Surgical approach to the intraabdominal infections.
OBJECTIVE
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.


METHODS
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.


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


CONCLUSIONS
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.
Uggeri
F R
FR
Department of General Surgery, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy.
Perego
E
E
Franciosi
C
C
Uggeri
F A
FA
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D006801:Humans; D007813:Laparotomy / Q000401:mortality; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D018805:Sepsis / Q000601:surgery*