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Persistent diffuse peritonitis in children
G Karagüzel1, F C Tanyel, M E Senocak
1Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Insights
Persistent diffuse peritonitis (PDP) is a distinct childhood infection. This study found PDP has unique features, higher mortality, and may benefit from conservative treatment.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Persistent diffuse peritonitis (PDP) is an aggressive intra-abdominal infection in adults.
- Its distinct characteristics and outcomes in children require further investigation.
Purpose of the Study:
- To define the clinical, microbiologic, treatment, and outcome characteristics of childhood PDP.
- To compare childhood PDP with other peritonitis types.
Main Methods:
- Retrospective classification of 175 pediatric peritonitis patients.
- Analysis of clinical presentation, microbiology, treatment strategies, and patient outcomes.
- Comparison of PDP group with primary peritonitis, secondary peritonitis, and intra-abdominal abscess groups.
Main Results:
- PDP was identified in 37 pediatric patients.
- The PDP group showed higher rates of host defense issues, extra-appendicular origin, and mortality compared to secondary peritonitis.
- Lower rates of polymicrobic and anaerobic infections were observed in PDP compared to secondary peritonitis.
- Mortality was 18% in conservatively treated and 23% in surgically treated PDP patients.
- Young age, comorbidities, and fungal growth were associated with increased mortality.
Conclusions:
- Persistent diffuse peritonitis (PDP) represents a distinct entity in pediatric patients, similar to adults.
- Accurate identification of childhood PDP can guide treatment decisions, potentially favoring conservative approaches to improve survival and avoid unnecessary surgeries.
Abstract:
In adults, persistent diffuse peritonitis (PDP) having a special microbiologic spectrum is now defined as a distinct intraabdominal infection because of its aggressive clinical course. Considering also other types of peritonitis, this study was performed to determine characteristics of childhood PDP in regard to clinical picture, microbiologic features, treatment and outcome. Classification of 175 patients with peritonitis showed that nine patients had primary peritonitis and 121, 37 and eight patients had secondary peritonitis, PDP, and intraabdominal abscess, respectively. Rates of host defense affecting disease, extra-appendicular origin, and mortality were markedly higher in the PDP group. However, polymicrobic and anaerobic infection rates were lower in the PDP group than those of the secondary peritonitis group. While 26 of 37 patients with PDP underwent surgical intervention, the remaining 11 patients were managed by conservative measures. In the PDP group, mortality was 18 percent for conservatively and 23 percent for surgically treated patients. Being of young age, presence of an accompanying disease and fungal growth increased the mortality. The results indicate that PDP is a distinct type of peritonitis in children as well as in adults. In addition, accurate identification of these patients may prevent some unnecessary operations and improve survival by the choice of more conservative treatment plans.