Perforative peritonitis in neonates. Ways to improve the diagnosis and treatment 
 

Fofanov O. D., Fofanov V. O., Nykyforuk R. I.

Ivano-Frankivsk National Medical University, Ukraine

The objective of the research — to analyze the outcomes of treatment for perforative peritonitis (PP) in neonates, to develop optimal algorithm of diagnostics and treatment strategy.

Materials and methods. The work is based on the results of examination and treatment of 54 newborns with PP, who were operated in the pediatric surgery clinic of Ivano-Frankivsk national medical university for the past 10 years. All children underwent surgery in the first days of life. Patients were divided into 2 groups. The first group included 24 patients, treated with conventional methods, the second group — 30 patients, in the treatment of which we have conducted a thorough preoperative and intraoperative correction of intraabdominal hypertension (IAH), applied a differentiated approach to the choice of surgical treatment.

Results and discussion. Among the operated children, antenatal (meconium) peritonitis was detected in 21 patients (38.9%), the rest (33 patients) were diagnosed with postnatal PP. Treatment outcomes in children from the second group with PP associated with IAH depended on the degree of hypertension, its timely correction and the type of pathology. Patients with the I degree of IAH didn’t have complications related to hypertension, all these children recovered. In the second degree of IAH, 2 children (16.7%) died, in the third degree of IAH, 6 patients (75.0%) died.

Conclusions. Results of treatment of children with PP greatly depend on the degree of IAH that accompanies it. Differentiated approach to the surgical treatment of PP, taking into account IAH and its correction, allowed us to improve outcomes in children of the II group, to reduce in them the incidence of postoperative complications from 25.0% (I group) to 16.7% (group II) and mortality from 37.5% (I group) to 26.7% (group II). Antenatal diagnosis is of great importance in improving treatment outcomes of children with meconium peritonitis.

Key words: perforative peritonitis, surgical treatment, newborn children.

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