Related Experiment Videos
[Subdiaphragmatic abscesses in children]
Insights
This study reviewed 30 pediatric subdiaphragmatic abscess cases, mostly post-emergency surgery. Surgical approaches varied by abscess location, with a low mortality rate despite complex cases.
Area of Science:
- Pediatric Surgery
- Abdominal Surgery
- Infectious Disease Management
Background:
- Subdiaphragmatic abscesses are serious complications in pediatric surgery.
- Post-operative abscesses frequently arise after emergency abdominal procedures.
Observation:
- 30 pediatric patients (3-14 years) treated for subdiaphragmatic abscesses between 1979-1989.
- 27 cases (90%) were post-emergency surgery, predominantly following appendicitis and peritonitis.
- Abscesses occurred on the left (53.3%) and right (46.6%) sides, with 36.6% having concurrent abscesses.
Findings:
- Diagnosis utilized clinico-laboratory methods, X-ray, ultrasound, and CT scans.
- Surgical intervention was performed in 29 patients, with approach selection based on abscess localization.
- Intensive postoperative therapy was crucial; one patient died from sepsis and polyorganic insufficiency.
Implications:
- Effective diagnosis and tailored surgical approaches are vital for managing pediatric subdiaphragmatic abscesses.
- Prompt and comprehensive postoperative care can improve outcomes in these complex cases.
- Understanding abscess etiology and localization aids in surgical planning and patient management.
Abstract:
At the clinic of pediatric surgery of the Sverdlovsk Medical Institute 30 children aged from 3 to 14 years were treated for subdiaphragmatic abscesses in 1979-1989. In 27 of them the abscesses occurred in 6 days to 6 months after an emergency operation. The largest group (19 children) was formed of patients who underwent operation for destructive appendicitis and peritonitis. The subdiaphragmatic abscess was found on the left side in 16 (53.3%) and on the right side in 14 (46.6%) cases. In 11 (36.6%) patients in was combined with abscesses of other localization. X-ray and ultrasonic studies and, occasionally, computed tomography were used along with clinico-laboratory methods in establishing the diagnosis of subdiaphragmatic abscesses. Operations were performed on 29 patients. One patient was treated by puncture followed by drainage of the abscess after Seldinger. The choice of the approach was determined by the localization of the abscess. The intraperitoneal approach was used in 11 cases (36.6%), Klermon's extraperitoneal approach in 16 (53.3%), Melnikov's extrapleural approach in 2, and the posterior retropleural approach in one case. Complex intensive therapy was applied in the postoperative period. Among the 30 patients one died from sepsis and developed polyorganic insufficiency.