The Role of Empirical Laparotomy in the Management of Sepsis and Multisystem Organ Failure

  • H. C. Polk
  • P. Burgess
  • W. G. Cheadle


A major diagnostic dilemma in the management of the critically ill surgical patient is the confirmation and identification of sources of occult infection as a cause of multisystem organ failure (MSOF). This condition currently accounts for 73% of all deaths after major operative procedures and trauma [1] and is the main cause of death and morbidity for all surgical intensive care unit patients [2, 3].


Intraabdominal Abscess Multisystem Organ Failure Multiple System Organ Failure Surgical Intensive Care Unit Patient Occult Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Fry DE, Pearlstein L, Fulton RL, Polk HC Jr (1980) Multiple system organ failure: the role of uncontrolled infection. Arch Surg 115:136–140PubMedCrossRefGoogle Scholar
  2. 2.
    Barton R, Cerra FB, (1989) The hypermetabolism multi-system organ failure syndrome. Chest 96:1153–1160PubMedCrossRefGoogle Scholar
  3. 3.
    Baue AE, Chaudry IH (1980) Prevention of multiple system organ failure. Surg Clin North Am 60 (5):1167–1178PubMedGoogle Scholar
  4. 4.
    Trunkey DD (1988) Inflammation and trauma. Arch Surg 123:1517 (editorial)Google Scholar
  5. 5.
    Hinsdale JG, Jaffe BM (1984) Re-operation for intra-abdominal sepsis: indications and results in modern critical care setting. Ann Surg 199:31–36PubMedCrossRefGoogle Scholar
  6. 6.
    Norton LW (1985) Does drainage of intraabdominal pus reverse multiple organ failure? Am J Surg 149:347–350PubMedCrossRefGoogle Scholar
  7. 7.
    Hohn DC, Myers AJ, Gherini ST, Beckman A, Markison RE, Churg AM (1980) Production of acute pulmonary injury by leukocytes and activated complement. Surgery 88:48–58PubMedGoogle Scholar
  8. 8.
    Thorne LJ, Kuenzig M, McDonald HM, Schwartz SI (1980) Effect of denervation of a lung on pulmonary platelet trapping associated with traumatic shock. Surgery 88:208–214PubMedGoogle Scholar
  9. 9.
    Clowes GH Jr, George BC, Villee CA Jr, Saravis CA (1983) Muscle proteolysis induced by a circulating peptide in patients with sepsis or trauma. N Engl J Med 308:545–552PubMedCrossRefGoogle Scholar
  10. 10.
    Eiseman B, Sloan R, Hansbrough J, Mcintosh R (1980) Multiple system organ failure: clinical and experimental. Am Surg 46:14–19PubMedGoogle Scholar
  11. 11.
    Saba TM, McCafferty MH, Lansey ME (1983) Depressed reticuloendothelial function in the surgical patient. Infect Surg 2:124–133Google Scholar
  12. 12.
    Ozawa K, Aoyama H, Yasuda K, Shimahara Y, Nakatani T, Tanaka J, Yamamoto M, Kamiyama Y, Tobe T (1983) Metabolic abnormalities associated with postoperative organ failure: a redox theory. Arch Surg 118:1245–1251PubMedCrossRefGoogle Scholar
  13. 13.
    Michie HR, Eberlein TJ, Spriggs DR, Manogue KR, Cerami A, Wilmore DW (1988) Interleukin-2 initiates metabolic responses associated with critical illness in humans. Ann Surg 208:493–503PubMedCrossRefGoogle Scholar
  14. 14.
    Doust BD, Doust VL (1976) Ultrasonic diagnosis of abdominal abscess. Am J Dig Dis 21:569–576PubMedCrossRefGoogle Scholar
  15. 15.
    Richardson R, Norton LW, Eule J, Eiseman B (1975) Accuracy of ultrasound in diagnosing abdominal masses. Arch Surg 110:933–939PubMedCrossRefGoogle Scholar
  16. 16.
    Hill BA, Yamaguchi K, Flynn JJ, Miller DR (1975) Diagnostic sonography in general surgery. Arch Surg 110:1089–1094PubMedCrossRefGoogle Scholar
  17. 17.
    Robison JG, Pollock TW (1980) Computed tomography in the diagnosis and localization of intraabdominal abscesses. Am J Surg 140:783–786PubMedCrossRefGoogle Scholar
  18. 18.
    Caffee HH, Watts G, Mena I (1977) Gallium 67 citrate scanning in the diagnosis of intraabdominal abscess. Am J Surg 133:665–669PubMedCrossRefGoogle Scholar
  19. 19.
    Damron JR, Beihn RM, Deland FH (1976) Detection of upper abdominal abscesses by radionuclide imaging. Radiology 120:131–134PubMedGoogle Scholar
  20. 20.
    Korobkin M, Callen PW, Filly RA, Hoffer PB, Shimshak RR, Kressel HY (1978) Comparison of computed tomography, ultrasonography, and gallium-67 scanning in the evaluation of suspected abdominal abscess. Radiology 129:89–93PubMedGoogle Scholar
  21. 21.
    Mandel SR, Boyd D, Jaques PF, Mandell V, Staab EV (1983) Drainage of hepatic, intraabdominal and mediastinal abscesses guided by computerized axial tomography: successful alternative to open drainage. Am J Surg 145:120–125PubMedCrossRefGoogle Scholar
  22. 22.
    Polk HC Jr, Shields CL (1977) Remote organ failure: a valid sign of occult intraabdominal infection. Surgery 81:310–313PubMedGoogle Scholar
  23. 23.
    Polk HC, Wellhausen SR, Regan MP, George CD, Cost K, Borzotta AP, Davidson PR (1986) A systematic study of host defense processes in badly injured patients. Ann Surg 204:282–299PubMedGoogle Scholar

Copyright information

© Springer-Verlag, Berlin Heidelberg 1993

Authors and Affiliations

  • H. C. Polk
    • 1
  • P. Burgess
    • 2
  • W. G. Cheadle
    • 1
  1. 1.Department of SurgeryUniversity of Louisville School of MedicineLouisvilleUSA
  2. 2.Department of SurgeryUniversity of Newcastle-Upon-TyneUK

Personalised recommendations