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Intra-abdominal Infections After Abdominal Organ Injuries

  • Infection and Trauma (M Sartelli, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review is focusing on intra-abdominal infections after abdominal injuries which are a major source of morbidity following abdominal trauma.

Recent Findings

Intra-abdominal infections after abdominal injuries pose a diagnostic and therapeutic challenge to the trauma surgeon. Its diagnosis is based on clinical and radiological findings. Once an intra-abdominal infection is diagnosed, the next step is to achieve prompt and efficient source control coupled with early initiation of broad-spectrum antibiotics. Over the past several years, research has found some predictors for intra-abdominal infections after abdominal trauma. However, the role of prophylactic and therapeutic antibiotics remains unclear. The operative strategy for these patients is largely based on the trauma surgeon experience. However, temporary abdominal closure with negative pressure wound therapy seems to be the best approach to managing post-traumatic intra-abdominal infections.

Summary

Early administration of broad-spectrum antimicrobials coupled with rapid and efficient source control is of paramount importance for improving outcomes in patients with post-traumatic intra-abdominal infections.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Vincent J, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323–9.

    Article  CAS  PubMed  Google Scholar 

  2. •• Sartelli M, Catena F, Ansaloni L, et al. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW study. World J Emerg Surg. 2014;9:37. A multicenter observational study in 68 medical institutions worldwide during a 6-month study period (October 2012–March 2013) describing the clinical, microbiological, and treatment profiles of both community- and healthcare-acquired complicated IAIs in a global context.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Poret HA III, Fabian TC, Croce MA, Kudsk KA. Analysis of septic morbidity following gunshot wounds to the colon: the missile is an adjuvant for abscess. J Trauma Acute Care Surg. 1991; 31.

  4. Fabian TC, Croce MA, Stanford GG, Payne LW, Mangiante EC, Voeller GR, Kudsk KA. Factors affecting morbidity following hepatic trauma. A prospective analysis of 482 injuries. Ann Surg. 1991;213:540–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Ivatury RR, Gaudino J, Nallathambi MN, Simon RJ, Kazigo ZJ, Stahl WM. Definitive treatment of colon injuries: a prospective study. Am Surg. 1993;59:43–9.

    CAS  PubMed  Google Scholar 

  6. Demetriades D, Murray JA, Chan L, et al. Penetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study. J Trauma. 2001;50:765–75.

    Article  CAS  PubMed  Google Scholar 

  7. Bulger EM, McMahon K, Jurkovich GJ. The morbidity of penetrating colon injury. Injury. 2003;34:41–6.

    Article  PubMed  Google Scholar 

  8. Morales CH, Villegas MI, Villavicencio R, et al. Intra-abdominal infection in patients with abdominal trauma. Arch Surg. 2004;139:1278–85.

    Article  PubMed  Google Scholar 

  9. • Bradley MJ, Dubose JJ, Scalea TM, et al. Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: results from the prospective AAST open abdomen registry. JAMA Surg. 2013;148:947–55. This study provides an overview of predictors of complications (including intra-abdominal sepsis) after damage control laparotomy for trauma.

    Article  PubMed  Google Scholar 

  10. • Paulus EM, Croce MA, Shanan CP, Zarzaur BL, Sharpe JP, Dileepan A, Boyd BS, Fabian TC. Synergistic effect of combined hollow viscus injuries on intra-abdominal abscess formation. Am Surg. 2015;81:674–8. This study highlights the effect of combined hollow viscus injuries in the development of intra-abdominal infections.

    PubMed  Google Scholar 

  11. Tatebe LC, Jennings A, Tatebe K, et al. Traumatic colon injury in damage control laparotomy—a multicenter trial: is it safe to do a delayed anastomosis? J Trauma Acute Care Surg. 2017; 82.

  12. Sarmiento JM, Yugueros P, Garcia AF, Wolff BG. Bullets and their role in sepsis after colon wounds. World J Surg. 21:648–52.

  13. Ugur M, Akkucuk S, Koca YS, Oruc C, Aydogan A. Missed injuries in patients with abdominal gunshot trauma: risk factors and mortality rates. Eur Surg. 2016;48:347–51.

    Article  Google Scholar 

  14. Sung CK, Kim KH. Missed injuries in abdominal trauma. J Trauma. 1996;41:276–82.

    Article  CAS  PubMed  Google Scholar 

  15. Scalea TM, Phillips TF, Goldstein AS, Sclafani SJ, Duncan AO, Atweh NA, Shaftan GW. Injuries missed at operation: nemesis of the trauma surgeon. J Trauma. 1988;28:962–7.

    Article  CAS  PubMed  Google Scholar 

  16. Stone HH, Fabian TC. Management of perforating colon trauma: randomization between primary closure and exteriorization. Ann Surg. 1979;190:430–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Nelson RL, Singer M. Primary repair for penetrating colon injuries. In: Nelson RL, editor. Cochrane Database Syst. Chichester: Rev. John Wiley & Sons Ltd; 2003. p. CD002247.

    Google Scholar 

  18. Ordonez CA, Pino LF, Badiel M, Sanchez AI, Loaiza J, Ballestas L, Puyana JC. Safety of performing a delayed anastomosis during damage control laparotomy in patients with destructive colon injuries. J Trauma. 2011;71:1512–8.

    PubMed  PubMed Central  Google Scholar 

  19. Ordoñez CA, Puyana JC. Management of peritonitis in the critically ill patient. Surg Clin North Am. 2006;86:1323–49.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chen S-C, Wang H-P, Chen W-J, Lin F-Y, Hsu C-Y, Chang K-J, Chen W-J. Selective use of ultrasonography for the detection of pneumoperitoneum. Acad Emerg Med. 2002;9:643–5.

    Article  PubMed  Google Scholar 

  21. Saber AA, LaRaja RD. Abdominal Abscess Workup. In: MEDSCAPE. 2016. http://emedicine.medscape.com/article/1979032-workup#c11.

  22. Chen S, Lin F, Hsieh Y, Chen W. Accuracy of ultrasonography in the diagnosis of peritonitis compared with the clinical impression of the surgeon. Arch Surg. 2000;135:170–4.

    Article  CAS  PubMed  Google Scholar 

  23. •• Sartelli M, Viale P, Catena F, et al. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2013;8:3. These are current guidelines on the management of intra-abdominal infections.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:133–64.

    Article  PubMed  Google Scholar 

  25. Go HLS, Baarslag HJ, Vermeulen H, Laméris JS, Legemate DA. A comparative study to validate the use of ultrasonography and computed tomography in patients with post-operative intra-abdominal sepsis. Eur J Radiol. 2017;54:383–7.

    Article  Google Scholar 

  26. Velmahos GC, Kamel E, Berne TV, et al. Abdominal computed tomography for the diagnosis of intra-abdominal sepsis in critically injured patients: fishing in murky waters. Arch Surg. 1999;134:831–8.

    Article  CAS  PubMed  Google Scholar 

  27. Sartelli M, Catena F, Di Saverio S, et al. Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg. 2014;9:22.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hau T, Ohmann C, Wolmershäuser A, Wacha H, Yang Q. Planned relaparotomy vs relaparotomy on demand in the treatment of intra-abdominal infections. Arch Surg. 1995;130:1193–7.

    Article  CAS  PubMed  Google Scholar 

  29. van Ruler O, Mahler CW, Boer KR, et al. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA. 2007;298:865–72.

    Article  PubMed  Google Scholar 

  30. Cirocchi R, Birindelli A, Biffl WL, Mutafchiyski V, Popivanov G, Chiara O, et al. What is the effectiveness of the negative pressure wound therapy (NPWT) in patients treated with open abdomen technique? A systematic review and meta-analysis. J Trauma Acute Care Surg. 2016;81.

  31. Roberts DJ, Zygun DA, Grendar J, Ball CG, Robertson HL, Ouellet J-F, et al. Negative-pressure wound therapy for critically ill adults with open abdominal wounds: a systematic review. J Trauma Acute Care Surg. 2012;73.

  32. Cheatham ML, Demetriades D, Fabian TC, Kaplan MJ, Miles WS, Schreiber MA, Holcomb JB, Bochicchio G, Sarani B, Rotondo MF. Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker’s vacuum packing technique. World J Surg. 2013;37:2018–30.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kirkpatrick AW, Roberts DJ, Faris PD, et al. Active negative pressure peritoneal therapy after abbreviated laparotomy: the intraperitoneal vacuum randomized controlled trial. Ann Surg. 2015;262:38–46.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Fang J-F, Chen R-J, Lin B-C, Hsu Y-B, Kao J-L, Kao Y-C, et al. Retroperitoneal laparostomy: an effective treatment of extensive intractable retroperitoneal abscess after blunt duodenal trauma. J Trauma Acute Care Surg. 1999;46.

  35. Ordoñez C, García A, Parra MW, et al. Complex penetrating duodenal injuries: less is better. J Trauma Acute Care Surg. 2014;76.

  36. Brand M, Grieve A. Prophylactic antibiotics for penetrating abdominal trauma. Cochrane Database Syst Rev. 2013; doi:10.1002/14651858.CD007370.pub3.

  37. Goldberg SR, Anand RJ, Como JJ, Dechert T, Dente C, Luchette FA, et al.. Prophylactic antibiotic use in penetrating abdominal trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73.

  38. Howell MD, Davis AM. Management of sepsis and septic shock. JAMA. 2017;317:847–8.

    Article  PubMed  Google Scholar 

  39. Montravers P, Gauzit R, Muller C, Marmuse JP, Fichelle A, Desmonts JM. Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clin Infect Dis. 1996;23:486–94.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia

    Carlos A. Ordoñez

  2. Professor of Surgery, Universidad del Valle, Cali, Colombia

    Carlos A. Ordoñez

  3. Clinical Research Center, Fundación Valle del Lili, Cali, Colombia

    Ramiro Manzano Nunez

Authors
  1. Carlos A. Ordoñez
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  2. Ramiro Manzano Nunez
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Correspondence to Carlos A. Ordoñez.

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Drs. Ordoñez and Manzano declare no conflicts of interest relevant to this manuscript.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Infection and Trauma

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Ordoñez, C.A., Manzano Nunez, R. Intra-abdominal Infections After Abdominal Organ Injuries. Curr Trauma Rep 3, 300–307 (2017). https://doi.org/10.1007/s40719-017-0095-x

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  • DOI: https://doi.org/10.1007/s40719-017-0095-x

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