POSTOPERATIVE CLOSTRIDIAL SEPSIS OF ABDOMINAL WALL

被引:11
作者
FROMM, D
SILEN, W
机构
[1] University of California School of Medicine San Francisco, CA
[2] Harvard Medical School Boston, MA
[3] Department of Surgery, Beth Israel Hospital Boston, MA
关键词
D O I
10.1016/0002-9610(69)90173-1
中图分类号
R61 [外科手术学];
学科分类号
摘要
1. 1. The diagnosis of clostridial sepsis after abdominal operation is difficult prior to the development of signs and wound infection. Hypotension, fever, tachycardia out of proportion to the fever, jaundice, renal failure, or mental changes may precede signs of wound infection. 2. 2. A review of the literature reveals that the average time between operation and the first indication of wound infection was twenty-four to forty-eight hours (ranging from four hours to eighteen days). The over-all mortality of clostridial infection of the abdominal wall is 60 per cent; in the presence of peritonitis (20 to 36 per cent of cases) the mortality is 86 per cent. 3. 3. Wound crepitus is a late sign not essential for the diagnosis of clostridial sepsis. 4. 4. A high index of suspicion is required to make the diagnosis of clostridial sepsis before obvious signs of wound infection occur. Once the diagnosis is suspected, the wound must be opened and inspected and material obtained for gram stain and culture. 5. 5. Despite reluctance to undertake unnecessary radical excision of a wound, treatment must be instituted rapidly if the clinical picture is compatible with the diagnosis and if organisms resembling Clostridia are present on gram stain. Treatment should consist of antibiotics and radical debridement with or without hyperbaric oxygen therapy. © 1969.
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页码:517 / &
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