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Intra-abdominal abscesses in children
O Adejuyigbe1, K A Ako-Nai, P A Ajayi
1Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
Insights
This study investigated pediatric intra-abdominal abscesses in Nigerian children, finding intraperitoneal locations most common. High mortality rates underscore the need for prompt diagnosis and treatment of these serious infections.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Intra-abdominal abscesses pose significant challenges in pediatric populations.
- Understanding the epidemiology and microbiology is crucial for effective management.
Purpose of the Study:
- To prospectively analyze the location, etiology, microbiology, and clinical course of intra-abdominal abscesses in Nigerian children.
- To identify prognostic factors influencing patient outcomes.
Main Methods:
- Prospective study of 41 intra-abdominal abscesses in 30 Nigerian children over two years.
- Data collection included abscess location, causative agents, and clinical outcomes.
- Microbiological analysis identified aerobic and anaerobic bacteria, and fungi.
Main Results:
- 83% of abscesses were intraperitoneal, commonly in subphrenic and pelvic regions.
- Gastrointestinal diseases were the primary cause of intraperitoneal abscesses; suppurating adenitis caused retroperitoneal ones.
- Mixed aerobic and anaerobic bacteria were prevalent (53%), with a 23% mortality rate.
Conclusions:
- Intra-abdominal abscesses in Nigerian children are frequently linked to gastrointestinal issues and present with high mortality.
- Factors like remote organ failure and perforation indicate a poor prognosis.
- Effective management requires early detection and targeted antimicrobial therapy.
Abstract:
Forty-one intra-abdominal abscesses in 30 Nigerian children seen over a 2-year period at the Obafemi Awolowo University Teaching Hospital were studied prospectively to determine their location, aetiology, microbiology and clinical course. Thirty-four abscesses (83%) were intraperitoneal with the subphrenic spaces and pelvis being the commonly involved intraperitoneal sites. Six abscesses (15%) were retroperitoneal while there was only one visceral abscess (2%). Diseases of the gastrointestinal tract occurring in 20 patients (67%) were responsible for the majority of intraperitoneal abscesses, while suppurating external iliac adenitis was the major cause of retroperitoneal abscesses. There were 62 microbiological isolates, with 52% being anaerobic bacteria and 47% aerobic bacteria. A fungus, Candida, was isolated once (2%). Escherichia coli and Staphylococcus aureus were the commonest aerobic bacteria, while Bacteroides and anaerobic streptococci were the commonest anaerobes. Sixteen patients (53%) had a mixed flora of aerobic and anaerobic bacteria, while in seven patients each (23%) only aerobic or anaerobic bacteria were isolated. The mortality rate in this series was 23%. Association of an intra-abdominal abscess with remote organ failure, postoperative anastomotic leakage, non-localization of the abscess within the peritoneal cavity and gastrointestinal perforation due to typhoid enteritis was found to portend poor prognosis.