Lung Abscess, Pediatric

ExitCare ImageA lung abscess is a sore in the lung that has become infected. Usually, medicine can be taken to make the abscess go away. Other times, the abscess is more serious and medicine is not enough. Then, surgery is needed. The surgery is called a thoracotomy. A small part of the lung will be removed. During the operation, the surgeon usually takes out just the area where the abscess or abscesses are located.

LET YOUR CAREGIVER KNOW ABOUT:

  • Any allergies.

  • All medications your child is taking, including:

  • Herbs, eyedrops, over-the-counter medications and creams.

  • Blood thinners (anticoagulants), aspirin, or other drugs that could affect blood clotting.

  • Previous problems with anesthetics, including local anesthetics.

  • Any history of bleeding or other blood problems. This includes problems other family members have had, including parents, grandparents, brothers, and sisters (immediate family).

  • Previous surgery.

  • Other health problems.

RISKS AND COMPLICATIONS

  • Short-term possibilities include:

  • Pain.

  • Infection near the incision.

  • A pool of blood under the wound (hematoma).

  • Heavy bleeding. If this happens, your child may need to receive blood from someone else (transfusion).

  • Slow healing.

  • Nerve damage. This is possible during any surgery. However, it is not likely to happen.

  • Longer-term possibilities include:

  • Scarring.

  • Skin damage.

  • Damage to blood vessels in the area.

  • Lung damage.

  • Pain that continues.

  • Need for more surgery.

BEFORE THE PROCEDURE

  • You will have to give what is called informed consent. This requires signing a legal paper that gives permission for the surgery. To give informed consent:

  • You must understand how the procedure is done and why.

  • You must be told all the risks and benefits of the procedure.

  • You will talk with the person who is in charge of the medication that will make your child sleep through the surgery (anesthesiologist). Thoracotomy requires being completely asleep during surgery (general anesthesia). Ask the anesthesiologist or your child's surgeon what to expect.

  • The surgeon may order a test that takes pictures of the inside of the lung (imaging). Or, your child may need a test that checks how well the lungs are working (lung function).

  • Your child must not eat or drink anything for about 8 hours before the surgery. Make sure that all people who care for your child know this.

  • Your child will need to stay in the hospital for several days after the procedure. You or other adult should stay overnight with your child each night.

PROCEDURE

  • The preparation:

  • Your child will change into a hospital gown.

  • Medicine will be given to help your child relax (sedative).

  • Once your child is relaxed, an intravenous (IV) needle will be put in the child's arm. Medication will be able to flow directly into the child's body through this needle.

  • General anesthesia will be given. This will make sure the child feels nothing during the operation.

  • A tube that lets urine drain before and after the procedure (Foley catheter) may be placed in your child's body.

  • The surgery:

  • Once the child is asleep, the surgeon will make a cut (incision) in the child's chest. The cut will be between the ribs. Sometimes it is under an arm. Or, the incision might be on the front of the chest.

  • The surgeon then opens the chest. The bad lung tissue is taken out through the opening.

  • Tubes will then be put in the chest. These tubes will let fluid drain out. They also let out any air or gas that gets trapped inside.

  • The incision is then closed with stitches or staples.

  • A bandage (dressing) is put over the incision.

  • The operation may take up to 4 hours.

  • Sometimes, the procedure can be done using a minimally invasive technique. Healing may be faster with this technique. Also, your child should feel less pain after the surgery. During a minimally invasive procedure:

  • There are 2 or 3 smaller incisions.

  • A thin tube with a tiny camera on the end is used. This is put into the chest through one of the incisions. What the camera sees is shown on a TV in the operating room. This lets the surgeon see inside the chest.

  • The lung tissue is taken out through one of the other incisions.

  • A drain may also be placed in your child's body around the surgery site to allow excess fluid to drain from the body.

  • A dressing is put over the incisions.

AFTER THE PROCEDURE

  • Your child will stay in a recovery area until the anesthesia has worn off. Your child's blood pressure and heart rate will be checked often. You may be able to be in the room when your child starts to wake up.

  • Your child then may be taken to an intensive care unit. This is a part of the hospital where your child can be watched very closely. In time, your child may be taken to a regular hospital room.

  • Several tubes will be in your child's body.

  • One is used to drain fluid from the lungs.

  • Another drains urine from the bladder.

  • Some children also have tubes in their nose or their mouth or both. The tubes are hooked to a machine that helps them breathe (ventilator).

  • Pain medicine will probably be given. Let the hospital caregivers know any time you think your child is in pain.

  • Your child may continue to get fluids through the IV for awhile.

  • Do not let your child get out of bed until the hospital caregivers say it is OK.

  • A physical therapist may show your child how to do exercises to help heal the lungs.

  • Before taking your child home, be sure you know:

  • How often the dressing should be changed.

  • If the dressing can get wet.

  • If over-the-counter pain medicine can be used.

  • When your child can start to eat regular foods.

  • If there is anything your child should or should not do while recovering.