Empyema thoracits in children: results of tube thoracostomy and decortication

ABSTRACT

Empyema thoracis is a common surgical complication of pneumonia. Various modes of treatment are described for the management of this condition. This study describes results of different modes of management of empyema thoracis. During a period of one year, 25 patients of post pneumonic empyema thoracis were managed at the Department of Paediatric Surgery at National Institute of Child Health [NICH], Karachi. There were 11 male and 14 female patients. Majority of patients [56%] was under five years of age. Tube thoracostomy resulted in expansion of lungs in 12 cases [Group I], while decortication was performed in 13 patients [Group II]. Lobectomy was performed in one case. Complications were noted in a] patients who presented late with organized stage, b] patients in whom air leaks persisted for longer duration and c] in whom lung expansion was also delayed. One patient in this series died. At follow-up asymmetry of chest wall was noted in 5 patients of Group II. The hospital stay of Group I patients on average was 11.8 days in comparison to Group II where it was 31.3 days. The postdecortication stay average was 14 days. Tube thoracostomy in early stage of disease results in expansion of lung in most of the cases. Decortication is well tolerated in children and procedure related complications are few, therefore, decortication should not be delayed if no or partial response is observed in patients with tube thoracostomy