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  3. 13. Management of Complicated Intra Abdominal Sepsis
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13. Management of Complicated Intra Abdominal Sepsis

Dileep Kumar, Mariyah Anwer, Shamim Qureshi and Muhammad Naeem

 

ABSTRACT

 

Objective: To describe the clinical, microbiological, and treatment profile of complicated intra abdominal infections in developing countries

Study Design: Retrospective case series study.

Place and Duration of Study: This study was conducted at the Surgical Ward 2, JPMC, Karachi from January 2013 to January 2016.

 

Material and Method: A total of 190 patients admitted via emergency department with the diagnosis of secondary peritonitis were included. Data was collected from previous records. Peritonitis was diagnosed on the basis of history, clinical examination, radiological assessment and intra-operatively findings.

 

Results: Amongst 190 cases, Tuberculosis and typhoid were the most common pathologies (n=57:30% and n=29:15%) in small intestine followed by perforated appendix (n=29:15.3%). The small bowel was the most common site of perforation (45%) followed by the appendix (15%), duodenal perforation (22.1%), and stomach perforation (10%), peritonitis due to advance malignancy (6.8%) and diverticulitis (0.52%) respectively. Pus C/S yielded E.coli in 100% of specimen followed by Enterobacter (85%) klebsilla (70%), pseudomonas (20%) and Acetobacter (8%). These organisms were 100 % sensitive to Amikacin, 95% to meroneum and imipenem, 97% to vancomycin, 75% to cefaprazone-sulbactum and Augmentin 20%. The overall mortality rate was 36.3%,(n=69), the morbidity rate was 31.05% (n=59) and 32.6 %( n=62) of patients were discharged uneventfully.

 

Conclusion: The current management modality for complicated intra-abdominal infections in developing countries is a surgical challenge with a high morbidity and mortality. Early recognition, prompt source control and effective use of septic care bundle are important tools of management

Key Words: Complicated intra-abdominal infections, septic care bundle, abdominal sepsis

 

Citation of article: Kumar D, Anwer M, Qureshi S Naeem M. Management of Complicated Intra Abdominal Sepsis. Med Forum 2017;28(11):54-58.