Conservative Management Of Pneumoperitoneum In Children

Objective:Pneumoperitoneum(PP)is a radiologic term denoting an abnormal collection of air in the peritoneal cavity and suggests perforation of an abdominal viscus.However,approximately 10%pneumoperitoneum is caused by a non-perforated hollow abdominal organs,can be treated conservatively.However,some patients with PP undergo negative laparotomy and develop serious postoperative complications.In order to avoid unnecessary negative laparotomy,surgeons need to fully recognize the indications for conservative treatment of pneumoperitoneum patients.This paper summarizes and analyzes the clinical data of children's pneumoperitoneum in shengjing hospital affiliated to China medical university,and discusses the evidence of conservative treatment of children's pneumoperitoneum.Methods:The clinical data of 43 children with pneumoperitoneum confirmed by radiographic examination at Shengjing Hospital from January 2011 to December 2017were retrospectively analyzed,including demographic data,common symptoms,signs,white blood cells,CRP,radiological examination data and treatment.It was divided into surgery group and conservative group according to different treatment methods,and the data of the two groups were statistically analyzed.Results:Among the 43 patients,18 were conservative and 25 were in the operation group.There were 21 males and 4 females in the surgical group,13 males and 5 females in the conservative group.There was no significant difference in gender between the two groups.The mean age of the surgical group was 5.40±4.21 years old,and that of the conservative group was 8.21±4.81 years old.The age of the surgical group was significantly lower than that of the conservative group.There was a statistically significant difference between the two groups(P=0.048).With blunt abdominal closed injury of the factors which causes pneumoperitoneum,haematology chemotherapy,hormone therapy,eating food allergies,severe infection,including blunt abdominal closed injury,the largest proportion of about 27.9%.Three(16.7%)in the conservative group had a history of abdominal trauma,which was significantly lower than the surgery group(36.0%),but the two were statistically insignificant(P=0.163).The clinical symptoms of the two groups were compared.The incidence of fever in the operating group(64.0%)was slightly higher than that in the conservative group(38.9%),but the difference was not statistically significant.There are other common symptoms,such as abdominal pain(P=0.763),vomiting(P=0.856),and bloating(P=0.818).Similarly,the leukocyte count surgery group was slightly higher than the conservative group(14.54±12.19 vs.14.36±5.73).The CRP operation group was slightly lower than the conservative group(90.27±94.78 vs.91.07±72.86),but the difference was not significant and was not statistically significant.In imaging studies,CT scans showed 38 cases of abdominal fluid in children,accounting for 38/43(88.37%).Among them,there were 25 patients in the surgical group and 13 in the conservative group.There was significant statistical difference between the two groups(P<0.05)(P=0.009).Our application software measures the maximum air bubble area on a CT scan when the child is admitted to hospital.The average maximum bubble area of the surgery group was 642.0(57.0,1523.0)mm~2,and the average maximum bubble area of the conservative group was 317.0(116.5,876.5)mm~2.Compared with the two groups,the P value was greater than 0.05 and there was no statistical significance(P=0.622).Of the 43 patients,6 had no peritonitis and all were in the conservative group;37had peritonitis,of whom 22 had full peritonitis and 15 had limited peritonitis.In the surgical group,there were 25 peritonitis per person,of which 19 were full peritonitis and6 were limited to local peritonitis.Of the 18 people in the conservative group,12 had peritonitis,of whom 3 were full peritonitis and 9 were limited to local peritonitis.The percentage of children with peritonitis in the two groups was 100%vs.66.7%.The difference was statistically significant(P=0.003).Conclusion:Symptoms such as fever,abdominal pain and vomiting,were not significantly different in the two groups,and were not contraindications for children with conservative treatment.In the case of stable vital signs,patients with no peritonitis and no abdominal effusion can be treated with conservative treatment regardless of the symptoms of the child and the amount of free gas in the abdominal cavity.