Surgical approach to the intraabdominal infections

The term intraabdominal infectioncomprises a broad of variety of pathological conditions which are characterized by signs of systemic infection as a response to an abdominal source of infection and ranges from a confined problem to a devastating disease regarding all organ systems. Septic abdomen is an interesting challenge in general surgery: to decide when and how to treat septic abdomen lacks of a general consensus and has not been standardized yet.

A total of 1 110 patients underwent surgical treatment for abdominal infection in a period of 10 years in the Department of Surgery of San Gerardo Hospital, Monza, Italy. We focused our attention on 94 patients who required re-exploration for residual or recurrent intra-abdominal infection.

The procedure was associated with a mortality rate of 40%. The median number of re-explorations was 5.1.

Planned multiple relaparotomies with temporarily abdomen closure are performed only in a selected high mortality risk group of elderly patients with surgical evidence of diffuse peritonitis, presence of primary infectious process of more than 72 hours, and a APACHE II score > 20. Relaparotomy on demand is required instead in those patients who develop a clinical deterioration after a first safe surgical control of the source of infection. Lack of improvement is not considered a condition to reoperate. Early detection of persisting infection, < 24-36 hours, is an important prognostic factor of outcome.