THE CHALLENGE OF INTRA-ABDOMINAL SEPSIS elroypat@yahoo.co.uk

 

THE CHALLENGE OF INTRA-ABDOMINAL SEPSIS

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Cameroon

Oral only

An overview of intra-abdominal sepsis is necessary at this time with new experimental studies, scoring systems and audits on management outcome. The understanding of the pathophysiology of the peritoneum in the manifestation of surgical sepsis and the knowledge of the source of pathogenic organisms which reach the peritoneal cavity are crucial.

The aim of the study was to ascertain why intra-abdominal sepsis remains a major clinical challenge. Electronic searches of the medline (PubMed) database, Cochrane library, and science citation index were performed to identify original published studies on intra-abdominal sepsis and the current management.

Inter individual variation in the pattern of mediator release and end-organ responsiveness may play a significant role in determining the initial physiological response to major sepsis and may be a key determinant of outcome. The ability to identify the presence of peritoneal inflammation probably has the greatest influence on the final surgical decision. The prevention of the progression of sepsis is by early goal-directed therapy and source control. Recent advances in interventional techniques have significantly reduced the morbidity and mortality of complicated abdominal infection. There is some evidence that the prevention of gut mucosal acidosis improves outcome. The arguments for a defunctioning ileostomy because of the burden of a colorectal anastomotic leak can be balanced with arguments for a proactive approach because of the burden of a defunctioning ileostomy.

Patient factors tend to be more crucial than surgeon-related factors in emergency surgery, but the latter can influence the prognosis in both emergency and elective (planned) surgery.