Treatment of Surgical Complications

Treatment

Diagnosis

Diagnosis is usually made by the clinical appearance of the umbilical cord stump and the findings on history and physical examination. There may be some confusion, however, if a well-appearing neonate simply has some redness around the umbilical stump. In fact, a mild degree is common, as is some bleeding at the stump site with detachment of the umbilical cord. The picture may be clouded even further if caustic agents have been used to clean the stump or if silver nitrate has been used to cauterize granulomata of the umbilical stump.

Omphalitis often resolves with medical treatment alone.

Generally the initial therapy for uncomplicated cases includes topical therapy (regular cleaning) without the use of parenteral antibiotics.

· Cleaning 1-3 times a day with some antiseptics (4% solutions of Chlorhexidine Gluconate, rubbing alcohol, Brilliant Green, 3% solutions of hydrogen peroxide)

Severe infections may require parenteral antibiotics, and surgery to remove infected tissue.

· Antibiotics

Antibiotics are the mainstay of medical treatment of omphalitis. The local antibiotic susceptibility patterns need to be considered in the initial therapy. Examples include ampiclox, cloxacillin, flucloxacillin, and methicillin in combination with gentamycin. Metronidazole may be added when anaerobes are suspected. Duration of treatment is typically for 10–14 days with initial parenteral therapy for complicated cases. A short antibiotic therapy of 7 days is adequate for simple uncomplicated omphalitis. Complications such as respiratory failure, hypotension, and disseminated intravascular coagulation (DIC) arising from infection may require supportive care in the form of intravenous fluids, fresh whole blood, fresh frozen plasma, platelets, or cryoprecipitate.

The surgical complications of omphalitis could be acute/early or long term/late and tend to be associated with significant morbidity and mortality. In addition to medical treatment for ongoing/active omphalitis, the surgical treatment is handled according to the surgical complication.

Acute/early Complications

· Necrotising Fasciitis - is one of the most commonly reported serious complications.

· Intestinal evisceration

· Peritonitis - may occur with or without intraperitoneal abscess collection

· Abscesses may develop at various sites, but are frequently intraabdominal. Abscesses may be located in the anterior abdominal wall or in other superficial locations. Intraperitoneal abscess is drained at laparotomy. Retroperitoneal abscess is best drained by an extraperitoneal approach, but if located anteriorly in the retroperitoneal, an intraperitoneal approach may be required. Hepatic abscess should be properly localised by ultrasonography or CT scan.

Late Complications

Late complications occur several weeks, months, or years after omphalitis in the neonatal period.

· Portal Vein Thrombosis

· Umbilical Hernia - several are the result of weakening of the umbilical cicatrix from neonatal omphalitis

· Peritoneal adhesions - are the result of previous subclinical or treated peritonitis from omphalitis.

Дата добавления: 2014-10-15