2 NYC Health and Hospitals/Kings County, New York, NY, USA
Background
Definition of disease
An acute abdomen is defined as the abdominal signs and symptoms of pain and tenderness that present with such sudden severity that emergency surgery is being considered.
Abdominal sepsis is defined as an intra‐abdominal infectious source that results in severe sepsis or septic shock.
Disease classification
Acute abdomen and abdominal sepsis can be further classified into primary, secondary, or tertiary peritonitis.
Incidence/prevalence
Hospitalization for severe sepsis: there is a national incidence rate of three cases per 1000 population in the USA.
About 8.6% of severe sepsis admissions are secondary to the abdominal source.
About 36% of ICU admissions with severe sepsis have the abdomen as the attributable site.
Etiology
Intra‐abdominal infections (such as appendicitis, cholecystitis).
Hemorrhage (solid organ trauma, hemorrhagic pancreatitis).
Pathology/pathogenesis
The acute abdomen typically presents initially with poorly localized visceral pain, secondary to hollow viscous distension, infection, obstruction, or ischemia, which then localizes more anatomically as the pathology progresses.
Abdominal sepsis results when there is an introduction of microorganisms into the peritoneal cavity. The result is an inflammatory response by the peritoneum with increased blood flow and permeability, and a subsequent sepsis syndrome.
Predictive/risk factors for abdominal sepsis
Chronic diseases: AIDS, COPD, malignancy.
Use of immunosuppressive agents.
Advanced age.
Prevention
Secondary prevention
Initial source control.
Open abdomen management (laparostomy) or on‐demand expeditious re‐laparotomy until source control is achieved.
Systemic antibiotics.
Diagnosis
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