Diagnosis and Treatment of Abdominal Abscesses in Children
Objective: to improve treatment outcomes in children with abdominal abscesses due to the improvement of diagnostic and surgical technologies. Materal and methods. Over 22 years in the Chernihiv region, 27,325 operations on the abdominal organs were performed, of which 19,842 (72.6 %) — for various forms of appendix. Infiltrates and abscesses of the abdominal cavity were found in 285 (100.0 %) patients, of whom infiltrates — in 78 (27.4 %) and abscesses — in 207 (72.6 %). Patients with abdominal abscesses are divided into two groups: research (2005–2015) group (I) — 79 (38.2 %) persons, and the comparison (1994–2004) group (II) — 128 (61.8 %). Each of them is divided into subgroups depending on the cause of abscess — primary and secondary. Out of 207 (100 %) patients with abdominal abscess, primary abdominal abscesses (PAA) were detected in 168 (81.2 %), of whom in group I in 72 (34.8 %) compared to 96 (46.4 %) in group II. Secondary abdominal abscesses (SAA) were found in 39 (18.8 %) patients, of them in group I in 7 (3.4 %) vs 32 (15.4 %) in group II. Diagnosis in children of the main group was carried out based on algorithms of examination, diagnostic scale, and comprehensive treatment — on advanced conservative methods and developed methods of surgery. Treatment of children in the comparison group was conducted using conservative methods. All patients underwent general clinical, laboratory, and in the research group — ultrasound examination (USE) of the abdomen with color flow mapping and computed tomography (CT) of the abdominal organs. Results. The results of the examination in 168 (81.2 %) patients with PAA showed the following. The general condition of the child and clinical manifestations of the disease with flatulence, nausea, lack of appetite, as well as acetonemic syndrome were established in 99 (58.9 %) of them, fever response — an increase was detected in 156 (92.9 %), abdominal pain syndrome — in 168 (100 %). Rigidity of the anterior abdominal wall muscles was found in 168 (100 %) patients. Peritoneal symptoms were detected in 158 (94 %). Symptom of tumor palpable in the right abdomen was noted in 18 (10.7 %). Rectal examination was informative in 27 (16 %) persons. Disease duration was up to 3 days in 58 (34.5 %), from 3 to 4 days — in 64 (38.1 %), and more than 4 days — in 46 (27.4 %) individuals. USE of the abdomen was performed in 45 (62.5 %) patients and CT of the abdomen — in 10 (15.2 %). Thus, according to the results of the examination and scoring of the child and the abdomen in terms of appendiceal complications — primary and secondary abdominal abscesses, the following points were obtained: infiltration with abscess formation — 37–45; abdominal abscess — 46–72 points. Secondary abdominal abscesses were diagnosed in 39 patients. Inadequate sanitation of the abdomen and abdominal revision — in 37 (94.5 %), omentitis — in 14 (35.9 %), inadequate drainage of abdomen — in 20 (57 %), inadequate access — in 17 (53 %), diagnostic errors — in 7 (17.9 %), abscess of the appendiceal stump — in 1 (2.5 %), gastrointestinal foreign body — in 1 (2.5 %). The survey results in 39 (18.8 %) patients with SAA showed the following. The general condition of the child and clinical manifestations of the disease with flatulence, nausea, lack of appetite and acetonemic syndrome were established in 11 (28.2 %), fever response — an increase was noted in 36 (92.3 %), abdominal pain syndrome — in 39 (100 %), rigidity of the anterior abdominal wall muscles — in 39 (100 %), peritoneal signs — in 39 (100 %), symptom of tumor palpable in the right abdomen — in 11 (28.2 %), rectal examination was informative in 7 (17.9 %). Duration of the disease up to 7 days was in 17 (43.6 %) patients of group II, from 8 to 14 days — in 20 (51.3 %), and more than 15 days — in 2 (5.1 %). USE of the abdomen was performed in patients of research group I, an abscess was diagnosed in 7 (100 %) cases, and CT of the abdominal organs was performed in patients of group I, and an abscess was found in 3 (42.8 %). Treatment of abdominal abscesses in children. Thus, a survey has shown that in 131 (63.3 %) patients with PAA, a local access was used. The transition from local access to laparotomy was performed in 6 (2.8 %) patients, and in 37 (17.9 %), due to the prevalence of purulent process, we have used laparotomy. In 21 (10.2 %) patients with SAA, according to survey data, a local access was used, while in 18 (8.6 %) — laparotomy. After surgery, all patients were discharged. Conclusions. Complications in the form of abdominal abscesses and infiltrates in children with appendiceal inflammation were diagnosed in 1.4 % of patients, of them abdominal abscesses make up to 72.6 %. Using the scoring and abdominal USE, and in doubtful cases also CT allows to establish the correct diagnosis at the stages of both the formation of abscessed infiltrate and abscess. The use of adequate surgical treatment — drainage and sanitation of abdominal abscess makes it possible to achieve good results at the stages of abscess formation and spread of purulent process in the abdominal cavity.
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