Septic Abdomen Surgery Jayce Lineberger, DVM, DACVS

Surgery Outline Common causes Goals Surgical approach Surgical techniques   Drains Post-op

Common Causes Gastrointestinal tract Dirty or contaminated does not equal septic By far the most common source Multiple related issues: drug therapy, foreign bodies, recent surgery

Intestinal R/A

Dehiscence

Common Causes Gastrointestinal tract Penetrating wounds Migrating foreign bodies Hepatic abscess Pancreatic abscess Genitourinary tract Dog bite wounds do not have to cause an open wound to rupture the bowel Recent lab with a SQ abscess Don’t let the sun set on a closed pyo.

Goals Eliminate the source Repair damage Reduce bacterial load Consider nutritional support To drain or not to drain

Still closed?

Surgical Approach Ventral midline celiotomy Directly over wounds

Surgical Techniques Halsted’s principles Gentle tissue handling Adequate hemostasis Preservation of blood supply Strict asepsis No tension Close approximation of tissues Obliteration of dead space *Don’t leave extra stuff behind

Surgical Techniques Systematic evaluation of all intra-abdominal structures The source is usually at the site of the most adhesions Lavage Drain(s) vs. open peritoneal drainage +/- Feeding tube

Drains Jackson-Pratt Sump Penrose

Jackson-Pratt Abdominal Drain Multiple fenestrations 7-10 mm

Jackson-Pratt Abdominal Drain

Jackson-Pratt Abdominal Drain Multiple fenestrations 7-10 mm 100 or 400 ml reservoir

Jackson-Pratt Abdominal Drain Multiple fenestrations 7-10 mm 100 or 400 ml reservoir Do not require 2nd surgery

Drains Jackson-Pratt Sump (double lumen, air in & fluid out) Penrose Commercially available vs. Homemade

Open Peritoneal Drainage Requires more intensive care Risk of ascending bacterial infection Requires second anesthetic/surgical episode Loose simple continuous pattern in the linea Tie-on bandage Thick sterile absorptive layer followed by a non-permeable layer Bandages changes potentially several times a day with “sterile technique”

Post-op Intensive care Intensive treatment Intensive monitoring