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Children with progressive or postoperative peritonitis require intensive therapy with higher fluid and potassium administration. Early relaparotomy is crucial for managing complications like intestinal suture incompetence and perforating ulcers.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Gastroenterology
Context:
- Peritonitis in children presents unique challenges, especially post-operatively.
- Intensive care management is critical for patients undergoing early relaparotomy for abdominal complications.
Purpose:
- To delineate the specific clinical manifestations of progressive and postoperative peritonitis in children receiving intensive care.
- To compare peritonitis signs in children with uneventful postoperative courses versus those requiring early relaparotomy.
Summary:
- A study of 48 children undergoing early relaparotomy for peritonitis revealed key causes including progressive peritonitis, postoperative peritonitis, intestinal suture incompetence, and perforating ulcers.
- Children in intensive care with peritonitis exhibited increased gastric fluid and required significantly higher fluid and potassium correction for dehydration and hypokalemia compared to those without complications.
Impact:
- Highlights the distinct needs for fluid and electrolyte management in pediatric peritonitis patients under intensive care.
- Informs clinical practice regarding the recognition and management of severe peritonitis and its complications in children.
Abstract:
The peculiarities of the manifestation of progressive and postoperative peritonitis under conditions of intensive postoperative therapy are shown on basis of generalized experience in the treatment of 48 children who underwent early relaparotomy for postoperative complications. The following causes of purulent peritonitis were determined during relaparotomy: progressive peritonitis in 14, postoperative peritonitis in 30, incompetence of the intestinal sutures in 9, and perforating ulcers of the small intestine in 3 patients. Manifestations of postoperative peritonitis in 13 patients (group I) treated in the intensive care department after operation for peritonitis of appendicular origin in whom the early postoperative period was uneventful were compared with those in 12 patients (group II) who were in the intensive care department after the first operation and who were later subjected to early relaparotomy. Besides the well-known manifestations of purulent peritonitis complicating an operation on the abdominal organs, other objective signs characterizing the peculiarities of intensive therapy were revealed. Among them are increased volume of the stagnant gastric contents and increased volume and doses of corrective therapy for the control of dehydration and hypokalemia. To correct dehydration and loss of potassium during intensive therapy, much more solutions and potassium must be administered than in children with an uneventful postoperative course.