Surgery for lung abscess in immunocompetent and immunocompromised children

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Abstract

Purpose: The aim of this study was to evaluate the surgical management results of lung abscess in immunocompetent and immunocompromised children. Methods: Surgery was performed on 30 children with lung abscess or necrotizing pneumonia refractory to medical treatment in a 12-year period. Of them, 23 were immunocompetent, and 7 were immunocompromised. Pulmonary resection was performed including unilateral lung in 28, bilateral in 2, and 2 lobes in 6. Concomitant decortication was performed in 18 (78.2%) immunocompetent patients. Results: Increased incidence of surgery for lung abscess was caused mainly by drug-resistant and fungal infection. Surgery was performed commonly for bacterial lung abscess on patients less than 5 years old and fungal lung abscess on adolescence. A multiple small abscess was the predominant type of abscess in immunocompetent patients, whereas 2-lobe involvement tended to occur in immunocompromised patients. Fungal lung abscess tended to occur on left lung and in female patients. Left lower lobe was involved most commonly in both groups of patients in which majority need lobectomy. Immunocompromised patients required a more extensive pulmonary resection. There were 3 postoperative complications (morbidity of 10.2%) with no postoperative mortality. Length of postoperative hospital stay ranged from 6 to 85 days with average of 18.4 days. Conclusions: The incidence and pattern of lung abscess that required surgery between immunocompetent and immunocompromised children were different. A more aggressive, extensive surgical procedure is preferable for immunocompromised patients, and the surgical results were comparatively excellent to immunocompetent patients. However, the prognosis of immunocompromised children depends on their underlying disease process. J Pediatr Surg 36:470-473. Copyright © 2001 by W.B. Saunders Company.

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Materials and methods

Between July 1988 and December 1999, pediatric patients (less than 16 years old) with pathologically documented lung abscess or necrotizing pneumonia at the National Cheng Kung University Hospital, Tainan, Taiwan were enrolled into this study. They were divided into 2 groups.

Group 1 consisted of immunocompetent patients. Five of them had associated underlying diseases of premature with respiratory distress syndrome, glucose-6-phosphate dehydrogenase deficiency, congenital cystic adenomatoid

Results

In this study series, there were 30 patients including 23 immunocompetent (group 1) and 7 immunocompromised (group 2) patients. Sex incidence showed predominance of male (M, 14; F, 9) and female (M, 1; F, 6) in group 1 and group 2, respectively. The average age was 3.3 years (range, 1 month to 13.9 years) on group 1, in which only 2 patients were older than 5 years. The average age was 10.9 years (range, 4 to 14.8 years) on group 2, in which 6 were older than 7 years.

The interval between

Discussion

Moore and Battersby1 and Mark and Turner2 reported the largest series of lung abscess; since then, pediatric lung abscess surgically treated were reported sporadically. Herein, we report this series to evaluate the presence of any significant differences during these past years.

Therapeutic options in lung abscess include conservative treatment, transcutaneous needle aspiration, bronchoscopic drainage, transbronchial or transthoracic catheter drainage, and surgery. Conservative management of

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Address reprint requests to Ming-Ho Wu, MD, Department of Surgery, National Cheng Kung University Hospital, No. 138, Sheng-Li Road, Tainan, Taiwan, Republic of China.

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