Sepsis after gastroduodenal operations: relationship to gastric acid, motility, and endogenous microflora.

We reviewed 254 consecutive gastroduodenal operations done at Charity Hospital of Louisiana in New Orleans between June 1974 and June 1977. Forty-one septic complications occurred in 30 patients, for an overall infection rate of 11.8%. Statistically higher infection rates followed operations for bleeding gastric or duodenal ulcer, obstructed duodenal ulcer, gastric ulcer, and gastric malignancy when compared to those done for chronic uncomplicated ulcer or perforated duodenal ulcer. Of these 30 patients, 22 had a compromise of either gastric acidity or motility at the time of operation. These two factors appear to be most significant in controlling the organisms which reach the stomach from swallowed saliva or by reflux through the pylorus. The organisms most frequently causing infection after gastroduodenal operations are endogenous to the stomach and include aerobic enteric gram-negative bacilli and oral, penicillin-sensitive anaerobes. Exogenous bacteria such as Staphylococcus aureus are a less frequent cause of infection after these operations.