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[Postoperative management. Critical care in intra-abdominal infection after surgical intervention]
P Montravers1, S Lepers, D Popesco
1Service C d'Anesthésie-Réanimation, Groupe Hospitalier Sud-Salouel, Amiens. pmontrav@planete.net
Abstract:
UNDERESTIMATED FREQUENCY: Post-operative intraabdominal infections usually appear as abscesses or injury of the bowel, either alone or in combination. These complications of frequently underestimated frequency are characterized by high mortality. Improvement of their prognosis is obtained by early recognition of the complication and a multidisciplinary approach. ALARM SIGNS: In a patient who recently underwent abdominal surgery, the onset of abnormal signs must be considered as an alarm which imposes ruling out intraabdominal complications. Unexplained multiple organ failure or septic shock in the post-operative period of intraabdominal surgery must lead to considering explorative laparotomy.
Therapeutics:
Etiologic treatment must be ideal and total from the first reoperation. Antibiotic therapy administered from the surgical reoperation must be different from previous treatments. This treatment is aimed at eradicating enterobacteriaceae, non-fermenting Gram negative aerobes, Gram positive cocci, anaerobes and fungi.
Insights
Post-operative intraabdominal infections are often underestimated but lead to high mortality. Early recognition and a multidisciplinary approach, including prompt explorative laparotomy and tailored antibiotic therapy, are crucial for improving patient outcomes.
Area of Science:
- Surgical infections
- Gastrointestinal surgery complications
Context:
- Post-operative intraabdominal infections, including abscesses and bowel injury, present a significant challenge.
- These complications are frequently underestimated and associated with high mortality rates.
Purpose:
- To emphasize the importance of early recognition and multidisciplinary management of post-operative intraabdominal infections.
- To highlight alarm signs necessitating further investigation and potential surgical intervention.
Summary:
- Abnormal signs in post-operative patients require ruling out intraabdominal complications.
- Unexplained multiple organ failure or septic shock warrants consideration of explorative laparotomy.
- Etiologic treatment from the first reoperation must be comprehensive, targeting a broad spectrum of pathogens including enterobacteriaceae, Gram-negative aerobes, Gram-positive cocci, anaerobes, and fungi, with distinct antibiotic regimens.
Impact:
- Improved prognosis through early detection and intervention.
- Effective management strategies for severe post-operative complications.
- Guidance on appropriate antibiotic selection for complex intraabdominal infections.