Lung resection in infants and children with pulmonary infections refractory to medical therapy

doi:10.1053/jpsu.2002.31629

Journal of Pediatric Surgery

Volume 37, Issue 4, April 2002, Pages 643-647

https://doi.org/10.1053/jpsu.2002.31629 Get rights and content

Abstract

Background/Purpose: Pulmonary infections in children are common and often resolve with antibiotics and supportive therapy. When these infections become refractory to medical therapy or develop into an abscess, operative intervention may become necessary. This study was undertaken to review the experience with these pulmonary infections at the authors' institution. Methods: Charts of patients who underwent pulmonary resection for infectious causes were reviewed and their presentation, operative course, and long-term outcome analyzed. Results: Between 1975 and 1999, 21 children underwent operative resection of lung parenchyma for infection. Sixty-six percent of children previously had required hospitalization for pneumonia, and 91% had been treated previously, either as an inpatient or as an outpatient, for pneumonia. Seventy-one percent of children had an identifiable underlying comorbidity. Eighteen lobectomies were performed on 17 children with the remaining children requiring either segmentectomy or wedge resection. The median length of stay was 6 days. There were 3 minor complications and 3 deaths. At follow-up (median, 8.25 months), all surviving children had improvement of the chest x-ray, and this was paralleled by clinical improvement. Conclusions: In children with pulmonary infection refractory to conservative medical therapy, operative resection can provide significant clinical improvement. When resection is performed, formal lobectomy often is required and yields a good outcome. J Pediatr Surg 37:643-647. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Materials and methods

The charts of all patients who underwent pulmonary surgery at C.S. Mott Children's Hospital between 1975 and 1999 were reviewed. Charts of patients who had undergone resection of lung parenchyma for infectious causes were separated and reviewed in detail. Patient demographics, prior medical history, presenting complaints, preoperative evaluation, treatment, operation, and postoperative course were reviewed and follow-up and long-term results assessed.

Results

Twenty-one patients were identified who underwent pulmonary resection for infection between 1975 and 1999. This patient population included 13 boys and 8 girls with a median age of 8 years (range, 2 to 20).

Discussion

Pneumonia is a common condition and is felt to occur when defenses against infection are overcome by offending organisms. The cornerstone of treatment remains appropriate antimicrobial therapy directed against the identified or presumed microbial pathogen. Pneumonia that is resistant to medical therapy or that progresses to lung abscess is rare and requires more aggressive treatment strategies. This study shows that pulmonary infections requiring parenchymal resection are rare, with 21 cases

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There are more references available in the full text version of this article.

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^☆: Address reprint requests to Arnold G. Coran, MD, 1500 E Medical Center Dr, F3970 Mott Children's Hospital, Ann Arbor, MI 48109-0245.

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Lung resection in infants and children with pulmonary infections refractory to medical therapy☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Chest

J Pediatr Surg