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Surgical Intensive Care Medicine pp 461–470Cite as

Intra-Abdominal Sepsis

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Abstract

Postoperative infection has surpassed hemorrhage as the leading cause of mortality among surgical patients. Despite advances in diagnostic modalities, antibiotic therapy, and critical care medicine, mortality remains high. Infra-abdominal infection is defined as an inflammatory response of the peritoneum to microorganisms and their toxins, which results in purulent exudate in the abdominal cavity (1). The transition from infra-abdominal infection to infra-abdominal sepsis occurs when the domain of the local inflammatory process breaches the abdominal cavity and the patient develops the systemic physiologic and immunologic manifestations of inflammation. This chapter reviews the systemic response to inflammation, the causes of infra-abdominal sepsis, diagnosis, and management.

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References

  1. Wittman DH, Schein M, Condon RE. Management of secondary peritonitis. Ann Surg 1996; 224: 10–8.

    Article  Google Scholar 

  2. Fry DE. Sepsis syndrome. Am Surg 2000; 66: 126–32.

    PubMed  CAS  Google Scholar 

  3. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. Definition for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20: 864–74.

    Article  Google Scholar 

  4. Velmahos GC, Kamel E, Berne TV, Yassa N, Ramicone E, Song Z, Demetriades D. Abdominal computed tomography for the diagnosis of intra-abdominal sepsis in critically injured patients: fishing in murky waters. Arch Surg 1999; 134: 831–6.

    Article  PubMed  CAS  Google Scholar 

  5. Weinstein WM, Onderdonk AH, Bartlett JG, Gorbach SL. Experimental infra-abdominal abscesses in rats: development of an experimental model. Infect Immun 1974; 10: 1250–5.

    PubMed  CAS  Google Scholar 

  6. Bohnen JM, Solomkin JS, Dellinger EP, Bjomson HS, Page CP. Guidelines for clinical care: anti-infective agents for infra-abdominal infection. A Surgical Infection Society policy statement. Arch Surg 1992; 127: 83–9.

    Article  PubMed  CAS  Google Scholar 

  7. Mercer-Jones MA, Hadjiminas DJ, Heinzelmann M, Peyton J, Cook M, Cheadle WG. Continuous antibiotic treatment for experimental abdominal sepsis: effects on organ inflammatory cytokine expression and neutrophil sequestration. Br J Surg 1998; 85: 385–9.

    Article  PubMed  CAS  Google Scholar 

  8. Wilmore DW, Smith RJ, O’Dwyer ST, Jacobs DO, Ziegler TR, Wang XD. The gut: a central organ after surgical stress. Surgery 1988; 104: 917–23.

    PubMed  CAS  Google Scholar 

  9. Gerzof SG, Robbins AH, Johnson WC, Birkett DH, Nabseth DC. Percutaneous catheter drainage of abdominal abscesses: a five year experience. N Engl J Med 1981; 305: 653–7.

    Article  PubMed  CAS  Google Scholar 

  10. Bohnen J, Mustard RA, Oxholm SE, Schouten BD. APACHE II score and abdominal sepsis. A prospective study. Arch Surg 1988; 123: 225–9.

    Google Scholar 

  11. Wickel DJ, Cheadle WG, Mercer-Jones MA, Garrison RN. Poor outcome from peritonitis is caused by disease acuity and organ failure, not recurrent peritoneal infection. Ann Surg 1997; 225: 744–56.

    Article  PubMed  CAS  Google Scholar 

  12. Cornwell EE 3rd, Rodriguez A, Mirvis SE, Shorr RM. Acute acalculous cholecystitis in critically injured patients. Preoperative diagnostic imaging. Ann Surg 1989; 210: 52–5.

    Article  PubMed  Google Scholar 

  13. Savino JA, Scalea TM, Del Guercio LR. Factors encouraging laparotomy in acalculous cholecystitis. Crit Care Med 1985; 13: 377–80.

    Article  PubMed  CAS  Google Scholar 

  14. Long TN, Heimbach DM, Carrico CJ. Acalculous cholecystitis in critically ill patients. Am J Surg 1978; 136: 31–6.

    Article  PubMed  CAS  Google Scholar 

  15. Greif WM, Forse RA. Hemodynamic effects of the laparoscopic pneumoperitoneum during sepsis in a porcine endotoxic shock model. Ann Surg 1998; 227: 474–80.

    Article  PubMed  CAS  Google Scholar 

  16. Greif WM, Forse RA. Interventions to improve cardiopulmonary hemodynamics during laparoscopy in a porcine sepsis model. J Am Coll Surg 1999; 189: 450–8.

    Article  Google Scholar 

  17. Jacobi CA, Ordemann J, Zieren HU, Volk HD, Bauhofer A, Halle E, Muller JM. Increased systemic inflammation after laparotomy vs laparoscopy in an animal model of peritonitis. Arch Surg 1998; 133: 258–62.

    Article  PubMed  CAS  Google Scholar 

  18. Balague C, Targarona EM, Pujol M, Filella X, Espert JJ, Trias M. Peritoneal response to a septic challenge. Comparison between open laparotomy, pneumoperitoneum laparoscopy, and wall lift laparoscopy. Surg Endosc 1999; 13: 792–6.

    Article  PubMed  CAS  Google Scholar 

  19. Brandt CP, Priebe PP, Eckhauser ML. Diagnostic laparoscopy in the intensive care patient. Avoiding the nontherapeutic laparotomy. Surg Endosc 1993; 7: 168–72.

    Article  PubMed  CAS  Google Scholar 

  20. Orlando R 3rd, Corwell KL. Laparoscopy in the critically ill. Surg Endosc 1997; 11: 1072–4.

    Article  PubMed  Google Scholar 

  21. McCloskey RV, Straube RC, Sanders C, Smith JM, Smith CR. Treatment of septic shock with human monoclonal antibody HA-1A. A randomized, double-blind, placebo-controlled trial. CHESS Trial Study Group. Ann Intern Med 1994; 121: 1–5.

    PubMed  CAS  Google Scholar 

  22. Cohen J, Cadet J. INTERSEPT: an international, multicenter, placebo-controlled trial of monoclonal antibody to human tumor necrosis factor alpha in patients with sepsis. International Sepsis Trial Study Group. Crit Care Med 1996; 24: 1431–40.

    Article  PubMed  CAS  Google Scholar 

  23. Opal SM, Fisher CJ Jr, Dhainaut JF, Vincent JL, Brase R, Lowry SF, Sadoff JC, Slotman GJ, Levy H, Balk RA, Shelly MP, Pribble JP, LaBrecque JF, Lookabaugh J, Donovan H, Dubin H, Baughman R, Norman J, DeMaria E, Matzel K, Abraham E, Seneff M. Confirmatory interleukin1 receptor antagonist trial in severe sepsis: a phase III, randomized, double-blind, placebo-controlled, multicenter trial. The Interleukin-1 Receptor Antagonist Sepsis Investigation Group. Crit Care Med 1997; 25: 1115–24.

    Article  PubMed  CAS  Google Scholar 

  24. Fein AM, Bernard GR, Criner GJ, Fletcher EC, Good JT Jr, Knaus WA, Levy H, Matuschak GM, Shanies HM, Taylor RW, Rodell TC. Treatment of severe systemic inflammatory response syndrome and sepsis with a novel bradykinin antagonist, deltibant (CP-0127). Results of a randomized, double blind, placebo-controlled trial. CP-0127 SIRS and Sepsis Study Group. JAMA 1997; 277: 482–7.

    Article  PubMed  CAS  Google Scholar 

  25. Strand OA, Leone AM, Giercksky KE, Skovlund E, Kirkeboen KA. N(G)-monomethyl-L-arginine improves survival in a pig model of abdominal sepsis. Crit Care Med 1998; 26: 1490–9.

    Article  PubMed  CAS  Google Scholar 

  26. Doig GS, Martin CM, Sibbald WJ. Polymyxin-dextran antiendotoxin pretreatment in an ovine model of normotensive sepsis. Crit Care Med 1997; 25: 1956–61.

    Article  PubMed  CAS  Google Scholar 

  27. Davis KA, Fabian TC, Ragsdale DN, Trenthem LL, Croce MA, Proctor KG. Granulocyte colony-stimulating factor and neutrophil-related changes in local host defense during recovery from shock and intra-abdominal sepsis. Surgery 1999; 126: 305–13.

    Article  PubMed  CAS  Google Scholar 

  28. Zhang P, Bagby GJ, Stoltz DA, Summer WR, Nelson S. Enhancement of peritoneal leukocyte function by granulocyte colony-stimulating factor in rats with abdominal sepsis. Crit Care Med 1998; 26: 315–21.

    Article  PubMed  CAS  Google Scholar 

  29. Tzianabos AO, Gibson FC 3rd, Cisneros RL, Kasper DL. Protection against experimental intraabdominal sepsis by two polysaccharide immunomodulators. J Infect Dis 1998; 178: 200–6.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Lahey Clinic Medical Center, Burlington, MA, 01805, USA

    Peter W. Marcello M.D.

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  1. Peter W. Marcello M.D.
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Editor information

Editors and Affiliations

  1. Surgical Intensive Care Unit, Department of Surgical Critical Care, Lahey Clinic Medical Center, Burlington, MA, USA

    John Merritt O’Donnell M.D. (Director, Chairman) (Director, Chairman)

  2. Department of Surgical Critical Care, Lahey Clinic Medical Center, Burlington, MA, USA

    Flávio Eduardo Nácul M.D. (Senior Fellow) (Senior Fellow)

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© 2001 Springer Science+Business Media New York

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Marcello, P.W. (2001). Intra-Abdominal Sepsis. In: O’Donnell, J.M., Nácul, F.E. (eds) Surgical Intensive Care Medicine. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-6645-5_28

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  • DOI: https://doi.org/10.1007/978-1-4757-6645-5_28

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4757-6647-9

  • Online ISBN: 978-1-4757-6645-5

  • eBook Packages: Springer Book Archive

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