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[Treatment of generalized purulent appendicular peritonitis in children]
Insights
Severe appendicitis in children requires specialized pediatric surgery centers. A comprehensive treatment approach, including plasmapheresis and intestinal intubation, significantly reduced mortality rates in the Moscow Region.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Infectious Diseases
Context:
- Generalized purulent peritonitis in children presents severe challenges.
- Appendicular genesis peritonitis requires complex management strategies.
- Concentrating severe cases in specialized centers improves outcomes.
Purpose:
- To generalize experience in treating severe pediatric peritonitis.
- To evaluate the efficacy of a comprehensive treatment protocol.
- To highlight the benefits of specialized care and advanced therapies.
Summary:
- A study generalized experience from 137 children with severe appendicular peritonitis.
- Key interventions included: specialized centers, antibiotic therapy, immunocorrection, and detoxification.
- Discrete plasmapheresis demonstrated detoxification and immunocorrection effects in 22 cases.
- Surgical management involved thorough cleansing, adequate drainage, intestinal intubation with aspiration, and enterosorption.
Impact:
- The integrated approach significantly reduced mortality from acute appendicitis and complications.
- Centralization of care in pediatric surgery centers is crucial for severe cases.
- Effective detoxification and immunocorrection strategies are vital for patient survival.
Abstract:
Experience in the treatment of 137 children with a most severe and complicated course of generalized purulent peritonitis of appendicular genesis is generalized. It is shown that such patients must be concentrated in centers of pediatric surgery providing the possibility of applying a complex of diagnostic examinations and therapeutic measures, including purposeful antibiotic therapy, differentiated immunocorrection, and effective detoxification. The detoxification and immunocorrection effect of discrete plasmapheresis with two-stage "washing out" of the red cells is illustrated in the discussion of 22 cases. It is pointed out that in operations for generalized purulent peritonitis the abdominal cavity must not only be cleansed but also drained adequately and intubation of the intestine must be carried out with aspiration of its content for 3-5 days and application of enterosorption through an intestinal tube. A complex of organizational and therapeutic measures made it possible to reduce considerably the mortality rate in acute appendicitis and its complications in the Moscow Region.