Pediatric empyema thoracis: our surgical experience
DOI:
https://doi.org/10.18203/2349-2902.isj20210976Keywords:
Empyema thoracis, Pediatric empyema, VATS, Decortication, Open thoracotomy, Fibrinolytic therapy, Intercostal chest tubeAbstract
Incidence of empyema is increasing despite various treatment modalities available. Management of pediatric empyema remains a challenge due to factors like malnutrition, poverty, TB, delay in early intervention and incomplete treatment course. It is necessary to address these issues at ground level. A short 2-year prospective study was carried out at a tertiary care teaching hospital where 17 consecutive cases of pediatric empyema were managed. Among 17 cases, all patients intercostal tube drainage (ICD) was required. Six patients underwent surgical interventions [2 video-assisted thoracoscopic surgery (VATS) and 4 open thoracotomies] while 11 were managed on ICD and antibiotics. Fibrinolytic therapy was not administered in any case. Follow-up showed good lung expansion with apparent rib crowding in 3 cases and no mortality. Majority of empyema in children are post pneumonic. Chest tube drainage, antibiotics along with intrapleural fibrinolytic is a safe and effective method of treating empyema thoracis in children in resource- poor settings and can reduce the need for invasive interventions.
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References
Balagopal BC, Goutham HA, Raju LS. Video Assisted Thoracoscopic Surgery Emerging as a Primary Treatment for Empyema Thoracis. J Clin Diagn Res. 2018;12:3.
Light RW. Parapneumonic effusions and empyema. Proceedings Am Thoracic Society. 2006;3(1):75-80.
Singh M, Singh SK, Chowdhary SK. Management of empyema thoracic in children. Indian pediatrics. 2002;39(2):145-57.
Ekpe EE, Akpan MU. Outcome of tube thoracostomy in paediatric non-traumatic pleural fluid collections. Afr J Paediatr Surg. 2013;10(2):122.
Strachan R, Jaffe A. Assessment of the burden of pediatric empyema in Australia. J Pediatr Child Health. 2009;45:431-6.
Eastham KM, Freeman R, Kearns AM, Eltringham G, Clark J, Leeming J et al. Clinical features, aetiology and outcome of empyema in children in the north east of England. Thorax. 2004;59:522-5.
Rengarajan R, Venkatasaravanan S, Anandan H. Comparison of Outcomes between Video-assisted Thoracoscopic Surgery and Thoracotomy in Pediatric Patients for Empyema Thoracis. Int J Sci Study. 2017;5(3):264-7.
Mitra AS, Nagdeve NG, Khatri SR, Chandak UA. Video assisted thoracoscopic surgery in the management of acute fibrinopurulent empyema in paediatric patients. Int Surg J. 2020;7(6):1847-51.
Shen KR, Bribriesco A, Crabtree T, Denlinger C, Eby J, Eiken P et al. The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J thoracic cardiovascular surg. 2017;153(6):e129.
Janda S, Swiston J. Intrapleural fibrinolytic therapy for treatment of adult parapneumonic effusions and empyemas: a systematic review and meta-analysis. Chest. 2012;142(2):401-11.
Avansino JR, Goldman B, Sawin RS, Flum DR. Primary operative versus nonoperative therapy for pediatric empyema: a meta-analysis. Pediatrics. 2005;115(6):1652-9.
McLaughlin FJ, Goldmann DA, Rosenbaum DM, Harris GB, Schuster SR, Strieder DJ. Empyema in children: clinical course and long-term follow-up. Pediatrics. 1984;73(5):587-93.
Gocmen A, Kiper N, Toppare M, Ozcelik U, Cengizlier R, Cetinkaya F. Conservative treatment of empyema in children. Respiration. 1993;60(3):182-5.
Baranwal AK, Singh M, Marwaha RK, Kumar L. Empyema thoracis: a 10-year comparative review of hospitalised children from south Asia. Archives of disease in childhood. 2003;88(11):1009-14.
Satpathy SK, Behera CK, Nanda P. Outcome of parapneumonic empyema. Indian J Pediatr. 2005;72(3):197-9.
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