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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 133 children, aged 16 months to 15 years (mean 6.7 years), with presumptive acute appendicitis, was included in a double-blind, placebo-controlled trial of the short-term (72 hour) use of metronidazole suppositories as prophylaxis against post-operative infection. There was no significant difference in the incidence or severity of wound infection or post-operative intra-abdominal sepsis between the metronidazole-treated and placebo groups. It is suggested that intra-rectal metronidazole, when used exclusively, is not sufficient for effective prophylaxis for appendicitis in childhood.
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PMID:A double-blind controlled trial of metronidazole suppositories in children undergoing appendicectomy. 634 59

Single doses of clindamycin hydrochloride and gentamicin sulfate given preoperatively, combined with intraoperative topical application of povidone-iodine were given to patients with perforated or gangrenous appendicitis. The incidence of wound sepsis was reduced from 36% to 5%; severe infections were reduced from 25% to 0% when compared with a control untreated group of patients. When used alone, povidone-iodine had little effect in these patients. No toxic effects of the antibiotics or antiseptic were recorded nor were any resistant strains of pathogenic organisms grown from cultures.
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PMID:Combined preoperative antibiotic therapy and intraoperative topical povidone-iodine. Reduction of wound sepsis following emergency appendectomy. 637 44

Laparotomy was performed on 579 children at the University Clinic of Paediatric Surgery in Mainz from 1.1.1975 to 31.12.1982. The children were up to 15 years of age; appendicitis or inguinal and umbilical hernia cases were not included. Postoperative sepsis occurred in 74 patients (12.8% of all children with laparotomy); in 51 cases positive bacteriological findings were seen besides the clinical and clinicochemical ones. Sepsis morbidity was particularly high in children who had not yet completed their first year of life (postoperative sepsis occurring in approximately every fourth infant); among the disease patterns, the following were particularly prominent: Defects of the abdominal wall (23 out of 50 children developed postoperative sepsis); intestinal atresia (18 out of 59 children); intestinal perforation (11 out of 39 children). In addition, sepsis morbidity was enhanced after relaparotomies. Gram-negative bacteria were most frequent among the 51 patients with bacteriologically positive findings; these bacteria consisted mostly of representatives of the group of enterogenous pathogens. These groups of bacteria were also the most frequently occurring pathogens in mixed and secondary infections. 33 out of 74 children with postoperative sepsis died. The mortality rate was 68% in prematurely born infants compared with mature newborns. Lethality was highest among children with congenital defects of the abdominal wall and intestinal perforations. Among the patients with bacteriologically positive findings the lethality was particularly high with multiple attacks of sepsis, in case of septitides caused by multiple pathogens, by Candida albicans and after relaparotomy.
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PMID:[Importance of infection following laparotomy in childhood]. 639 38

Forty-four patients with enterocutaneous fistulas treated at the University of Nigeria Teaching Hospital (UNTH) Enugu in five years (1977-81) are reviewed. Most fistulas resulted from complications of surgery (29 per cent) and appendicitis (55 per cent). The commonest locations were in the cecum (48 per cent), ileum (30 per cent), and colon (20 per cent). The outstanding complication was sepsis. Spontaneous closure occurred in 15 patients (34 per cent). Twenty-two patients were treated surgically. There was a high mortality of 18 per cent from septic complications and malnutrition.
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PMID:Enterocutaneous fistulas in Enugu, Nigeria. 646 92

Prospective investigation of consecutive children suffering from non-perforating appendicitis indicated that metronidazole prophylaxis significantly reduces the risk of postoperative wound sepsis regardless of the method of closure. However, in view of the advantages of subcuticular polyglycolic acid this must be regarded as the method of closure of choice in non-perforating appendicitis in children.
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PMID:The influence of metronidazole prophylaxis and the method of closure on wound infection in non-perforating appendicitis in childhood. 664 97

Twenty-three surgeons at three McGill University hospitals were interviewed about their treatment of intra-abdominal sepsis. They described their use of antibiotics, operative practices and other treatment of generalized peritonitis and intra-abdominal abscesses. If more than 75% of respondents used a given method, its use was considered "uniform" unless substantial interhospital variation existed for that method. Treatment was variable in 18 situations. Only four of these involved systemic antibiotic use--drug regimens in appendicitis and intra-abdominal abscess, and duration of antibiotic therapy following appendicitis and perforated duodenal ulcer. The other 14 examples of variation were in operative management. In generalized peritonitis, they were: use of diagnostic paracentesis; abdominal lavage with saline alone versus saline plus antibiotic use; whether the peritoneum should ever be left open; the use or avoidance of drains; primary versus delayed wound closure in appendicitis, bowel perforation and trauma with gastrointestinal perforation and, finally, wound lavage with saline alone or with antibiotics. Treatment of intra-abdominal abscesses varied in regard to the diagnostic and therapeutic roles of percutaneous needle aspiration, the preferred route of drainage of a pelvic abscess, the use of an extra- or trans-serosal approach to a subphrenic abscess, local versus full abdominal exploration for a single abscess and the type of drain used. The authors conclude that operative management of intra-abdominal sepsis varies widely among surgeons. This fact invalidates many "controlled" trials of antibiotics and should focus attention less on drugs and more on surgical treatment.
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PMID:Treatment of intra-abdominal sepsis. 672 70

The clinical importance of the anaerobic organisms, especially the toxicogenic Clostridia and some of the nonsporulating anaerobes, has been recognized for some time. Only within the last 20 years, however, owing to improved methodology, have gram-negative anaerobic bacilli, anaerobic cocci, and streptococci been commonly recognized and encountered in clinical infections. Today, anaerobic organisms are common isolates from infections involving intra-abdominal sites, the female genital tract, soft tissue, and oral areas and from major infections involving the lung, brain, and head and neck. Most of these infections are polymicrobial--involving both anaerobic and facultative or aerobic organisms. In some instances, it is difficult to ascertain what role is played by what organisms. No doubt, synergism is present in many cases. Because anaerobes are prevalent normal flora of the body, almost all anaerobic infections are of endogenous origin. Many of these anaerobes are opportunists; given the appropriate set of conditions, they will penetrate tissue and cause infection. Many have been associated with wound infection subsequent to bowel surgery or trauma, tubo-ovarian abscess, perirectal abscess, subphrenic abscess, postabortal sepsis, appendicitis, and many other infectious conditions. This article reviews the distribution of anaerobes in infected hospitalized patients and their relation to infection over a 5-year period.
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PMID:Epidemiology of anaerobic infections. 684 97

Reports in the surgical literature are conflicting as to whether appendectomy "in passing" during laparotomy for trauma or for some other disease state does or does not significantly increase patient morbidity or mortality. A chart survey of all appendectomies (342 for acute appendicitis and 146 as incidental procedures) performed on the trauma service of Grady Memorial Hospital over a 40 month period appeared to indicate that the wound infection rate (6.8 percent) was the same as that for acute simple or suppurative appendicitis (6.7 percent), whereas the intraabdominal sepsis rate (17.5 percent) paralleled that for more advanced gangrenous or perforative appendicitis (18.6 percent). Since the validity of a retrospective review is always open to question, a prospective, randomized trial was carried out only on patients with a negative abdominal exploration for trauma over a 22 month interval at the same trauma service. An odd second from the last digit hospital number dictated appendectomy, provided the appendix was readily accessible; an even digit in the same locus dictated retention of the appendix. In no patient did intraperitoneal sepsis develop, regardless of the procedure chosen. Wound infection rates were 1.8 percent for appendectomy (1 of 56), if local anatomic considerations precluded an easy appendectomy (0 of 45), and 3.6 percent for the control subjects without appendectomy (3 of 83). There were no deaths. These data cast considerable doubt on the reliability of retrospective reviews and support the generally accepted dictum that incidental appendectomy, especially in the trauma patient, can be a relatively innocuous procedure.
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PMID:Safety of incidental appendectomy. 685 20

Patients often present to the surgeon with abdominal pain, tenderness, and fever. Many exhibit progressive sepsis due to abdominal pathology. Delay in diagnosis and treatment often occurs due to the use of multiple, time-consuming, expensive diagnostic studies. We delineate the use of diagnostic laparoscopy in subsets of patients in whom confusion exists as to the cause of abdominal sepsis--i.e., females in child-bearing years, elderly patients, obese patients, immunosuppressed patients, and patients with suppression of physical findings. The methodical assessment of the entire abdominal cavity is performed utilizing manipulation of the patient's position (Trendelenburg, supine, reverse Trendelenburg, left side up, right side up) and meticulous inspection of the entire small bowel. Diagnoses included acute appendicitis, gangrenous appendicitis, perforated appendicitis with peritonitis or abscess, gangrenous cholecystitis, ischemic bowel disease, perforating carcinoma of the colon, perforating diverticulitis with abscess or peritonitis, tubo-ovarian abscess, closed-loop small-bowel obstruction, megacolon, and perforation of the colon. Laparoscopic treatment of 96% of the patients was performed successfully and a laparoscopic-assisted approach was used in the remainder. There was one mortality (cardiac) and no major morbidity. The development of a Formal Diagnostic Exploratory Laparoscopic (FDEL) approach has aided in the assessment of each of the diagnoses of sepsis in the abdominal cavity. The diagnostic and therapeutic approach laparoscopically avoids extensive preoperative studies, avoids delay in operative intervention, and appears to minimize morbidity and shorten the postoperative recovery interval.
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PMID:Use of laparoscopy in the diagnosis and treatment of patients with surgical abdominal sepsis. 759 89

Intraabdominal abscess formation is a well-recognized complication of perforated appendicitis. Extraabdominal complications, however, are rare. The authors present the case of an 8-year-old boy who had an acute painful right-sided scrotal mass 2 days after an operation for perforated appendicitis. During exploration, an abscess within a previously undiagnosed patent processus vaginalis was found and successfully managed by drainage. This case demonstrates that a persistent patent processus vaginalis may predispose to scrotal pathology secondary to intraabdominal sepsis and represents a unique complication of perforated appendicitis.
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PMID:An unusual complication of appendectomy. 787 54


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