospectively collected. All children aged <14 years undergoing chronic PD were included. The demographic characteristics of patients, peritonitis rates, and clinical outcomes‏ were collected.ResultsIn total, 131 children [boys, 68 (51.9%)] underwent automated PD for 305 years. The most common age group was 6–12 years (61 patients, 46.6%). A total of 74.0% of patients were new to dialysis; 25.2% were transferred from hemodialysis. Peritonitis incidence was 0.6 episodes/patient-year. Gram-positive and -negative organisms were identified in 50.1% and 22% episodes, respectively, whereas cultures remained negative in 20.5% episodes. Coagulase-negative Staphylococcus was the most common isolated organism (22.1%), followed by methicillin-sensitive S. aureus (11.1%). Peritonitis was resolved in 153 (73.6%) episodes, whereas 52 (25.0%) episodes required removal through the catheter. The multivariate logistic regression analysis found the exit site infection to be a risk factor for catheter removal. Three (1.4%) episodes caused death due to peritonitis complicated by septic shock‏.ConclusionsOur data showed that the most common organisms causing peritonitis were similar to those reported in the previous international registry. The rate of peritonitis was high, but markedly improved in the past two years.

Fungal peritonitis in children on peritoneal dialysis at a tertiary care Centre

BackgroundFungal peritonitis (FP) is an infrequent but serious complication in children undergoing peritoneal dialysis (PD). This study aimed to explore the risk factors, clinical manifestations, causative organisms, fungal susceptibility findings, and outcomes of FP in children from Saudi Arabia.MethodsIn this case–control study, the medical records and laboratory results of paediatric patients aged 0–14 years who underwent PD were reviewed for FP episodes. All FP episodes were matched with PD-related bacterial peritonitis episodes (1:4 ratio).ResultsA total of 194 episodes of PD-related peritonitis occurred between 2007 and 2017, among which 11 were FP episodes (5.6%), representing a rate of 0.03 episodes per patient-year. Of these 11 episodes, 9 were caused by Candida species (82%). Compared with the bacterial peritonitis group, the FP group had a higher proportion of patients with congenital/infantile nephrotic syndrome (p = 0.005) and those younger than 5 years of age (p = 0.001). We observed a higher rate of catheter removal in the FP group than in the bacterial peritonitis group (p < 0.001); however, 1 patient died despite catheter removal. Moreover, 75% of Candida species isolates were susceptible to fluconazole.ConclusionsThis study revealed that FP is associated with a significant risk of peritoneal membrane failure among children undergoing PD. Therefore, early diagnosis and prompt management are essential. We also found that congenital/infantile nephrotic syndrome and young age (5 years old or younger) were risk factors for FP in children undergoing PD.

An integrated approach to the treatment of diffuse peritonitis in children

The purpose of the study . Improving the treatment of advanced peritonitis with using in therapy antihypoxant Reamberin and hepatoprotector Remaxol, nutritional support, sanitation laparoscopic abdominal cavity. Materials and methods. A total of 327 children aged 1 to 15 years with generalized purulent peritonitis treated at the children's surgical departments of Samara from 2001 to 2018. A study group comprised 241 patients who used the optimized pathogenetic therapy. In the study group was allocated two groups: 69 patients in the pathogenetic therapy that used antihypoxant Reamberin, and 110 children in the treatment of which Reamberin and hepatoprotector Remaxol. All the children of the main group received nutritional support (trophic feedings), used in the surgical treatment of abdominal laparoscopic sanitation. Comprehensive survey includes the study of the dynamics of the level of white blood cells, leukocyte index, total albumin concentration. Results. Comparison of the studied parameters in the study and control groups, showed a more rapid decrease in the symptoms and signs of intoxication (leukocytosis, LII), relief of enteric disease, recovery of protein-synthetic function of the liver, a decrease of cytolytic and mesenchymal-inflammatory syndrome in the study group, especially in the subgroup in which therapy was included Remaxol. Conclusions . Optimization of treatment involving the application of the combined drugs – antihypoxant Reamberin, hepatoprotector Remaxol, nutritional support and implementation of laparoscopic abdominal sanitation led to improved results of therapy common purulent peritonitis in children.

Emergencia de peritonitis bacteriana espontánea asociada a neumococo.

Emergent Pneumococcus primaiy peritonitis in children: presentation of two cases Introduction. Primary peritonitis is rare condition in children previously healthy. It is often elated to cirrosis and kidney disease or peritoneal dyalisis. The diagnosis must be made at aparotomy in the absence of intraabdomina intraabdominal fin dings and positive cultures f peritoneal fluids. Matcrials and rnethods. Two cases were studied. Both cases were iagnosed during cirur and had positive cultures for streptococcus pneumaniae, recovey was apid with broad-spectrum antibiotie therapy in peritonitis caused by gram positives cocos. Conclusion. Recent reports indicate an increase of pnmary peritonitis caused by grarn negative organims specially by neumococo. It seems Lo he a rising of the pathology since the massive antineumococcical vaccinacion. The prognosis has improved with the correct therapy but its incidence appears unvarying.

Biochemical Correlations in Peritoneal Sepsis in Children

The biochemical analysis in acute peritonitis follows the assessment of the objective severity degree sustained by endotoxicosis, homeostasis disorders and acid-base balance. We had monitored the biochemical peculiarities and correlations in acute peritonitis in children during a retrospective study statistically analyzed on a group of 127 patients in the period 2009-2014. The obtained results were consistent with the form and late phase of peritonitis.