Laparotomy for Intra-abdominal Sepsis in Patients in an Intensive Care Unit

Mika Sinanan, MD; Ronald V. Maier, MD; C. James Carrico, MD
Arch Surg. 1984;119(6):652-658. doi:10.1001/archsurg.1984.01390180020004.
Text Size: A A A
Published online

• Patients in an intensive care unit who have intra-abdominal (IA) infections producing clinical deterioration in their conditions require urgent intervention. However, detection is often difficult. To define preoperative criteria for, and improve the specificity of, laparotomy, we reviewed 100 explorations in 71 patients with suspected IA sepsis. Eighty-one explorations demonstrated an infected or ischemic process; 19 were negative. Preoperative features associated with a positive laparotomy were as follows: (1) objective evidence by physical examination, ultrasonography, or computed tomography suggesting an IA focus (89%); (2) septic shock (80%); and (3) positive blood cultures (95%). Absence of these features significantly lowered the accuracy of exploration. Septic shock or bacteremia had a 90% mortality regardless of findings at exploration. The best accuracy (89%) and survival (51%) rates were achieved with "directed" exploration before septic shock or bacteremia. Early use of sensitive detection techniques that permit directed laparotomy before septic deterioration should improve survival.

(Arch Surg 1984;119:652-658)


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.