In Spain, two pediatricians were sentenced to negligence prison that led to the death of an 8 -year -old boy. The child had presented himself several times in the emergency room with stomach aches, before dying of peritonitis a few days later.
Referred to emergencies 5 times, without any analysis
The facts date back to October 24, 2020. The little Airor, 8, complains of abdominal pain while he is in Alicante, with his maternal grandmother and her companion, who have her care. Direction the nearest health center, which prefers to direct them to the Elda University Hospital, a few kilometers away. But there, the doctors who receive the child evoke a simple virus and invite the family to go home.
But 48 hours later, Airor is not better. He always complains and now vomits every day. The health center returns them once again to the hospital which directs him again at home, without having checked the heart rate, nor requested tests such as abdominal ultrasound or blood tests, we can learn in the report. The facts occur a third time at the health center on October 28, a few hours before the child’s death. He was actually suffering from peritonitis.
Negligence that has been fatal to the child
Without blood test, or verification of vital signs, the two pediatricians, from the health center hospital has missed clear signs of a vital emergency. The Criminal Tribunal of Alicante sentenced the first to two years in prison for the offense of homicide by serious negligence in the death of the child due to acute appendicitis evolving in peritonitis. A sentence to which a special ban on medical prohibition has been added for three and a half years. The second was sentenced to one year in prison for the same crime of homicide by serious negligence and is disqualified for the exercise of medicine for three years.
Peritonitis in children: a vital emergency to never underestimate
Peritonitis is an acute inflammation of the peritoneum, this thin membrane which envelops the organs of the abdomen. “”It is an absolute medical emergency, in children as in adults, and a surgical emergency engaging the vital prognosis “insists Dr. Gérald Kierzek, emergency artist and medical director of DCOCTISSIMO. It most often occurs in complication of an appendicitis went unnoticed or not treated, but can also have other causes (digestive perforation, infection, etc.).
In children, some signs must immediately alert parents and caregivers. Dr. Kierzek describes a typical clinical picture:
- Intense, diffuse, persistent abdominal pain, aggravated by movements;
- An abdominal contracture: the belly is “hard as a board” with palpation, or presents a defense, a reflex of protective to the examination;
- The child often adopts an analgesic position, curled up, knees brought against the belly.
To these signs are often added severe infectious manifestations: fever greater than 38.5 ° C, acceleration of heart rate (tachycardia), rapid breathing (polypnea) and alteration of the general condition. “The behavior changes: the child is pale, amorphous, refuses to eat, vomit, cry abnormally”underlines Dr. Kierzek.
Let us also remember that in very young children, signs can be more misleading, making the diagnosis more complex. “”The pain can be poorly localized, inconsistent fever, the painting more vague. You must therefore be particularly vigilant, even without a typical ‘”symptom”, warns Dr. Kierzek.
What to do with a suspicion of peritonitis?
“The development of peritonitis can occur in 24 to 48 hours after the first signs of appendicitis. Each hour counts”, Alert the emergency room. Faced with intense and persistent abdominal pain, especially if it is associated with fever, you should not wait. Good reflexes:
- Call 15 or go immediately to the emergency room;
- Do not give the child to drink or eat;
- Do not administer painkillers without medical advice: they can mask the symptoms and delay the diagnosis.
The medical examination is based on the clinic, but also on imaging: ultrasound or abdominal scanner confirm the diagnosis. Treatment is surgical, urgently.
A golden rule: all acute abdominal pain with fever = emergency
“The golden rule,” he concludes, is that any significant abdominal pain in a child, especially if it is accompanied by fever or a change in behavior, should lead to consult immediately. It is not a simple stomach ache. Time, here, is a vital factor “.