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Post-pneumonic thoracic empyema in children: a continued surgical challenge
O N Gofrit1, D Engelhard, K Abu-Dalu
1Department of Pediatric Surgery, Hadassah University Hospital, Jerusalem, Israel.
Insights
Open mini-thoracotomy is a safe and effective treatment for children with post-pneumonic thoracic empyema. This surgical drainage procedure successfully removed empyema sacs, leading to rapid recovery and fever reduction in most pediatric patients.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- Optimal treatment for pediatric post-pneumonic thoracic empyema remains debated.
- This study evaluates open surgical drainage as a therapeutic option.
Purpose of the Study:
- To review a seven-year experience with open surgical drainage for pediatric thoracic empyema.
- To assess the safety and efficacy of mini-thoracotomy in this patient population.
Main Methods:
- Retrospective analysis of 20 children (median age 2.7 years) undergoing posterolateral mini-thoracotomy.
- Diagnosis confirmed by pleural tap exudate and imaging (ultrasound or CT).
- Surgical evacuation of empyema sac contents and drain placement.
Main Results:
- Fever resolved within 48 hours in 85% of cases post-surgery.
- Mean hospital stay post-surgery was 9 days.
- Uneventful postoperative course and successful recovery in all patients.
Conclusions:
- Open mini-thoracotomy with complete empyema sac removal is a safe and curative procedure.
- This surgical approach offers a definitive solution for pediatric thoracic empyema.
Abstract:
The optimal treatment of post-pneumonic thoracic empyema in children is controversial. In this retrospective study, we review our seven-year experience with open surgical drainage in this condition. Between July 1, 1989, and June 30, 1996, 20 children (median age 2.7 years, range 1-8 years) underwent thoracotomy for post-pneumonic empyema in our department. The diagnosis of thoracic empyema was established by the combination of exudate in a pleural tap and the demonstration of multi-loculated pleural effusion by either chest ultrasound or computerized tomography of the chest. The surgical approach was through a posterolateral mini-thoracotomy under general anesthesia. Intrapleural debris, gelatinous, and fibrinous material were evacuated and drains were placed, under vision, at the most dependent pleural locations. The mean length of pre-hospital illness was 5 days (S.D. 3.1 days) and the mean hospital length of stay in a pediatric ward prior to surgery, during which all children received intravenous antibiotics, was 9.4 days (S.D. 7.7 days). A causative pathogen was identified in 8 cases: Streptococcus pneumoniae in 6 cases, Streptococcus group A, and H. influenzae each in one case. Cultures from the pus removed during surgery were sterile for all 19 children who received antibiotics for more than 24 hours prior to surgery. Within 48 hours after surgery, fever dropped to < 37.5 degrees C in 85% of the cases. The postoperative course was uneventful in all cases and the children were discharged home 9 days (S.D. 2.8 days) after surgery. We conclude that open mini-thoracotomy and removal of the entire empyema sac is a safe and curative procedure for children with thoracic empyema.