Intrapleural Fibrinolysis and Early Decortication in The Treatment of Pediatric Parapneumonic Empyema

Ahmet ÇEKİRDEKÇİ, Oğuz KÖKSEL, Ömet TETİK, *M. Hamdi MUZ, **Filiz YAŞAR, **Hüseyin GÜVENÇ

Fırat Üniversitesi Tıp Fakültesi Göğüs, Kalp ve Damar Cerrahisi Anabilim Dalı,
^*Fırat Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalı,
^**Fırat Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Elazığ

Parapneumonic empyema in children is a serious complication that occurs in patients with bacterial pneumonia. In this article, 23 children treated for empyema complicating pneumonia from July 1992 to November 1994 were reviewed. Mean age was 4 years 10 months (7 months to 12 years). After the diagnostic thoracentesis, closed tube drainage was carried out in all patients. Pleural lavage with Povidoniodîne was performed successfuly in 11 (47.8%) patients. Because of having multiloculated empyemas in 6 patients (26.2%) the drainages by chest tubes alone couldn't be effective. In these patients, intrapleural fibrinolytic treatment by using streptokinase was performed. In 5 of them drainage had been accelerated by enzymatic debritment. In 7 patients who had bronchial fistula or thickened pleura, early thoracotomy and decortication was performed successfuly. There was no mortality in the 23 patients.

Closed tube drainage and appropriate antibiotics was the regimen most commonly used in the rnanagement of pediatric parapneumonic empyema. If drainage fails, lavage or fibrinolysis can be performed for effective drainage. In selected patients early decortication must be done. So that they can be discharged early without tubes or open wounds.

It is concluded that early decortication has proved to be a safe and effective treatment for children with parapneumonic empyema.

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