Antonyuk V. Diagnosis, clinical course and treatment of children with postoperative intra-abdominal infiltrates

The thesis is devoted to to improvement the efficiency of treatment of children with postoperative intra-abdominal infiltrates on the basis of complex diagnosis and sparing approach to treatment, which is the actual scientific and practical task. Basing on the results of own clinical studies, the program for the complex treatment of postoperative intra-abdominal infiltrates in children with appendicular peritonitis was developed by the way of combining the usage of medical and preformed physical factors under conditions of in-patient and out-patient treatment. It is proved that the detection of clinical signs (independent and provoked abdominal pain, a palpable "tumor") indicates the development of postoperative intra-abdominal infiltration and the site of its localization, which requires the need for comprehensive, sparing treatment at all stages of possible involvement. It was found that an ultrasound study conducted on the 4th-5th day after surgery for appendicular peritonitis, allows us to verify the formation and stage of infiltrate and predict its effect: postoperative intra-abdominal infiltration abscessing in patients was most often observed with the infiltrate area over 40 cm2. The application of the developed method of "stepwise" resection of the inflammatory changed large omentum in children with appendicular peritonitis in order to prevent omentitis development at the postoperative period and its abscess, promotes realization of the main principle of pediatric surgery - a sparing approach to tissues and provides a "good" direct result in 94.4 % of cases and the absence of "poor" result. The developed method of treatment of postoperative intra-abdominal infiltration in children with appendicular peritonitis by the way of combining the usage of local antibiotic therapy and endorectal anti-inflammatory treatment allowed to avoid abscesses and contributed to the shortening of inpatient treatment terms. The developed method of treatment of postoperative intra-abdominal infiltration through the use of therapeutic physical factors and rectal suppositories of fibrinolytic and proteolytic enzymes at an out-patient stage provided the achievement of "good" results in 92.7 % of cases, reducing "poor" results to 4.9 % of cases, while "poor" nearest results were in 11.8 % of the control group. The use of the developed program of complex sparing treatment of children with postoperative intra-abdominal infiltrates resulted in improvement of effectiveness of treatment and provided "good" result in 95.1 % of cases and the lack of "poor" results.