Multidisciplinary treatment of patients with severe intra-abdominal infection (report of 17 cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WEI Jie , WEN Zhang , ZHANG Lian , XU Banghao ,  GUO Ya

Department of Hepatobiliary Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, P.R.China;

Corresponding author：

GUO Ya, Email: guoya2000@medmail.com.cn

Keywords：

severe intra-abdominal infection; ultrasound; abdominal cavity puncture; drainage; surgical operation; multidisciplinary

DOI：

10.7507/1007-9424.201606071

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize experience and efficacy of multidisciplinary treatment for severe intra-abdominal infection. Methods The clinical data of 17 patients with severe intra-abdominal infection underwent multidisciplinary treatment were analyzed retrospectively. There were 5 cases of severe acute pancreatitis, 4 cases of postoperative biliary fistula, 2 cases of intestinal fistula, 2 cases of pancreatic trauma, 1 case after resection for intestinal necrosis, 1 case of abdominal trauma, 1 case after operation for liver abscess, 1 case of unexplained severe intra-abdominal infection. The experiences of multidisciplinary treatment including the intensive care unit (ICU), surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on were summarized. Results After multidisciplinary treatment, 13 patients were cured, of which 4 patients treated by non-open operation. Three patients died, including 1 patient died of infectious shock, 1 patient died of pancreatic bed bleeding, 1 patient died of multiple organ failure. There was 1 case of automatic discharge. Conclusions Multidisciplinary treatment including ICU, surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on has an exact clinical curative effect in patients with severe intra-abdominal infection. Concept of damage control should be followed by surgical intervention. Abdominal cavity puncture and drainage has some advantages of small trauma and good clinical effect, which is suitable for infection control of patients with severe intra-abdominal infection, it could provide surgical condition and opportunity for patients required further surgical treatment.

Citation： WEIJie, WENZhang, ZHANGLian, XUBanghao, GUOYa. Multidisciplinary treatment of patients with severe intra-abdominal infection (report of 17 cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(2): 190-194. doi: 10.7507/1007-9424.201606071 Copy

1.	任建安, 黎介寿. 严重腹腔感染的综合治疗. 中国实用外科杂志, 2007, 27(12): 940-942.
2.	王红旭, 付月云, 陈志权, 等. 腹部外科危急重症的损伤控制性外科治疗. 中国医学工程, 2015, 23(11): 171.
3.	郭佐铭, 孙备, 白雪巍, 等. 经皮穿刺置管引流在重症急性胰腺炎继发腹腔感染中的应用. 腹部外科, 2013, 26(3): 158-160.
4.	伊敏, 么改琦, 白宇. 腹腔内压监测在危重患者中的临床应用. 中华危重病急救医学, 2014, 26(3): 175-178.
5.	江明万, 于双, 王晴雷. 置管引流应用于重症急性胰腺炎继发腹腔感染的临床研究. 中华医院感染学杂志, 2015, 25(5): 1119-1121.
6.	马炳强, 赵允召, 赵坤, 等. 脓毒症时肠道细菌易位发生部位的研究. 肠外与肠内营养, 2010, 17(3): 156-159.
7.	雷衍军, 王湘英, 肖彦, 等. 床旁超声引导经皮腹腔穿刺置管引流治疗重症急性胰腺炎. 中国普通外科杂志, 2013, 22(9): 1216-1219.
8.	吕少诚, 史宪杰, 梁雨荣, 等. 肝脏及胆管术后胆瘘合并腹腔感染的诊疗分析. 中华保健医学杂志, 2012, 14(5): 348-350.
9.	Wondberg D, Larusson HJ, Metzger U,et al. Treatment of the open abdomen with the commercially available vacuum-assisted closure system in patients with abdominal sepsis: low primary closure rate. World J Surg, 2008, 32(12): 2724-2729.
10.	Solomkin JS, Mazuski JE, Bradley JS,et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis, 2010, 50(2): 133-164.
11.	杨帆, 赵允召, 陈钰, 等. 血液滤过治疗对严重腹腔感染病人血浆内毒素及细胞因子的影响. 肠外与肠内营养, 2013, 20(3): 151-153, 156.
12.	Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg, 1984, 199(1): 28-30.
13.	Cinat ME, Wilson SE, Din AM. Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. Arch Surg, 2002, 137(7): 845-849.
14.	Cheadle WG, Spain DA. The continuing challenge of intra-abdominal infection. Am J Surg, 2003, 186(5A): 15S-34S.
15.	Babu RY, Gupta R, Kang M,et al. Predictors of surgery in patients with severe acute pancreatitis managed by the step-up approach. Ann Surg, 2013, 257(4): 737-750.
16.	van Santvoort HC, Besselink MG, Bakker OJ,et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.
17.	Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10): 2379-2400.
18.	Xue P, Deng LH, Zhang ZD,et al. Infectious complications in patients with severe acute pancreatitis. Dig Dis Sci, 2009, 54(12): 2748-2753.
19.	Sturkenboom MC, Goettsch WG, Picelli G,et al. Inappropriate initial treatment of secondary intra-abdominal infections leads to increased risk of clinical failure and costs. Br J Clin Pharmacol, 2005, 60(4): 438-443.
20.	吴涛, 刘玉村. 2010 年版 IDSA 复杂腹腔感染诊治指南解读. 中华医学信息导报, 2010, 25(24): 14-16.
21.	楼征, 黎介寿, 任建安, 等. 腹腔感染及腹腔高压影响肠蠕动功能的实验研究. 肠外与肠内营养, 2007, 14(6): 326-329.
22.	Powell-Tuck J. Nutritional interventions in critical illness. Proc Nutr Soc, 2007, 66(1): 16-24.
23.	徐红梅. 经鼻空肠管行早期肠内营养支持应用于严重腹腔感染术后患者的效果评价. 中国实用护理杂志, 2012, 28(24): 48-49.
24.	李幼生. 损伤控制性外科时代严重创伤病人的营养支持. 肠外与肠内营养, 2016, 23(1): 4-7.
25.	宋飞翔, 崔玉梅, 韩春红, 等. 早期肠内营养对胃癌患者术后肠功能的影响评价. 中国医药导刊, 2011, 13(7): 1247-1252.
26.	陈健, 王磊, 李炳庆, 等. 肠内营养支持治疗对急性重症胰腺炎肠黏膜屏障功能及细菌移位的影响. 中国老年学杂志, 2014, 34(12): 3325-3326.

1. 任建安, 黎介寿. 严重腹腔感染的综合治疗. 中国实用外科杂志, 2007, 27(12): 940-942.
2. 王红旭, 付月云, 陈志权, 等. 腹部外科危急重症的损伤控制性外科治疗. 中国医学工程, 2015, 23(11): 171.
3. 郭佐铭, 孙备, 白雪巍, 等. 经皮穿刺置管引流在重症急性胰腺炎继发腹腔感染中的应用. 腹部外科, 2013, 26(3): 158-160.
4. 伊敏, 么改琦, 白宇. 腹腔内压监测在危重患者中的临床应用. 中华危重病急救医学, 2014, 26(3): 175-178.
5. 江明万, 于双, 王晴雷. 置管引流应用于重症急性胰腺炎继发腹腔感染的临床研究. 中华医院感染学杂志, 2015, 25(5): 1119-1121.
6. 马炳强, 赵允召, 赵坤, 等. 脓毒症时肠道细菌易位发生部位的研究. 肠外与肠内营养, 2010, 17(3): 156-159.
7. 雷衍军, 王湘英, 肖彦, 等. 床旁超声引导经皮腹腔穿刺置管引流治疗重症急性胰腺炎. 中国普通外科杂志, 2013, 22(9): 1216-1219.
8. 吕少诚, 史宪杰, 梁雨荣, 等. 肝脏及胆管术后胆瘘合并腹腔感染的诊疗分析. 中华保健医学杂志, 2012, 14(5): 348-350.
9. Wondberg D, Larusson HJ, Metzger U,et al. Treatment of the open abdomen with the commercially available vacuum-assisted closure system in patients with abdominal sepsis: low primary closure rate. World J Surg, 2008, 32(12): 2724-2729.
10. Solomkin JS, Mazuski JE, Bradley JS,et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis, 2010, 50(2): 133-164.
11. 杨帆, 赵允召, 陈钰, 等. 血液滤过治疗对严重腹腔感染病人血浆内毒素及细胞因子的影响. 肠外与肠内营养, 2013, 20(3): 151-153, 156.
12. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg, 1984, 199(1): 28-30.
13. Cinat ME, Wilson SE, Din AM. Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. Arch Surg, 2002, 137(7): 845-849.
14. Cheadle WG, Spain DA. The continuing challenge of intra-abdominal infection. Am J Surg, 2003, 186(5A): 15S-34S.
15. Babu RY, Gupta R, Kang M,et al. Predictors of surgery in patients with severe acute pancreatitis managed by the step-up approach. Ann Surg, 2013, 257(4): 737-750.
16. van Santvoort HC, Besselink MG, Bakker OJ,et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.
17. Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10): 2379-2400.
18. Xue P, Deng LH, Zhang ZD,et al. Infectious complications in patients with severe acute pancreatitis. Dig Dis Sci, 2009, 54(12): 2748-2753.
19. Sturkenboom MC, Goettsch WG, Picelli G,et al. Inappropriate initial treatment of secondary intra-abdominal infections leads to increased risk of clinical failure and costs. Br J Clin Pharmacol, 2005, 60(4): 438-443.
20. 吴涛, 刘玉村. 2010 年版 IDSA 复杂腹腔感染诊治指南解读. 中华医学信息导报, 2010, 25(24): 14-16.
21. 楼征, 黎介寿, 任建安, 等. 腹腔感染及腹腔高压影响肠蠕动功能的实验研究. 肠外与肠内营养, 2007, 14(6): 326-329.
22. Powell-Tuck J. Nutritional interventions in critical illness. Proc Nutr Soc, 2007, 66(1): 16-24.
23. 徐红梅. 经鼻空肠管行早期肠内营养支持应用于严重腹腔感染术后患者的效果评价. 中国实用护理杂志, 2012, 28(24): 48-49.
24. 李幼生. 损伤控制性外科时代严重创伤病人的营养支持. 肠外与肠内营养, 2016, 23(1): 4-7.
25. 宋飞翔, 崔玉梅, 韩春红, 等. 早期肠内营养对胃癌患者术后肠功能的影响评价. 中国医药导刊, 2011, 13(7): 1247-1252.
26. 陈健, 王磊, 李炳庆, 等. 肠内营养支持治疗对急性重症胰腺炎肠黏膜屏障功能及细菌移位的影响. 中国老年学杂志, 2014, 34(12): 3325-3326.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multidisciplinary treatment of patients with severe intra-abdominal infection (report of 17 cases)

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content