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Surgical management of stage III pediatric empyema thoracis
Aditya Pratap Singh1, Arvind Kumar Shukla1, Pramila Sharma1
1Department of Pediatric Surgery, SMS Medical College Jaipur, Rajasthan, India.
Insights
Delayed referral in pediatric empyema thoracis leads to thickened pleura and lung injury. Open decortication offers effective treatment, with lung status post-surgery being a key prognostic factor.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- Empyema thoracis is a serious infection in children.
- Delayed diagnosis and treatment can lead to significant lung damage.
Purpose of the Study:
- To evaluate open decortication for pediatric empyema thoracis.
- To analyze presentation, referral delays, surgical findings, and outcomes.
Main Methods:
- Retrospective study of 100 pediatric patients with stage III empyema thoracis.
- Treatment involved open decortication.
- Preoperative assessment included imaging (CECT) and lab tests.
Main Results:
- 90% of patients were referred over 3 weeks after disease onset.
- Thickened pleura, multiloculated pus, and lung involvement were common.
- No mortality was observed; 5 patients had tuberculosis.
Conclusions:
- Disease duration correlates with pleural thickness and lung injury.
- Delayed referral negatively impacts lung recovery.
- Open surgical debridement yields positive outcomes.
Aim And Objective:
This study aims to report 100 pediatric patients of empyema thoracis treated by open decortication, highlighting the presentation, delay in referral, operative findings, the response to surgical intervention, and follow-up.
Materials And Methods:
All the children who underwent open decortication for stage III empyema thoracis during the study period January 2015-December 2016 were included. Preoperative workup included hemogram, serum protein, chest radiographs, and contrast-enhanced computed tomographic (CECT) scan of the chest.
Results:
One hundred (65 males, 35 females) (age 2 months-13 years, mean 4.5 years) were operated during a 2-year period. Among them, 90% patients were referred 3 weeks after the onset of disease. Intercostal chest drainage (ICD) had been inserted in (95) 95% cases. Thickened pleura, multiloculated pus, and lung involvement were invariably seen on CECT scan. Bronchopleural fistula was present in five patients. Decortication and removal of necrotic tissue were performed in all the patients. Mean duration of postoperative ICD was 4 days. Follow-up ranged from 1 month to 2 years (mean 12 months). There was no mortality. Five patients had proven tuberculosis. Only 10% presented within the early period of the disease.
Conclusion:
The duration of the disease had a direct relationship with the thickness of the pleura and injury to the underlying lung. Delayed referral causes irreversible changes in the lung prolonging recovery. Meticulous open surgical debridement gives gratifying results. The status of the lung at the end of surgery is a major prognostic factor.
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