LEUKOCYTE SCINTIGRAPHY OR COMPUTED-TOMOGRAPHY FOR THE FEBRILE POSTOPERATIVE-PATIENT

Objective: The optimal initial investigation for the post-operative pa tient with suspected occult intra-abdominal sepsis is controversial, a lthough the diagnostic accuracy of a variety of techniques is known. O ur objective is to determine which investigation has the greatest posi tive effect on patient management. Methods and patients: We reviewed 6 7 consecutive post-operative patients investigated for suspected occul t sepsis retrospectively and analysed the sequence of investigations r equired to achieve the diagnosis depending on the choice of initial in vestigation, and the interval between initiating investigations and pe rforming definitive percutaneous drainage. Results: Forty patients had scintigraphy as the initial investigation and 21 of these went on to require CT. None of the 27 patients who had CT as the initial investig ation required any other imaging (chi(2) = 20.6, P < 0.0001) and appro priate percutaneous drainage was ofered immediately. Conversely, the a verage interval to drainage in those who had scintigraphy first was 3. 1 days, Fourteen out of 20 patients (70%) who had scintigraphy as the initial investigation following recent surgery, and 7 of 20 (35%) foll owing old surgery, needed subsequent CT. None of the 20 and 7 patients in the recent and old surgery groups respecitvely who had CT initiall y required further imaging. Conclusion: Our results suggest recommendi ng CT as the initial investigation in the early post-operative period as this will reduce the total number of investigations required to ach ieve the diagnosis and the time to definitive drainage, In the late po st-operative period, scintigraphy will resolve the majority of problem s.