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Surgical lessons learned from the Shigella dysenteriae type I epidemic
H W Grant1, G P Hadley, R Wiersma
1Department of Paediatric Surgery and Medical Paediatrics, University of Natal, Durban, South Africa.
Journal of the Royal College of Surgeons of Edinburgh
|July 9, 1998
Summary
An epidemic of Shigella dysenteriae type I, a severe form of dysentery, requires careful surgical consideration. Surgery should be reserved for confirmed perforation, as non-operative management is safe for peritonitis without perforation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Surgical Gastroenterology
Background:
- Shigella dysenteriae type I outbreaks pose a significant public health challenge in Africa.
- This virulent pathogen can mimic other endemic diseases, complicating diagnosis and management.
- Surgical complications, such as peritonitis and perforation, necessitate careful evaluation.
Purpose of the Study:
- To analyze the surgical presentations and outcomes of children with Shigella dysenteriae type I infection.
- To determine the appropriate role of surgery in managing abdominal complications of this infection.
Main Methods:
- Retrospective review of 140 children with Shigella dysenteriae type I admitted in 1995.
- Analysis of 35 children referred to surgeons due to abdominal symptoms.
- Evaluation of surgical interventions (laparotomy) and outcomes in a cohort of 10 children.
Main Results:
- Ten children underwent laparotomy; six for perforation and four for peritonitis.
- Three of the four peritonitis cases had transmural colitis, leading to surgery only for objective perforation evidence.
- Non-operated children with peritonitis showed no acute surgical deterioration or mortality.
Conclusions:
- Laparotomy for Shigella dysenteriae type I should be reserved for confirmed intestinal perforation.
- Non-operative management appears safe for children presenting with peritonitis but without clear signs of perforation.
- Early surgical intervention is not always indicated in the acute phase of Shigella dysenteriae type I-related peritonitis.