EMERGENCY ABDOMINAL SURGERY;

INCIDENCE OF INTRA-ABDOMINAL SEPSIS AND ITS MANAGEMENT

Abstract

Intra-abdominal (I.A) sepsis is widely recognized as the leading cause of death in patients following emergency abdominal surgery. Objective To determine the incidence of intra-abdominal sepsis after emergency abdominal surgery. To study the predisposing factors which lead to post-op. I.A sepsis. To determine the micro flora involved in I.A sepsis Study design: A quantitative cross sectional study.. Place of study: Surgical unit-l General Hospital Rawalpindi. Period: March 1999 to August 2000. Material & methods:565 patients) were followed after emergency abdominal surgery and incidence determined. Results: These 565 patients included 400 patients of acute appendicitis, 140 patients of emergency laparotomy and 25 patients of obstructed/strangulated hernias. The incidence of I.A sepsis after emergency abdominal surgery was found to be 10.6% with incidence of generalized I.A sepsis of 6.6%. Different risk factors predispose to the development of post-op. I.A sepsis. Aerobic microflora of the I.A
sepsis consists predominantly of E.coli. Overall mortality rate was 7.6% with 4% cases due to post-op. I.A sepsis. Mortality rate in patients with post-op. I.A sepsis was 38.33% with mortality rate of 78% in patients with post-op, generalized I.A sepsis and of 20% in patients with I.A abscesses. Conclusion: IA sepsis continues to be one of the major challenges in general surgery. A successful outcome depends on early diagnosis, rapid and appropriate surgical intervention, prompt administration of broad spectrum antibiotics and aggressive supportive care in ICU remains the therapeutic strategy for these patients. It is important first to determine the risk status of these patients and then to apply proper and sound surgical technique and do timely decision.