Diagnosis and Treatment of Abdominal Infiltrates in Children
The aim was to improve treatment outcomes for children with abdominal infiltrates, through the improvement of diagnostic, surgical methods and postoperative rehabilitation.
Material and methods. Over 22 years in Chernihiv region there were performed 27,325 operations in the abdominal cavity in children, among which 19,842 (72.6 %) due to various forms of appendicular vermix. Complications as infiltrates and abscesses in the abdominal cavity were found in 285 (100.0 %) pediatric patients, whereas the infiltrates were diagnosed in 78 (27.4 %) and abscesses in 207 (72.6 %) cases. The patients were divided into two groups: group I (2005–2015) — 29 (37.2 %) patients and a comparison group (II) (1994–2004) — 49 (62.8 %). Primary abdominal infiltrates (PAI) were found in 51 (65.4 %) patients: 27 (34.6 %) in group I compared to 24 (30.8 %) patients in group II. Secondary abdominal infiltration (SAI) were found in 27 (34.6 %) patients: 2 (2.6%) patients and 25 (32.0%) children in group I and II, respectively. All patients underwent general clinical, laboratory observation and in the research group colour Doppler ultrasound and computed tomography (CT) of abdominal cavity were performed as well. Results. Studies have shown that the term of staying at hospital for the children with primary infiltrates in group I was 11.75 ± 0.23 days and 13 ± 1 day in group II. The term of staying at hospital for the children with secondary infiltrates was 13.65 ± 1.65 days: 19 ± 9 days in group I compared to 12.52 ± 1.71 days in group II. The clinical picture in patients with PAI was as follow: fever in 86.3 % cases; gastrointestinal dysfunction in 41.1 %; nausea in 29.4 %; abdominal pain in 62.4 % patients. Those symptoms pointed to the atypical disease course that caused the wrong diagnosis. The reasons for PAI late diagnosis were self-medication in 43.1 %; a late appeal for medical care in 37.2 %; late diagnosis in 19.6 % of outpatient cases. Radial methods (plain radiographs and CT) were performed in 6 (11.7 %) patients in group II versus 18 (35.3 %) children in group I. The clinical picture of SAI included fever in 100.0 % children, nausea in 63 %, vomiting in 37 %, abdominal swelling in 55.6 % children, and it was more specific for early postoperative infiltrates in 10 (37 %) patients. An objective examination determined abdominal pain in 81.4 %, peritoneal irritation symptoms in 96.3 %, a tumour symptom in 63 % cases. Ray methods were used in 5 (18.5 %) children in group II and in 2 (100 %) patients in group I. We developed a scoring scale to improve treatment results. The patients having 26–36 points by diagnostic scale were recommended to receive a standard treatment. The patients who had 37–45 points underwent surgical treatment via local access. Patients who had 46–72 points underwent surgical treatment via median laparotomy. Seven (9 %) patients with PAI by the diagnostic scale had 26–36 points and were recommended for a standard treatment in 3 (3.9 %) patients in group I versus 4 (5.1 %) in group II. Thirty-five (44.9 %) patients having 37–45 points underwent surgical treatment via local access: 18 (23.1 %) patients in group I and 17 (21.8 %) patients in group II. Nine (11.5 %) patients having 46–72 points underwent surgery through median laparotomy: 6 (7.6 %) patients in group I and 3 (3.9 %) patients in group II. Thus, 44 patients with PAI were operated. Twenty-six (33.4 %) patients with SAI having 26–36 points by the diagnostic scale underwent a standard treatment: 2 (2.6 %) patients in group I versus 24 (30.8 %) patients in group II. One (1.2 %) patient from group II had 37–45 points and underwent a surgical treatment via local access to this second group. Conclusions. The clinical course of abdominal infiltrations was found to be atypical in 12.5 to 18.9 % cases that in most cases leads to delayed admission to the children’s surgical hospital. Implementation of scale scoring for abdominal ailment allows achieve improved treatment results in both close and delayed period. Research has found that the most vulnerable category for abdominal infiltrates are patients aged 7 to 12 years old with atypical localization appendicular vermix (62.3 % cases).
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