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Intestinal perforation in children
H Wardhan1, A N Gangopadhayay, G D Singhal
1Department of Surgery, Banaras Hindu University, Varanasi, India.
Insights
Pediatric intestinal perforation in Varanasi was frequently caused by uncommon conditions like typhoid. Most patients over five years old showed pneumoperitoneum, and the high mortality rate underscores the severity of these surgical emergencies.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Infectious Diseases
Background:
- Intestinal perforation in children is a critical surgical condition.
- Etiologies and outcomes vary significantly across different geographical regions.
- Understanding local patterns is crucial for timely diagnosis and management.
Purpose of the Study:
- To analyze the causes, clinical presentation, and outcomes of intestinal perforation in pediatric patients.
- To identify common and rare etiologies of intestinal perforation in the study population.
- To evaluate diagnostic methods and microbial patterns associated with pediatric intestinal perforation.
Main Methods:
- Retrospective analysis of 102 pediatric intestinal perforation cases over three years.
- Review of patient demographics, clinical history, surgical findings, and radiological data.
- Microbiological analysis of peritoneal fluid cultures.
Main Results:
- Enteric (typhoid) perforation, intussusception, Ascaris lumbricoides infestation, and appendicitis were major causes.
- Radiological evidence of pneumoperitoneum was present in 88% of cases.
- Escherichia coli and Klebsiella were common aerobes; Bacteroides fragilis, Clostridia, and Peptostreptococcus were frequent anaerobes.
Conclusions:
- Uncommon causes of intestinal perforation in children are prevalent in this region.
- Prompt surgical intervention and appropriate antibiotic therapy are vital.
- The high mortality rate (19%) highlights the need for improved diagnostic and therapeutic strategies.
Abstract:
There were 102 cases of intestinal perforation seen in children at the Department of Paediatric Surgery at S.S. Hospital, Varanasi during a 3 year period. Enteric (typhoid) perforation (29%), intussusception (15%) Ascaris lumbricoides infestation (9%) and appendicitis (9%), which are rarities in the reported literature, were the major causes of intestinal perforation. Radiological evidence of pneumoperitoneum was seen in 88% of patients. The majority of cases in this study were older than 5 years of age (48%). Peritoneal fluid culture revealed Escherichia coli and Klebsiella to be the most common aerobic micro-organisms, while Bacteroides fragilis, Clostridia and Peptostreptococcus were the most frequent anaerobes. The overall mortality rate was high (19%).