Pediatric empyema thoracis: our surgical experience

Abstract

Incidence of empyema is increasing despite various treatment modalities available. Management of pediatric empyema remains a challenge due to factors like malnutrition, poverty, TB, delay in early intervention and incomplete treatment course. It is necessary to address these issues at ground level. A short 2-year prospective study was carried out at a tertiary care teaching hospital where 17 consecutive cases of pediatric empyema were managed. Among 17 cases, all patients intercostal tube drainage (ICD) was required. Six patients underwent surgical interventions [2 video-assisted thoracoscopic surgery (VATS) and 4 open thoracotomies] while 11 were managed on ICD and antibiotics. Fibrinolytic therapy was not administered in any case. Follow-up showed good lung expansion with apparent rib crowding in 3 cases and no mortality. Majority of empyema in children are post pneumonic. Chest tube drainage, antibiotics along with intrapleural fibrinolytic is a safe and effective method of treating empyema thoracis in children in resource- poor settings and can reduce the need for invasive interventions.