Relaparotomy for postoperative intra-abdominal sepsis in jaundiced patients.

During the period 1979-84, 30 abdominal re-explorations were performed for postoperative intra-abdominal sepsis and single or multiple organ failure in jaundiced patients. Postoperative sepsis was caused by intra-abdominal abscess in 16 cases (53 per cent), by suture line leakage in 9 cases (30 per cent) and by technical error in 5 cases (17 per cent). Abscesses occurred most commonly in the subphrenic space (6 cases), in the subhepatic space (6 cases) and in the lesser sac (5 cases). Sepsis was associated with single organ failure in 20 cases and with multiple organ failure in 10 cases. The overall mortality rate was 50 per cent (15/30). Factors that were statistically associated with fatal outcome were: serum bilirubin greater than 100 mumol/l (P less than 0.008), positive blood culture (P less than 0.013), malignant disease (P less than 0.02), multiple organ failure (P less than 0.02) and age greater than 60 years (P less than 0.031). Mortality rose with the number of failed organs. Autopsy revealed continuing sepsis in 12 of the 15 fatal cases. Because mortality was high in spite of adequate operative drainage at relaparotomy, it is concluded that earlier definitive diagnostics are needed to lower the mortality rate.