Jerin Evangelin, F (2019) A Study on Outcome in the Management of Intra Abdominal Sepsis at a Tertiary Care Hospital. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Intra-abdominal sepsis is the inflammation of the peritoneum which is caused by pathogenic micro-organisms and their products. Intra abdominal sepsis pose a constant challenge to the surgeons. It usually present as peritonitis which is the “inflammation of serosal membrane lining the abdominal cavity and the organs contained within it”. The inflammatory process can be localized or diffuse in nature. Being a sterile environment, peritoneum reacts to various pathologic stimuli and irritants with an inflammatory response. It is mostly caused by introduction of an infection into the otherwise sterile peritoneal cavity through perforation of hollow virus, leakage of contents as in anastomotic leakage or leakage of bile / gastric acid from a perforated duodenal / gastric ulcer or rupture of abscess from solid organs. Anastomotic dehiscence is a common cause in post-operative period. Sepsis is defined as systemic inflammatory response to infection which is frequently associated with hypoperfusion following tissue injury and organ failure. The diagnosis of intra-abdominal sepsis is mainly based on clinical assessment. The patient usually comes to emergency department with complaints of abdominal pain, abdominal distension, fever or vomiting. General examination may reveal dehydration and anemia. On abdomen examination, tenderness and distension with guarding or rigidity and presence or absence of bowel sounds, depending on onset of paralytic ileus, may be present Basic investigations like Chest X-ray PA view, X-ray Abdomen erect, is done to look for air under diaphragm. Air under diaphragm will be seen on abdomen X-ray, when the intra-abdominal sepsis is due to hollow viscus perforation. Other investigations include ultrasonogram to look for free fluid and CECT is taken when the diagnosis is in doubt. The outcome in the course of intra-abdominal sepsis depends on the complex interaction of many factors and the success of it depends mainly on the early diagnosis and appropriate timely intervention. Morality increases with delay in diagnosis and treatment, hence Surgeon factor in deciding on the surgical management of intra-abdominal sepsis is the crucial determinant of outcome, as the main stay of management is source control. AIM AND OBJECTIVES: 1. To study the various causes of intraabdominal sepsis and analyse the factors influencing the course of sepsis like age, comorbid conditions and time of diagnosis to intervention. 2. To analyse the various surgical and radiological interventions done to eliminate the source of sepsis and the outcome in management based on complications and duration of hospital stay / death. MATERIALS AND METHODS: Patients admitted with intra-abdominal sepsis in Kilpauk Medical College and Hospital, Chennai during the period of January 2018 to September 2018 were enrolled in the study. Cases suspected of intra abdominal sepsis based on presenting complaints and clinical features are subjected to series of investigations. Appropriate medical, surgical / radiological intervention is done to eliminate the source of sepsis. RESULTS: In this study males (69%) outnumbered females (31). 30% of the patients fall under the category of 46-55 years. Diabetes mellitus is the most common comorbidity (10%) with a mortality rate of 9.09%. Age wise mortality is high in the category of 36 – 45 years (23%). The most common cause of intraabdominal sepsis is appendicular perforation followed by duodenal and gastric perforation. Most cases needed surgical intervention (97 %), only 3% underwent radiological intervention. Intensive supportive care management needed in 14% of cases. The most common surgery done for source control is primary closure or resection anastomosis for hollow viscus perforation. Resurgery is done in 11% of cases. The common procedures done are re-resection and anastomosis, reinforcement of anastomosis and ileostomy. Mortality in resurgery accounts for 18.18%. Duration of hospital stay varies from 2-27 days with a mean period of 10 days. The most common complication is wound infection leading to wound dehiscence (15%) followed by respiratory complications (6%) which lead to increased mortality. CONCLUSION: The overall outcome in the management of intraabdominal sepsis, at our tertiary care hospital has a good recovery of 84 % with a mortality of 11%.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Intra-abdominal sepsis, surgical intervention, good recovery, mortality. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Sep 2019 07:45 |
| Last Modified: | 08 Sep 2019 09:37 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11424 |
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