Exploratory Laparotomy in Children

Exploratory Laparotomy in Children

Exploratory laparotomy is an emergency surgery done to diagnose and treat a problem inside your child’s belly (abdomen). This type of problem is often called an acute abdomen. It may be caused by injury (trauma), infection, bleeding, or blockage (obstruction) of the digestive tract.

Symptoms of acute abdomen include fever, pain, vomiting, and bleeding from the final section of the large intestine (rectum).

Finding the cause of these symptoms in infants and young children can be difficult. Your child may have an exploratory laparotomy if an emergency diagnosis and treatment are needed.

Tell a health care provider about:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Previous problems your child or members of your family have had with the use of anesthetics.
• Any blood disorders your child has.
• Any surgeries your child has had.
• Any medical conditions your child has.

What are the risks of Exploratory Laparotomy in Children?

Generally, this is a safe procedure. However, problems can occur and include:

• Bleeding.
• Infection.
• Lung problems.
• Obstruction.
• Constipation or diarrhea.
• Weight loss.

What happens before the procedure?

If your child needs an exploratory laparotomy, it is likely that he or she will already be in the hospital.

• Do not let your child eat or drink anything after midnight on the night before the procedure or as directed by your child’s health care provider.
• An IV tube will be put in a vein in your child’s hand or arm. Your child will receive fluids and nutrition through this tube. Antibiotic medicine may also be given through the IV tube.
• If your child will need fluids and nutrition for several days, the IV tube may be started in a large vein in the chest or shoulder.
• Your child may also have a tube placed through the nose or mouth and into the stomach to remove stomach fluid and any food or other fluids before surgery.
• Your child may have imaging studies, such as:
  • Ultrasound.
  • CT scan.
• A thin drainage tube may be placed into your child’s bladder to drain urine (urinary catheter).
• Your child might be given an enema to empty the lower digestive tract.

What happens during the procedure?

• Your child will be given a medicine to make him or her fall asleep (general anesthetic).
• A tube will be placed into your child’s windpipe to help your child breathe during the procedure.
• The skin of your child’s abdomen will be cleaned with a germ-killing solution.
• The surgeon will make a surgical cut (incision) through the skin.
  • This is usually an up-and-down (vertical) incision near the middle of the abdomen.
  • The incision may be several inches long so the surgeon can explore inside the abdomen.
• The abdominal muscles will be moved aside until the central wall of the abdomen is found. An incision will be made through that wall.
• Underneath the wall is a sac that holds the abdominal organs (peritoneum). The peritoneum will be opened, and the inside will be examined.
• If there is blood inside the peritoneum, the surgeon will look for the source of the bleeding.
• If there is digestive tract fluid inside the peritoneum, the surgeon will look for a hole or leak (perforation) in the digestive tract.
• The small intestine, which is part of the digestive tract, may be lifted out of the abdomen so that the whole abdomen can be inspected carefully. The digestive tract will also be checked for bleeding, perforation, infection, or obstruction.
• The surgeon will repair any problems.
• After the abdomen has been inspected and treated (if necessary), the contents of the abdomen will be put back in place.
• The peritoneum and the abdominal wall will be closed with stitches (sutures).
• The skin incision will be closed with sutures or staples.

What happens after the procedure?

Your child will be taken to a recovery area for observation. His or her blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines he or she was given have worn off. Your child may need to stay in the hospital for several days after the procedure. The length of time that your child needs to stay will depend on what was done during the procedure.

• Your child’s IV tube will be left in place for several days to give fluids and nutrition.
• Your child may continue to receive antibiotic medicines through the IV tube to prevent infection.
• Your child may also be given pain medicines through the IV tube.
• As soon as your child is making enough urine, the urinary catheter can be taken out.
• The stomach tube will be left in place until your child is passing gas. This indicates that air is moving through the digestive tract after surgery.
• Eating by mouth can start after your child’s surgeon removes the stomach tube.
• When your child is eating well by mouth, the IV tube can also be removed.
• Nursing health care providers will change your child’s bandages (dressings) as needed. They will show you how to do this at home if necessary.
• You may receive additional instructions for taking care of your child at home.

Care After Exploratory Laparotomy in Children

These instructions provide you with information about caring for your child after his or her procedure. Your child’s health care provider may also give you more specific instructions.

Your child’s treatment has been planned according to current medical practices, but problems sometimes occur. Call your child’s health care provider if your child has any problems or if you have any questions after your child’s procedure.

What can I expect after the procedure?

After your child’s procedure, it is typical for him or her to have the following:

• Pain.
• Bloating.
• Gas.
• Spitting up (regurgitation) after eating or feeding.
• Diarrhea or constipation.
• Irritability.

Follow these instructions at home:

• Children often are able to do most things as usual after the procedure. However, this will depend on exactly what was done during the procedure. Ask your child’s health care provider if your child has any restrictions in:
  • Diet.
  • Activities.
  • Bathing routine.
• Check your child’s abdomen and incision daily for signs of infection. Watch for:
  • Swelling.
  • Redness.
  • Tenderness.
  • Warmth.
  • Pus.
• Do not give your child any over-the-counter medicines without checking with your child’s health care provider first. Give medicines only as directed by your child’s health care provider.
• Keep all follow-up visits as directed by your child’s health care provider. This is important.
• Follow instructions from your child’s health care provider about:
  • Incision care.
  • Bandage (dressing) changes and removal.
  • Incision closure removal.

Contact a health care provider if:

• Your child has a fever.
• Your child is not feeding or eating well.
• Your child is an infant and is irritable.
• Your child is older and complains of abdominal pain.
• Your child spits up (regurgitates) food often.
• Your child has diarrhea or constipation often.

Get help right away if:

• Your child is younger than 3 months and has a fever.
• Your child is older than 3 months and has a fever as well as abdominal symptoms, such as:
  • Pain.
  • Tenderness.
  • Swelling.
  • Vomiting.
  • Diarrhea.
• Your child’s incision shows signs of infection, such as:
  • Drainage.
  • Redness.
  • Swelling.
  • Pain.
• Your child has severe abdominal pain or tenderness.
• Your child has a seizure.
• Your child has persistent diarrhea, vomiting, or constipation.
• Your child has blood in a bowel movement.
• Your child is not feeding or eating.