[Problems of enterectomy for diffuse peritonitis in children (author's transl)]
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This study details treating childhood perforative peritonitis, emphasizing intestinal resection and enterostomy over anastomosis in septic areas. This approach reduced mortality compared to international averages.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Critical Care Medicine
Context:
- Diffuse perforative peritonitis in children, excluding appendicitis, presents a significant surgical challenge.
- Perforated enterocolitis is a common etiology in this patient population.
- Current treatment strategies require careful evaluation for optimal outcomes.
Purpose:
- To analyze treatment outcomes for childhood perforative peritonitis without appendicitis.
- To present a refined surgical and therapeutic approach for perforated enterocolitis.
- To establish criteria for delayed reanastomosis.
Summary:
- The study advocates for resection of perforated intestinal segments or resection proximal to the perforation.
- Performing a double-lumen enterostomy is recommended instead of anastomosis in septic areas.
- Intensive therapy and sepsis management, including exchange transfusion, are crucial; reanastomosis should be deferred until full recovery.
Impact:
- The author's treatment strategy resulted in a 46% mortality rate, significantly lower than the 65% reported in international literature.
- This approach offers a potentially life-saving protocol for pediatric patients with diffuse perforative peritonitis.
- Definitive criteria for evaluating recovery prior to reanastomosis are provided, aiding clinical decision-making.
Abstract:
An analysis was made of the author's own patients with diffuse perforative peritonitis (without appendicitis) in childhood. Most patients had a perforated enterocolitis. Treatment of choice: Resectioning the perforated areas of the intestine or Resectioning the intestine just before the perforation; anastomosis in the septic area should not be carried out, instead an enterostomy with two lumina should be performed; intensive therapy; therapy for sepsis with exchange transfusion. The reanastomazation should take place only after the patient has fully recovered; definite criteria for evaluation, when this is the case, were presented. The mortality rate for the author's cases was 46%; statistics taken from international literature indicate a mortality rate of 65%.