Abstract
Purpose
Upper abdominal surgery for cholecystectomy or splenectomy is the most frequently performed surgical procedure in patients with sickle cell disease (SCD). The acute chest syndrome (ACS) is the most common sickle-related postoperative complication. The objective of the study was to characterize the clinical and radiological presentation of ACS complicating cholecystectomy and splenectomy.
Methods
The medical records of all children with SCD undergoing cholecystectomy or splenectomy during the 15-year period from January 1988 through December 2002 were reviewed. Patients who experienced ACS within 14 days after surgery were identified. Data collected included demographics, perioperative management, clinical and radiological findings, and outcome.
Results
The overall incidence of postoperative ACS was 16%, occurring in nine of 51 patients having cholecystectomy and in seven of 48 patients having splenectomy. Mean time to onset of symptoms was 49 hr after surgery (range, 24–96 hr). Cough, fever, and an abnormal chest examination were documented for all patients at presentation. Radiologically, ACS involved the basal lobes in all cases and was multi-lobar in 25%. Patients were more likely to have new infiltrates involving the lung on the side of the surgery or bilateral infiltrates than isolated contralateral infiltrates at presentation (P < 0.0001). Isolated upper or middle lobe involvement did not occur. Fifty percent of cases demonstrated evidence of a pleural effusion.
Conclusion
ACS complicating cholecystectomy or splenectomy shows a predilection for basal lung regions and for the lung on the side of surgery. These results have implications for the pathogenesis and prevention of postoperative ACS.
Résumé
Objectif
L’intervention chirurgicale abdominale haute pour une cholécystectomie ou une splénectomie est l’opération la plus fréquente chez les patients atteints de drépanocytose. Le syndrome pulmonaire aigu (SPA) est la complication postopératoire la plus fréquente reliée à la drépanocytose. Nous voulions montrer la présentation clinique et radiologique du SPA suivant la cholécystectomie et la splénectomie.
Méthode
Les dossiers médicaux de tous les enfants atteints de drépanocytose, qui ont subi une cholécystectomie ou une splénectomie entre janvier 1988 et décembre 2002, ont été revus. Les patients atteints d’un SPA pendant les 14 jours suivant l’opération ont été repérés. Nous avons noté les caractéristiques démographiques, la prise en charge périopératoire, les constatations cliniques et radiologiques et les conséquences opératoires.
Résultats
L’incidence totale de SPA postopératoire a été de 16 %, survenant chez 9 des 51 patients avec cholécystectomie et chez 7 patients avec splénectomie. L’apparition des symptômes a pris en moyenne 49 h après l’opération (étendue, 24 – 96 h). La toux, la fièvre et l’examen pulmonaire anormal ont été notés pour tous les patients examinés. Au plan radiologique, le SPA intéressait les lobes inférieurs dans tous les cas et était multilobaire dans 25 % des cas. Lexamen montrait plus de nouveaux Infiltrats touchant le poumon du côté de l’opération ou des Infiltrats bilatéraux que des Infiltrats controlatéraux isolés (P < 0,0001). Une atteinte isolée du lobe supérieur ou moyen ne s’est pas présentée. Un épanchement pleural a été mis en évidence dans 50 % des cas.
Conclusion
Le SPA compliquant une cholécystectomie ou une splénectomie montre une prédilection pour les régions pulmonaires basses et pour le poumon du côté opéré. Ces résultats ont des implications sur la pathogenèse et la prévention du SPA postopératoire.
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Crawford, M.W., Speakman, M., Carver, E.D. et al. Acute chest syndrome shows a predilection for basal lung regions on the side of upper abdominal surgery. Can J Anesth 51, 707–711 (2004). https://doi.org/10.1007/BF03018430
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DOI: https://doi.org/10.1007/BF03018430