Related Experiment Videos
Sepsis after gastroduodenal operations: relationship to gastric acid, motility, and endogenous microflora
Abstract:
We reviewed 254 consecutive gastroduodenal operations done at Charity Hospital of Louisiana in New Orleans between June 1974 and June 1977. Forty-one septic complications occurred in 30 patients, for an overall infection rate of 11.8%. Statistically higher infection rates followed operations for bleeding gastric or duodenal ulcer, obstructed duodenal ulcer, gastric ulcer, and gastric malignancy when compared to those done for chronic uncomplicated ulcer or perforated duodenal ulcer. Of these 30 patients, 22 had a compromise of either gastric acidity or motility at the time of operation. These two factors appear to be most significant in controlling the organisms which reach the stomach from swallowed saliva or by reflux through the pylorus. The organisms most frequently causing infection after gastroduodenal operations are endogenous to the stomach and include aerobic enteric gram-negative bacilli and oral, penicillin-sensitive anaerobes. Exogenous bacteria such as Staphylococcus aureus are a less frequent cause of infection after these operations.
Insights
Gastroduodenal operations had an 11.8% infection rate, with higher risks for specific ulcers and gastric malignancy. Compromised gastric acidity or motility significantly increased septic complications, primarily from endogenous bacteria.
Area of Science:
- Gastroenterology
- Surgical Infections
- Microbiology
Background:
- Septic complications are a significant concern following gastroduodenal operations.
- Understanding the factors contributing to these infections is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of septic complications after gastroduodenal operations.
- To identify risk factors associated with these complications.
- To characterize the microorganisms responsible for post-operative infections.
Main Methods:
- Retrospective review of 254 consecutive gastroduodenal operations.
- Analysis of patient data to identify septic complications and associated factors.
- Microbiological analysis of causative organisms.
Main Results:
- An overall infection rate of 11.8% (30 out of 254 patients) was observed.
- Higher infection rates were associated with operations for bleeding gastric/duodenal ulcer, obstructed duodenal ulcer, gastric ulcer, and gastric malignancy.
- Compromised gastric acidity or motility was present in 22 of 30 infected patients, identified as significant factors.
- Predominant causative organisms were endogenous aerobic enteric gram-negative bacilli and oral anaerobes; Staphylococcus aureus was less frequent.
Conclusions:
- Gastric acidity and motility play critical roles in controlling microbial ingress into the stomach.
- Specific gastroduodenal conditions elevate the risk of post-operative septic complications.
- Endogenous gastric flora are the primary source of infections following these procedures.