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

One hundred and five patients underwent surgical treatment of septic complications of diverticular disease. In nine cases, operation was carried out for acute large bowel obstruction and in the remainder for peritonitis. An inflammatory mass and/or localized abscess was found in 23 cases. Free pus without evidence of 'communicating' perforation was found in a further 33 and 'communicating' perforation in 40. Treatment by primary resection or by transverse colostomy and drainage were both associated with significantly lower mortality from sepsis than treatment by drainage alone. In cases without 'communicating' perforation, there was no difference in mortality between primary resection and transverse colostomy with drainage. Although the advantage of primary resection was most apparent in cases with 'communicating' perforation, it did not reach statistical significance. In three cases treated primarily without resection the pathology was subsequently found to be that of carcinoma. In 'favourable' circumstances, i.e. without 'communicating' perforation, defunctioning colostomy with drainage has an acceptably low mortality rate and may be undertaken by a less experienced surgeon to avoid a difficult resection. Ideally these problems should be dealt with by an experienced surgeon; we prefer to treat the septic complications of diverticular disease by primary resection.
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PMID:Management of the septic complications of diverticular disease. 373 Jul 93

Mixed anaerobic-aerobic infections may occur in a variety of anatomical locations and are usually related to the spread of bacteria from a proximal mucosal surface. Much has been learned about the pathophysiology and treatment of mixed anaerobic-aerobic infections from the study of intra-abdominal sepsis related to spillage of colonic contents. There is an average of five microorganisms at the infected site: three anaerobic and two aerobic pathogens. Appendicitis and diverticulosis are the most common conditions which predispose to fecal contamination of the intra-abdominal cavity. Initially, peritonitis develops which, if untreated, progresses to an abscess. The abscess is a unique pathologic entity which may form a protective environment for the microorganisms and present a barrier to the action of certain antimicrobial agents. Treatment usually involves two modalities: surgical drainage or debridement and appropriate antimicrobial agents to cover both components of the mixed infection. On the basis of in vitro susceptibility there are six groups of antimicrobial agents that are useful in treating intra-abdominal infections: clindamycin; metronidazole; chloramphenicol; broad-spectrum penicillins (carbenicillin/ticarcillin/piperacillin); cephalosporins (cefoxitin/moxalactam); and imipenem. Randomized prospective studies have shown that the first five of these groups are effective in the therapy of intra-abdominal mixed infections. Preliminary data indicate that imipenem/cilastatin is very effective in the therapy of this serious infection; however its place in the therapeutic armamentarium awaits the completion of randomized prospective studies against established drugs.
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PMID:Therapy of mixed anaerobic-aerobic infections. Lessons from studies of intra-abdominal sepsis. 389 May 35

Seventy-three patients were seen between 1970 and 1983 with complicated diverticular disease. There were only six hospital deaths (8%). Two out of 7 patients with faecal peritonitis died, 2 of 27 patients with purulent peritonitis died and there was one death each associated with an inflammatory mass and a peridiverticular abscess. Five of the six hospital deaths were from cardiorespiratory disease and only one was from sepsis. Three of the early deaths were in patients who were receiving steroid therapy. There were three late deaths: one from uncontrolled sepsis, one an anaesthetic death from coronary occlusion during revision of a Hartmann operation and the third was an incidental myocardial infarction. A very conservative surgical policy was adopted, primary resection only being used for an inflammatory mass and selectively for fistula and local purulent disease. Despite our apparent low hospital mortality there was a high incidence of complication; wound sepsis 29%, fistula after colostomy closure 12% and anastomotic dehiscence after primary or secondary reconstruction 12%. These findings indicate the need for a prospective audit which is now in progress.
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PMID:Audit on complicated diverticular disease. 394 25

Abscesses of the thigh are rare and, although easily diagnosed, their cause is often obscure. We present two cases of thigh abscesses which resulted from the extension of intraabdominal sepsis. A review of the literature reveals only 46 previously reported cases. The underlying pathologic abnormality is usually a retroperitoneal perforation of a colorectal neoplasm or diverticular disease, whereas origin from the small bowel or appendix is distinctly less common. Routes of extension of infection into the thigh can be either direct, through the subcutaneous tissues, or through naturally occurring defects in the abdominal wall. These include: (1) along the psoas muscle deep to the inguinal ligament; (2) through the femoral canal; (3) by way of the obturator foramen; and (4) through the sacrosciatic notch. The two cases presented are unusual in that they both followed radical cystectomy with lymph node dissection, which opens up these natural avenues to the spread of intraabdominal infection. The overall mortality in the literature is high (53 percent), but recognition of an abdominal source and appropriate treatment combined with local drainage of the thigh abscess appears to improve survival.
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PMID:Thigh abscess. An uncommon presentation of intraabdominal sepsis. 395 63

Sigmoid diverticulitis with perforation and generalized peritonitis is a grave complication of diverticular disease. To compare accurately the results of two operative approaches--proximal colostomy with drainage and proximal colostomy with resection or exteriorization--the authors assessed the clinical and pathologic features of 121 consecutive patients with perforating sigmoid diverticulitis. There were no differences between treatment groups in age, sex, mean duration of symptoms, clinical presentation, number of coexistent diseases, type of peritonitis or chronic corticosteroid use. Overall mortality for emergency operation was 12 percent. Mortality was significantly greater (P less than 0.05) among the 31 patients treated by colostomy and drainage (26 percent) than among the 90 patients treated by colostomy and resection or exteriorization (7 percent). Seven of the nine patients who died from persistent sepsis had undergone colostomy and drainage. Four clinical factors were found to be predictive of mortality (P less than 0.05): persistent postoperative sepsis, fecal peritonitis, preoperative hypotension, and prolonged duration of symptoms. These factors identified a subgroup of patients who, because of an increased risk of death, would be likely to benefit from the more complete eradication of the septic focus that is achieved by colostomy and resection.
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PMID:Sigmoid diverticulitis with perforation and generalized peritonitis. 397 9

This paper includes a brief historic summary of the surgical aspects of diverticular disease and of corresponding developments in the Massachusetts General Hospital from 1911 to the present. The 350 cases observed in 1974-1983 are compared with 338 seen in the previous decade. Major trends include a decrease in hospital admissions for diverticular disease but a sustained number of operations; increased severity of the disease in hospitalized patients manifested by an increased percentage of patients with immunosuppression or serious other diseases (p less than 0.001), an increased number with sepsis and general peritonitis (p less than 0.001); an increased percentage of cases with one-stage resection and anastomosis (p less than 0.02); in patients with general peritonitis, resection of the perforated segment at the time of the original operation was accompanied by the lowest mortality (p less than 0.02); incidental splenectomy appears to be dangerous, with three deaths in eight cases; and overall mortality in the last decade is 6.4%; for emergency cases 10.2%, for urgent 9.7%, and for elective cases 2.4%.
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PMID:Changing patterns in the surgical treatment of diverticular disease. 633 17

There is little uniformity in either the indications for operation, the classification of the pathology or the operative management of generalized or faecal peritonitis secondary to perforated diverticular disease. Nevertheless, this review has shown a clear advantage both in terms of immediate mortality and morbidity for primary resection over conservative operations in which the colon is retained in the abdomen. We propose that, when a clinical diagnosis of localized sepsis secondary to diverticular disease is made, the management should be nonoperative with systemic antibiotics and supportive therapy. Operation should be reserved for those patients with obvious generalized peritonitis or failure of conservative treatment. When operation is necessary the affected sigmoid loop should be resected and the operation completed as a Hartmann's procedure in all but the most favourable circumstances when a primary anastomosis may be considered after on-table irrigation of the colon.
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PMID:Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: a review. 638 23

We describe the case of a 58-year-old man who presented to the hospital with central abdominal pain, nausea, fever, chills, and dyspnea. While in the hospital, jaundice appeared and the liver function tests revealed features of both cholestasis and hepatocellular injury. He developed gram-negative septicemia and died on the sixth hospital day. Autopsy disclosed a perforated terminal ileal diverticulum and a contiguous mesenteric abscess. There was also severe phlebitis of mesenteric venous radicles which extended superiorly to the intrahepatic portal venules and veins. The portal veins were surrounded by multiple hepatic abscesses that varied in size from microscopic to 2.5 cm. This appears to be the first report in the world literature of suppurative pylephlebitis and hepatic abscesses resulting from a perforated ileal diverticulum. The subject of small bowel non-Meckelian diverticulosis is reviewed because of the rarity of this condition and the diagnostic challenges it poses.
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PMID:Perforated diverticulum of the terminal ileum. A previously unreported cause of suppurative pylephlebitis and multiple hepatic abscesses. 642 54

During the past decade, primary resection with anastomosis has gained acceptance in the surgical treatment of complications arising from diverticular disease of the colon. We have reviewed our experience during the past 10 years to determine whether this approach has clinical validity. Of 673 patients followed over a 10-year period, 93 (14%) required operation. Operative indications were generally limited to urgent complications of the disease: abscess (36), bleeding (18), perforation (10), obstruction (10), and fistula (5). A small group of patients underwent operation for recurrent symptoms (7) and for the suspicion of coexistent carcinoma (8). Initial operative management included resection with anastomosis (44), resection and colostomy (26), and diverting colostomy (23). The overall incidence of complications was significant; the most common complication was infectious in nature: abscess (7), fistula (9), wound infection (11), dehiscence (2), and sepsis (5). Complications were more numerous in patients who did not receive primary resection of the diseased segment 2.1 versus 1.1 complications per patient, respectively), and the duration of hospitalization was significantly greater in this group as well. The perioperative mortality rate of our surgical patients was 6.4%; none of these deaths were associated with resection and anastomosis. These data indicate that resection with primary anastomosis is a sound approach in properly selected patients with urgent complications of diverticular disease, and that aggressive surgical management can yield results that are better than those obtained from the use of colostomy alone.
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PMID:Results of changing trends in the surgical management of complications of diverticular disease. 662 68

In a ten-year period 53 patients presented with perforated colonic diverticular disease with diffuse peritonitis. Eight patients died--all with uncontrolled intraabdominal sepsis. Various surgical techniques were employed. None of the 12 patients having immediate resection of the affected bowel segment died. There was no mortality from subsequent operations in any form of staged treatment. Primary resection without anastomosis is supported as the treatment of choice for this condition.
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PMID:The management of perforated diverticulitis with diffuse peritonitis. 692 60


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