Results of treatment of diffuse purulent peritonitis in children

BACKGROUND: Despite significant achievements in surgery and in antibiotic therapy, management of children with severe purulent complications of surgical diseases in the abdominal cavity remains an important issue. Due to the polyetiology of diffuse purulent peritonitis, sometimes not enough attention is paid to metabolism correction, especially in children. Optimization of comprehensive therapy in the diffuse purulent peritonitis promotes better outcomes in this group of patients.

AIM: To assess results of the treatment of children with diffuse purulent peritonitis applying the optimized pathogenetic therapy which includes a differentiated approach to the preoperative preparation, active correction of dysmetabolic disorders in the postoperative period as well as selection of the criteria for abdominal cavity sanation bearing in mind the degree of intra-abdominal hypertension.

METHODS: Outcomes of 339 patients, aged 1–14 years, with diffuse peritonitis of various etiology were analyzed. The patients were hospitalized to pediatric surgical departments in Samara in 2006–2022. The studied group included 237 children with diffuse purulent peritonitis who were prescribed the optimized comprehensive therapy. Control group included 102 children with diffuse purulent peritonitis who were prescribed traditional therapy according to the generally accepted standards. In the studied group, patients' therapeutic tactics included a therapeutic and diagnostic algorithm developed by the authors. Complex examination registered the dynamics of biochemical blood parameters: total protein, albumin, alanine transaminase, aspartate aminotransferase, as well as indicators of endotoxicosis (C-reactive protein and procalcitonin).

RESULTS: After studying the dynamics of transaminases, we concluded that in children with widespread peritonitis in the main group, despite the initial severity of endotoxicosis, there was a faster decrease in the level of liver enzymes, indicating a more effective restoration of cell membranes. The dynamics of the level of total protein and albumin revealed a faster recovery of protein-synthetic liver function in children of the main group, including antitoxic, which was reflected in the improvement of the general condition of patients and stabilization of hemostasis indicators, a decrease in the levels of acute phase proteins.

The analysis of the results of the complex treatment of children with advanced peritonitis revealed a statistically significant decrease in the main group: the duration of stay of patients in the intensive care unit after surgery, the timing of infusion therapy in the postoperative period, as well as the duration of hospitalization.

CONCLUSION: Thus, less stay in the intensive care unit in the postoperative period, less terms of infusion therapy as well as less length of stay in children with diffuse peritonitis demonstrate better effectiveness of the proposed comprehensive management of children with the discussed pathology.