Thoracotomy for the Treatment of Empyema Thoracis at the Fibrinopurulent Stage in Children

Akhand Tanzih Sultana1, Md. Mahmudul Huda2, Kazi Zahidul Hoque3, Jotsna Ara Begum4, Mamun Miah4, Md. Ruhul Amin6, Md. Kamruzzaman7

 

Abstract
Background:
Paediatric empyema is increasing in incidence and continues to be a
serious problem.But optimal management of empyema remains still controversial.
Objective: To determine the effectiveness of thoracotomy in the management of
empyema thoracis at the fibrinopurulent stage.
Methods: A prospective study was done on 16 cases of empyema up to 14 years of age
treated in the department of Pulmonology of Dhaka Shishu(Chidren)Hospital, from
May 2014 to April 2015. Diagnosis of empyema was confirmed by thoracocentesis.
All the children were treated with parenteral antibiotics and tube thoracostomy was
done immediately after diagnosis. However, patients with extensive pleural
involvement underwent formal decortication.
Results: Total 16 cases were included in the study. Male sex predominance was seen.
The most common age group affected was 1-5 years. Most common presenting complaints
were fever (100%), respiratory distress (81.3%) and cough (75%). More than 87.5% of
the children were presented with >7 days of illness and found to have advanced stage
of disease. The majority of the pleural collections were on the right pleural space. All
children were treated with parental antibiotics and tube thoracostomy. Out of these, 7
patients had adequate drainage of their empyema corresponding to a success rate of
43.8%. In the remaining 56.3% of cases (9 patients) required open decortications. In all
of the children, empyema was resolved after treatment.
Conclusion: Tube thoracostomy should be done in all patients regardless of the
stage as this leads to a reduction in septic load. In a developing country, decortication
remains a safe procedure in the management of empyema thorasis.
Keywords: Thoracotomy, Empyema, Tube thoracostomy

 

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