Journal of Indian Association of Pediatric Surgeons
Journal of Indian Association of Pediatric Surgeons
                                                   Official journal of the Indian Association of Pediatric Surgeons                           
Year : 2005  |  Volume : 10  |  Issue : 3  |  Page : 142--146

Management of empyema - Role of a surgeon


DK Gupta, Shilpa Sharma 
 Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
D K Gupta
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi
India

Postpneumonic empyema still remains quite common in developing countries, especially during the hot and humid months. While most cases would respond to antibiotic therapy, needle aspiration and intercostal drainage, few cases require further surgical management. The most common nontubercular etiological agent is Staphylococcus. Tubercular etiology is not uncommon in India, especially due to delayed presentation, multiresistant strains, mismanaged cases, and noncompliance with antitubercular treatment amidst malnutrition and anemia. Clinical symptoms, a skiagram chest followed by thoracentesis are enough for diagnosis. Pleural fluid is usually diagnostic and helps in choosing the appropriate antibiotics. Further investigations and management depends on the stage of the disease. Thoracentesis alone may be sufficient for the exudative phase. In fibrinopurulent stage, a properly sized and well-placed tube thoracostomy with underwater seal is curative in most cases. Interventional radiologists have placed small-bore catheters, specifically directed to the loculated collection and have used fibrinolytics like urokinase, streptokinase, and tissue plasminogen activator (TPA) to break loculations, ameliorate fibrous peel formation, and fibrin deposition. Thoracoscopic debridement and thoracoscopic decortication is an alternative with distinct advantages over thoracotmy and are indicated if there was no response with intercostal drainage procedure. In the organizing stage, a thoracotomy (for decortication) would be required if there is a loculated empyema, underlying lung disease or persistently symptomatic effusions. Timely institution of proper management prevents the need for any surgical intervention and avoids long-term morbid complications.


How to cite this article:
Gupta D K, Sharma S. Management of empyema - Role of a surgeon.J Indian Assoc Pediatr Surg 2005;10:142-146


How to cite this URL:
Gupta D K, Sharma S. Management of empyema - Role of a surgeon. J Indian Assoc Pediatr Surg [serial online] 2005 [cited 2020 Nov 1 ];10:142-146
Available from: https://www.jiaps.com/article.asp?issn=0971-9261;year=2005;volume=10;issue=3;spage=142;epage=146;aulast=Gupta;type=0