Pediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria.
Surg Infect (Larchmt). 2011 Apr;12(2):127-30. doi: 10.1089/sur.2010.046. Epub 2011 Feb 24.
Peritonitis is a surgical emergency of variable etiology with a high mortality rate, particularly in children. This paper reports our experience with the epidemiology and outcome of management of childhood peritonitis in an African setting.
Consecutive children with peritonitis managed over six years (2004-2009) at the University of Benin Teaching Hospital, Nigeria, were included in this prospective experience after approval by the local Ethics Committee.
Of the 721 children aged between one day and 18 years (mean 5 ± 4.2 years), comprising 415 males and 306 females (male/female ratio 1.4:1) who were managed for gastrointestinal disease, 182 (25.2%) developed peritonitis, 179 (98.4%) preoperatively and three (1.6%) postoperatively. Secondary bacterial peritonitis most often followed complicated appendicitis (120; 65.9%), intussusception (13; 7.1%), volvulus (5; 2.7%), and intestinal atresia (4; 2.2%). Peritonitis was generalized in all children younger than 11 years but less so after that age, and the outcome was poorest in neonatal infants, who accounted for 14 (63.6%) of the 18 peritonitis-related deaths (p < 0.0001). All the children had thorough peritoneal irrigation and lavage that included the insertion of drains in cases of localized peritonitis. The choice of antibiotics and additional surgical options that included bowel resection and anastomosis, stoma creation, and closure of perforation depended on the primary pathology and bacteriology findings. The duration of hospitalization was increased to between seven days in older children with localized peritonitis and 25 days in neonatal infants with generalized peritonitis compared with 3-5 days in children with similar pathology who did not have peritonitis (p < 0.0001).
Peritonitis was severe and generalized in younger children, especially neonatal infants, who accounted for the majority of the deaths recorded. Early referral of children, particularly neonatal infants, having gastrointestinal complaints for surgical consultation and prompt surgical management is recommended to prevent peritonitis and to improve the outcome of children with the disease.
腹膜炎是一种病因多样的外科急症，死亡率很高，尤其是在儿童中。本文报告了我们在非洲背景下对儿童腹膜炎的流行病学和治疗结果的经验。
经当地伦理委员会批准，连续 6 年（2004-2009 年）在尼日利亚贝宁大学教学医院接受治疗的患有腹膜炎的儿童被纳入本前瞻性研究。
721 名年龄在 1 天至 18 岁之间（平均年龄为 5±4.2 岁）的儿童中，有 415 名男性和 306 名女性（男女比例为 1.4:1）患有胃肠道疾病，其中 182 名（25.2%）发生了腹膜炎，其中 179 名（98.4%）在术前发生，3 名（1.6%）在术后发生。继发性细菌性腹膜炎最常继发于复杂阑尾炎（120 例；65.9%）、肠套叠（13 例；7.1%）、肠扭转（5 例；2.7%）和肠闭锁（4 例；2.2%）。所有年龄小于 11 岁的儿童腹膜炎均为弥漫性，但年龄较大者则不然，新生儿腹膜炎相关死亡 18 例中，新生儿占 14 例（63.6%），差异有统计学意义（p<0.0001）。所有儿童均进行了彻底的腹膜灌洗和冲洗，包括在局限性腹膜炎病例中放置引流管。抗生素的选择以及额外的手术选择，包括肠切除和吻合、造口术以及穿孔闭合，取决于原发性病理和细菌学发现。与无腹膜炎的具有相似病理的儿童相比，局部腹膜炎的年长儿童住院时间增加至 7 天，而新生儿腹膜炎的住院时间增加至 25 天（p<0.0001）。
腹膜炎在年龄较小的儿童中较为严重且弥漫性，尤其是新生儿，占记录死亡人数的大多数。建议对有胃肠道症状的儿童，特别是新生儿，尽早转诊进行外科会诊，并及时进行外科治疗，以预防腹膜炎并改善患有该疾病的儿童的预后。
