Intra-Abdominal Sepsis After Hepatic Resection

Abstract

One hundred and thirty hepatic resections performed over an 8-year period were reviewed for evidence of postoperative intra-abdominal sepsis. Of 126 patients who survived for more than 24 hours after operation, 36 developed culture positive intra-abdominal collections (28.6%). Significant independent variables associated with the development of intra-abdominal sepsis were diagnoses of trauma or cholangiocarcinoma, and the need for reoperation to control hemorrhage during the postoperative period. Before 1984, infected fluid collections were treated predominantly by operative drainage, but this has largely been replaced by percutaneous methods, which have proven effective in most cases. Eighteen (50%) of the infections were caused by a mixed bacterial culture, with Streptococcus faecalis, Staphylococcus epidermidis, Staphylococcus aureus and Escherichia coli being the most common isolates. Six patients with clinical signs of sepsis had a sterile fluid collection drained with complete relief of symptoms. This review suggests that intra-abdominal sepsis is a frequent complication after hepatic resection, and can often be managed successfully by nonoperative percutaneous drainage.

Promotion of bacterial translocation by major liver resection in obstructive jaundice in rats colonised predominantly with indigenous Escherichia coli

“…However, bacterial infections are still frequently observed as complications in patients who have undergone liver resection and in patients with obstructive jaundice [1,2]. Control of infection and endotoxaemia is an important factor determining morbidity and mortality in these patients [3][4][5][6][7][8]. The mechanism by which enteric bacteria reach an infective focus has not been entirely elucidated.…”

Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery: An algorithmic approach

“…Biliary complications in hepatobiliary surgery vary between 3%-15% and share a significant portion of the postoperative morbidity and mortality [11][12][13][14]18] . The cause of biliary leakage is usually due to unsutured collateral biliary branches of the cut surface and a non-surgical treatment settles the problem in the majority of the patients [19] .…”

“…Although biliary complications in liver resections occur approximately in 10%, they are responsible for one third of the postoperative mortality [11,12] . Fortunately, the majority is amenable to non surgical treatment, but when reoperation is necessitated mortality rate may reach up to 70% [13,14] . This high mortality rate is due to the fact that accurate diagnosis is delayed and surgical treatment is influenced by the ongoing intra-abdominal septic process.…”

Postoperative subphrenic abscess following gastrectomy for gastric cancer.

“…US and CT are generally important to confirm the presence and location of any subphrenic abscess (Sonnenberg et al 1982;Porter et al 1985;Pace et al 1989). However, in nonleakage related cases, surgical exploration must be performed to confirm the abscess.…”