Irene Mutua, Denver Mariga, Omondi Marilyn, Dan Kiptoon
Kampala International University, Uganda.
Kampala International University, Uganda.
Int J Surg Case Rep. 2019;55:171-173. doi: 10.1016/j.ijscr.2019.01.033. Epub 2019 Feb 1.
Peptic ulcer perforation is a common surgical emergency that is a complication of 9% of patients with peptic ulcer disease (Kjetil et al., 2015 [1]). Despite advances in the management of peptic ulcer disease, the number of acute complications have remained constant. Intra-abdominal sepsis is defined as inflammation of the peritoneum caused by pathogenic micro-organisms and their products (Pavlidis, 2003).
We present a case report on intra-abdominal sepsis in a 20 yr old patient admitted in the intensive care unit at our institution following a perforated duodenal ulcer that was repaired by modified Graham patch method but leaked and he had multiple surgeries thereafter necessitating the open abdomen.
The open abdomen remains an option to the surgeon as the patient may have severe peritonitis or be in septic shock. Hence the need of damage control laparotomy due to severe physiological derangement or a planned second look laparotomy if there is failed source control.
Intra-abdominal sepsis management of patient in an intensive care unit set-up with adequate surgery, open abdomen treatment and antibiotics given based on blood culture and sensitivity results enables successful management of difficult surgical abdomens.
消化性溃疡穿孔是一种常见的外科急症，是9%的消化性溃疡病患者的并发症（Kjetil等人，2015 [1]）。尽管消化性溃疡病的治疗取得了进展，但急性并发症的数量一直保持稳定。腹腔内感染被定义为由致病微生物及其产物引起的腹膜炎症（Pavlidis，2003）。
我们报告一例20岁患者的腹腔内感染病例，该患者因十二指肠溃疡穿孔入住我院重症监护病房，采用改良格雷厄姆补片法修复，但出现渗漏，此后进行了多次手术，需要开腹治疗。
对于患者可能患有严重腹膜炎或处于感染性休克的情况，开腹仍是外科医生的一种选择。因此，由于严重的生理紊乱需要进行损伤控制剖腹术，如果感染源控制失败，则需要计划进行二次剖腹探查。
在重症监护病房环境中，对患者进行腹腔内感染管理，通过充分的手术、开腹治疗以及根据血培养和药敏结果给予抗生素，能够成功处理复杂的外科腹部疾病。
