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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.
Insights
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.
Abstract:
An epidemic of Shigella dysenteriae type I is spreading through Africa. It is a particularly infectious and virulent form of dysentery which can cause clinical confusion with other endemic diseases and may present to the surgeon as a result of its complications. A total of 140 children with Shigella dysenteriae type I presented to the paediatricians at King Edward VIII Hospital in 1995; 35 were referred to the surgeons because of abdominal tenderness, distension, peritonitis or perforation. Ten children underwent laparotomy--four for peritonitis and six for perforation. Of the four children with peritonitis, three had transmural colitis. Therefore laparotomy was only performed for objective evidence of perforation. Of the subsequent non-operated group with the clinical features of peritonitis, none developed further surgical problems in the acute phase and none died. It is suggested that surgery in the acute phase should be avoided unless there is evidence of perforation.