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The disappearance of free air after pediatric laparotomy
Insights
Postoperative free air in children typically resolves quickly after laparotomy. Newborns and small infants clear air by postoperative day two, while older children with smaller incisions usually clear it by day three.
Area of Science:
- Pediatric Surgery
- Radiology
- Abdominal Imaging
Background:
- Intraperitoneal free air is common after pediatric laparotomy.
- The expected timeframe for its resolution is not well-established.
- Variability exists in clinical observations regarding free air disappearance.
Purpose of the Study:
- To determine the typical time course of intraperitoneal free air resolution after pediatric laparotomy.
- To establish a clearer understanding of normal postoperative free air clearance in pediatric surgical patients.
Main Methods:
- Prospective study of 88 pediatric surgical patients (newborn to 18 years) undergoing laparotomy.
- Serial upright abdominal X-rays performed starting postoperative day 2 until free air disappeared.
- Clinical parameters including temperature, nasogastric suction, bowel sounds, flatus, stools, drains, and wound infection were recorded.
Main Results:
- Newborns and small infants showed no free air by the second postoperative day.
- Older infants and children with small incisions (e.g., McBurney) typically had air disappear by the third postoperative day (longest observed: 8 days).
- Resolution time correlated with patient age and incision size.
Conclusions:
- Postoperative free air in pediatric patients generally resolves rapidly.
- Age and surgical approach influence the rate of free air disappearance after laparotomy.
- These findings provide a benchmark for expected free air resolution in pediatric surgical care.
Abstract:
The disappearance of intraperitoneal free air after pediatric laparotomy has been the subject of much talk and speculation, but little scientific publication. Moreover, there is no unanimous opinion as to the "correct" time of disappearance of such postoperative free air. Eighty-eight pediatric surgical patients ranging in age from newborn to 18 years were studied after each had a laparotomy to determine when the postoperative free intraabdominal air disappeared. Upright abdominal x-rays were taken in each patient starting on the second day after operation and these x-rays were repeated every few days until the free air was no longer visible. No more than eight such single upright abdominal x-rays were taken in any one patient, the majority having only two or three. Free air under the diaphragm(s) was the specific criterion followed until disappearance of the free air. At the time of the x-ray, the temperature was noted, as well as the presence or absence of the following: nasogastric suction, bowel sounds, flatus, stools, drains, and wound infection. The patients in this series fit into three distinct groups: all newborns and small infants had no free air seen on upright x-rays by the second postoperative day. The free air found in older infants and children operated on through small abdominal incisions (eg, McBurney) was gone in most by the third postoperative day, with the longest time being eight days.(ABSTRACT TRUNCATED AT 250 WORDS)