Raherinantenaina F, Rambel A H, Rakotosamimanana J, Rajaonanahary T M A, Rajaonera T, Rakototiana F A, Hunald F A, Andriamanarivo M L, Rantomalala H Y H, Rakoto Ratsimba H N
Unité de soins de formation et de recherche (USFR), service de chirurgie viscérale et vasculaire, CHU Joseph Ravoahangy Andrianavalona (CHU-JRA), BP 4150, Antananarivo, Madagascar.
Prog Urol. 2013 Oct;23(12):1004-11. doi: 10.1016/j.purol.2013.04.017. Epub 2013 Jun 12.
To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources.
We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012.
Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure.
Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively.
评估儿童尿性腹膜炎的发生率，并强调在资源有限国家的治疗方法。
我们回顾性观察了2009年1月1日至2012年12月31日在塔那那利佛大学中心医院外科复苏科收集的9例尿性腹膜炎病例报告。
在研究期间，尿性腹膜炎占我们科室收集的所有儿科腹部急症的0.5%，占儿科泌尿外科急症的5%。病因有3例是创伤性膀胱破裂，1例是医源性膀胱破裂，4例继发于梗阻性尿路病，1例是膀胱切开取石术后。我们发现了1例新的创伤后膀胱颈横行破裂病例。在观察到的梗阻性尿路病中，有2例后尿道瓣膜病和2例输尿管肾盂连接处梗阻。临床表现以发热为主，伴有腹胀和压痛。大多数病例的病因诊断是在术中做出的。在全身抗生素治疗的掩护下进行剖腹手术治疗。3例病情进展并发败血症，2例并发急性肾衰竭。4例观察到手术随访无并发症。1名儿童死于感染性休克和多脏器功能衰竭。
与因尿液经腹膜外渗导致的尿腹水不同，尿腹是腹腔与尿路内容物之间的瘘管。尿腹水是腹膜炎的罕见原因。相比之下，尿腹可迅速引起腹膜炎。尿性腹膜炎在儿童中是一种罕见疾病，但预后严重。大多数病例的病因诊断是在术中做出的。
