Results of treatment of diffuse purulent peritonitis in children

Abstract

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.

Keywords

diffuse peritonitis / treatment of peritonitis / children / antihypoxants / Reamberin / Remaxol

References

[1] Stets VV, Polovnikov SG, Zhuravlev AG, Shestopalov AE. Nutritional and metabolic correction in the intensive therapy of peritonitis. Wounds Wound Infections prof. B.M. Kostyuchenok J. 2016;3(1):25-31. EDN: WMZLCH doi: 10.17650/2408-9613-2016-3-1-25-31

[2] Стец В.В., Половников С.Г., Журавлев А.Г., Шестопалов А.Е. Нутритивно-метаболическая коррекция в интенсивной терапии перитонита. Раны и раневые инфекции // Журнал имени профессора Б.М. Костюченка. 2016. Т. 3, № 1. С. 25-31. EDN: WMZLCH doi: 10.17650/2408-9613-2016-3-1-25-31

[3] Schegolev AA, Tovmasyan S, Chevokin AY, et al. Tertiary peritonitis: State of the problem and possible perspectives. Lechebnoe delo. 2018;(4):32-35. EDN: YYSJBB doi: 10.24411/2071-5315-2018-12063

[4] Щеголев А.А., Товмасян Р.С., Чевокин А.Ю., и др. Третичный перитонит: состояние проблемы и возможные перспективы // Лечебное дело. 2018. № 4. С. 32-35. EDN: YYSJBB doi: 10.24411/2071-5315-2018-12063

[5] Coral LE, Ceron LN, Delgado AI. [Peritonitis treated by laparoscopy as an effective treatment. (In Spanish)]. Rev Gastroenterol Peru. 2018;38(3):261-264.

[6] Coral L.E., Ceron L.N., Delgado A.I. [Peritonitis treated by laparoscopy as an effective treatment. (In Spanish)] // Rev Gastroenterol Peru. 2018. Vol. 38, N 3. Р. 261-264.

[7] Isakov YF, Dronov AF. Paediatric surgery. National manual. Moscow: GEOTAR-Media; 2009. 1168 р. (In Russ).

[8] Исаков Ю.Ф., Дронов А.Ф. Детская хирургия. Национальное руководство. Москва: ГЭОТАР-Медиа, 2009. 1168 с.

[9] Razumovsky AY. Paediatric surgery. National guide. 2nd ed., revised and updated. Moscow: GEOTAR-Media; 2021. 1280 р. (In Russ).

[10] Разумовский А.Ю. Детская хирургия. Национальное руководство. 2-е изд., перераб. и доп. Москва: ГЭОТАР-Медиа, 2021. 1280 с.

[11] Grigoriev G, Sovtsov SA, Krivtsov GA. Acute peritonitis. Clinical recommendations. Moscow; 2017. 91 р. (In Russ).

[12] Григорьев Е.Г., Совцов С.А., Кривцов Г.А. Острый перитонит. Клинические рекомендации. Москва, 2017. 91 с.

[13] Shamsiev AM, Yusupov S, Ryazantsev VA, et al. The features of preoperational preparation of children with diffuse types of appendicular peritonitis. Russ J Pediatric Surg Anesthesia Intensive Care. 2013;3(1):88-92. EDN: PZVTVD

[14] Шамсиев А.М., Юсупов Ш.А. Рязанцев В.А., и др. Особенности предоперационной подготовки детей с распространенными формами аппендикулярного перитонита // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2013. Т. 3, № 1. С. 88-92. EDN: PZVTVD

[15] Sataev VU, Mironov PI, Mamleev IA, Gumerov AA. Role of planned interventions assisted surgery in the outcome of abdominal sepsis in children. Russ J Pediatric Surg Anesthesia Intensive Care. 2013;3(1):22-27. EDN: PZVTQN

[16] Сатаев В.У., Миронов П.И., Мамлеев И.В., Гумеров А.А. Роль эндовидеохирургических плановых вмешательств в исходах абдоминального сепсиса у детей // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2013. Т. 3, № 1. С. 22-27. EDN: PZVTQN

[17] Sokolov Yu, Korovin SA, Nedumov YN, et al. Laparoscopy efficacy in the children with acute appendicitis and peritonitis. Detskaya bolnitsa. 2013;(2):29-33. EDN: SDYLRL

[18] Соколов Ю.Ю., Коровин С.А., Недумов Ю.Н., и др. Эффективность лапароскопии у детей с острым аппендицитом и перитонитом // Детская больница. 2013. № 2. С. 29-33. EDN: SDYLRL

[19] Sokolov YY, Korovin SA, Dzyadchik AV. Laparoscopy in children with acute ischemia of abdominal organs. Scientific Notes Orel State University. 2014;2(7):110-111. EDN: VEIQKF

[20] Соколов Ю.Ю., Коровин С.А., Дзядчик А.В. Лапароскопия у детей с острой ишемией органов брюшной полости // Ученые записки Орловского государственного университета. Серия: Естественные, технические и медицинские науки. 2014. Т. 2, № 7. С. 110-111. EDN: VEIQKF

[21] Korovin SA, Dziadchik AV, Akopyan MK, Sokolov YY. Personalised approaches to surgical treatment of children with purulent-inflammatory diseases of abdominal cavity organs. Detskaya khirurgiya (Russian Journal of Pediatric Surgery). 2020;24(S1):46. EDN: HBEREM

[22] Коровин С.А., Дзядчик А.В., Акопян М.К., Соколов Ю.Ю. Персонифицированные подходы хирургического лечения детей с гнойно- воспалительными заболеваниями органов брюшной полости // Детская хирургия. 2020. Т. 24, № S1. С. 46. EDN: HBEREM

[23] Bagnenko SF, Baibarina EN, Beloborodov VB, et al. Sepsis: Classification, clinical and diagnostic concept and treatment. 4th ed., revised and updated. Moscow: MIA-Med; 2017. 408 р. (In Russ).

[24] Багненко С.Ф., Байбарина Е.Н., Белобородов В.Б., и др. Сепсис: классификация, клинико-диагностическая концепция и лечение. 4-е изд., доп. и перераб. Москва: МИА-Мед, 2017. 408 с.

[25] Gürlich R, Adámková V, Ulrych J, et al. [Basic principles of diagnosis and treatment of secondary peritonitis-recommendations of experts with the support of SIS. (In Czech)]. Rozhl Chir. 2014;93(6):334-348.

[26] Gürlich R., Adámková V., Ulrych J., et al. [Basic principles of diagnosis and treatment of secondary peritonitis-recommendations of experts with the support of SIS. (In Czech)] // Rozhl Chir. 2014. Vol. 93, N 6. Р. 334-348.

[27] Gelfand BR, Kirienko AI, Khachatryan NN. Abdominal surgical infection. Russian national recommendations. Moscow: Meditsinskoe informatsionnoe agentstvo; 2018. 168 р.

[28] Гельфанд Б.Р., Кириенко А.И., Хачатрян Н.Н. Абдоминальная хирургическая инфекция. Российские национальные рекомендации. Москва: Медицинское информационное агентство, 2018. 168 с.

[29] Gürlich R. et al. Basic principles of diagnosis and treatment of secondary peritonitis-recommendations of experts with the support of SIS. Rozhledy v Chirurgii: Mesicnik Ceskoslovenske Chirurgicke Spolecnosti. 2014;93(6):334-48.

[30] Gürlich R. et al. Basic principles of diagnosis and treatment of secondary peritonitis-recommendations of experts with the support of SIS // Rozhledy v Chirurgii: Mesicnik Ceskoslovenske Chirurgicke Spolecnosti. 2014. Vol. 93, №. 6. P. 334-348.

[31] Kim J, Kim YJ, Ryoo SM, et al. Risk factors for same pathogen sepsis readmission following hospitalization for septic shock. J Clin Med. 2019;8(2):181. doi: 10.3390/jcm8020181

[32] Kim J., Kim Y.J., Ryoo S.M., et al. Risk factors for same pathogen sepsis readmission following hospitalization for septic shock // J Clin Med. 2019. Vol. 8, N 2. Р. 181. doi: 10.3390/jcm8020181

[33] Petlakh VI, Lipatov VA, Eletskaya ES, Sergeev AV. Morphology of postoperative abdominal adhesions. Detskaya khirurgiya (Russian Journal of Pediatric Surgery). 2014;18(1):42-46. EDN: RVNDWD

[34] Петлах В.И., Липатов В.А., Елецкая Е.С., Сергеев А.В. Морфология формирования послеоперационных брюшинных спаек // Детская хирургия. 2014. Т. 18, № 1. С. 42-46. EDN: RVNDWD

[35] Magomedov MM, Imanaliev MR, Magomedov MA. Postoperative abdominal adhesion: Pathophysiology and prevention (review). Modern Science: Actual Problems Theory Practice. 2020;(8-2):73-80. EDN: PZYFGL doi: 10.37882/2223-2966.2020.08-2.10

[36] Магомедов М.М., Иманалиев М.Р., Магомедов М.А. Послеоперационные спайки брюшной полости: патофизиология и профилактика (обзор литературы) // Современная наука: актуальные проблемы теории и практики. Серия: Естественные и технические науки. 2020. № 8-2. С. 73-80. EDN: PZYFGL doi: 10.37882/2223-2966.2020.08-2.10

[37] Lazarev VV, Anchutin PE. Effects of succinates on the inflammatory response: A review. Alexander Saltanov intensive care herald. 2023;(3):155-165. EDN: IVCGIF doi: 10.21320/1818-474X-2023-3-155-165

[38] Лазарев В.В., Анчутин П.Е. Влияние сукцинатов на воспалительную реакцию: обзор литературы // Вестник интенсивной терапии им. А.И. Салтанова. 2023. № 3. С. 155-165. EDN: IVCGIF doi: 10.21320/1818-474X-2023-3-155-165

[39] Zavyalkin VA, Barskaya MA, Alkurdi AM, et al. A programme for selecting an algorithm of operative tactics in common peritonitis in children depending on intra-abdominal pressure. Certificate of state registration N 2023619650 from 15.05.2023. Register of certificates for computer programmes of Samara State Medical University; 2023. (In Russ).

[40] Завьялкин В.А., Барская М.А., Алкурди А.М., и др. Программа для выбора алгоритма оперативной тактики при распространенном перитоните у детей в зависимости от внутрибрюшного давления. Свидетельство о государственной регистрации № 2023619650 от 15.05.2023. Реестр свидетельств на программы для ЭВМ ФГБОУ ВО СамГМУ Минздрава России, 2023.

[41] Savelyev VS, Gelfand BR, Filimonov MI, et al. Assessment of the severity of abdominal damage in peritonitis. Infections in surgery. 2013;11(2): 5-9.

[42] Савельев В.С., Гельфанд Б.Р., Филимонов М.И., и др. Оценка тяжести поражения органов брюшной полости при перитоните // Инфекции в хирургии. 2013. Т. 11, № 2. С. 5-9.

[43] Aleksandrovich YS, Pshenisnov KV. Pre-operative preparation to anesthesia in children. Messenger Anesthesiol Resuscitation. 2020;17(3):79-94. EDN: QZNFOB doi: 10.21292/2078-5658-2020-17-3-79-94

[44] Александрович Ю.С., Пшениснов К.В. Предоперационная подготовка к анестезии у детей // Вестник анестезиологии и реаниматологии. 2020. Т. 17, № 3. С. 79-94. EDN: QZNFOB doi: 10.21292/2078-5658-2020-17-3-79-94

[45] Babaev BD, Sokolov YY, Smirnov GV, et al. Intra-abdominal hypertension in the perioperative period during abdominal surgery in children. Russkii meditsinskii zhurnal. 2022;(5):46-48. EDN: URWYKK

[46] Бабаев Б.Д., Соколов Ю.Ю., Смирнов Г.В., и др. Внутрибрюшная гипертензия у детей в периоперационном периоде при операциях на брюшной полости // РМЖ. 2022. № 5. С. 46-48. EDN: URWYKK

[47] Morozov DA, Morozova OL, Klyuev SA, et al. Intra-abdominal hypertension syndrome in children. Novosti hirurgii. 2017;25(6):621-631. EDN: ZSVXFR doi: 10.18484/2305-0047.2017.6.621

[48] Морозов Д.А., Морозова О.Л., Клюев С.А., и др. Синдром интраабдоминальной гипертензии у детей // Новости хирургии. 2017. Т. 25, № 6. С. 621-631. EDN: ZSVXFR doi: 10.18484/2305-0047.2017.6.621

RIGHTS & PERMISSIONS

Eco-Vector