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Relaparotomy for postoperative intra-abdominal sepsis in jaundiced patients
1Department of Surgery, Oulu University Central Hospital, Finland.
Abstract:
During the period 1979-84, 30 abdominal re-explorations were performed for postoperative intra-abdominal sepsis and single or multiple organ failure in jaundiced patients. Postoperative sepsis was caused by intra-abdominal abscess in 16 cases (53 per cent), by suture line leakage in 9 cases (30 per cent) and by technical error in 5 cases (17 per cent). Abscesses occurred most commonly in the subphrenic space (6 cases), in the subhepatic space (6 cases) and in the lesser sac (5 cases). Sepsis was associated with single organ failure in 20 cases and with multiple organ failure in 10 cases. The overall mortality rate was 50 per cent (15/30). Factors that were statistically associated with fatal outcome were: serum bilirubin greater than 100 mumol/l (P less than 0.008), positive blood culture (P less than 0.013), malignant disease (P less than 0.02), multiple organ failure (P less than 0.02) and age greater than 60 years (P less than 0.031). Mortality rose with the number of failed organs. Autopsy revealed continuing sepsis in 12 of the 15 fatal cases. Because mortality was high in spite of adequate operative drainage at relaparotomy, it is concluded that earlier definitive diagnostics are needed to lower the mortality rate.
Insights
High mortality rates in jaundiced patients undergoing abdominal re-exploration for sepsis are linked to factors like high bilirubin levels and organ failure. Earlier diagnostics are crucial for improving outcomes in these critical surgical cases.
Area of Science:
- Surgical Gastroenterology
- Critical Care Medicine
- Hepatology
Background:
- Postoperative intra-abdominal sepsis is a significant complication in jaundiced patients requiring abdominal re-exploration.
- Sepsis can lead to single or multiple organ failure, increasing patient morbidity and mortality.
Purpose of the Study:
- To analyze the causes and outcomes of abdominal re-explorations for postoperative intra-abdominal sepsis in jaundiced patients.
- To identify factors associated with mortality in this patient cohort.
Main Methods:
- Retrospective review of 30 abdominal re-explorations performed between 1979-1984.
- Analysis of sepsis causes (abscess, suture line leakage, technical error) and organ failure.
- Statistical analysis of factors correlating with fatal outcomes.
Main Results:
- Intra-abdominal abscesses (53%) were the most common cause of sepsis, followed by suture line leakage (30%).
- Sepsis was associated with single organ failure in 20 cases and multiple organ failure in 10 cases.
- The overall mortality rate was 50%, with factors like high serum bilirubin, positive blood cultures, malignancy, multiple organ failure, and age >60 years significantly associated with fatal outcomes.
Conclusions:
- High mortality persists despite surgical intervention, underscoring the severity of postoperative sepsis in jaundiced patients.
- Mortality increases with the number of failed organs.
- Earlier and more definitive diagnostic strategies are essential to reduce mortality rates in this high-risk group.