Critical Importance of Early Diagnosis and Treatment of Intra-abdominal Infection

Abstract

• The overall mortality in 77 cases of intra-abdominal infection (IAI) was 39%. A striking correlation was observed between delay in definitive medical or surgical treatment, the number of medical and surgical complications, and mortality. Only one of 29 patients who showed a rapid clinical response to appropriate antibiotic treatment and/or an exploratory operation died, compared with 29 of 48 who did not, justifying a vigorous diagnostic approach with repeated exploratory surgery when necessary. Results of abdominal ultrasound and gallium scanning altered management in a meaningful fashion far less frequently than might be inferred from earlier reports. Factors contributing to delays in instituting definitive therapy included failure to recognize the presence of IAI, prolonged observation in the absence of noticeable response to medical therapy, the desire for confirmation by ancillary studies, and the argument that the patient was "too sick" to undergo surgery. (<i>Arch Surg</i>1982;117:328-333)