[Characteristics of peritoneal fluid in children with severe diarrhea].
Mots clés
Abstrait
BACKGROUND
A significant number of acute diarrheal diseases produce severe damage to the bowel wall that can lead the patient to death. Peritoneal fluid (PF) analysis has been proposed as a tool to establish an early diagnosis of these injuries.
METHODS
Thirty patients with a diagnosis of acute diarrhea and suspected enteric perforation or gangrene were submitted to paracentesis. LP was classified according to its appearance immediately after obtention by the surgeon, and determinations of leukocytes, proteins, glucose, and chloride were done. Clinical diagnosis was established during laparotomy or necropsy, or after an uneventual recovery. Data were analyzed by means of diagnostic test statistics.
RESULTS
Clear and yellow PF was considered a sign of the absence of enteric perforation or gangrene, with a sensitivity (S) of 87%, specificity (SP) and positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 91.6%, with a predictive accuracy (PA) of 95%. A bloody PF was considered a sign of enteric gangrene, with an S of 54%, SP and PPV of 100%, and NPV of 72% (PA 80%). More than 1000 leukocytes per mm3 of PF were considered an sign of some kind of macroscopic injury of the bowel wall, with an S of 68%, a SP of 88%, a PPV of 91% and a NPV of 61% (PA 76%). PF glucose level less than 40 mg/dl was considered a sign of enteric gangrene (S 42%, SP 78%, PPV 71%, NPV 50%, with a PA of 57%), and also of bacteria viability in PF cultures (S and NPV 100%, SP 80%, PPV 67% and PA of 86%). Chloride levels greater than 90 meq/L were considered a sign of enteric perforation or gangrene, with an S and NPV of 100%, a SP of 60%, and a PPV de 82% (PA 86%).
CONCLUSIONS
PF analysis is of great value in the evaluation of the child with acute severe diarrhea in which enteric perforation or gangrene is suspected. A clear yellow fluid with less than 1000 leukocytes per mm3, more than 40 mg/dL of glucose, and less than 90 meq/L of chloride suggest that enteritis has not caused irreversible injury to the bowel wall.
