MULTIPLE LAPAROTOMIES FOR SEVERE INTRAABDOMINAL INFECTION

Background: Mortality rates for patients with severe peritoneal infect ion are high. The present study was undertaken in order to examine mor tality rates in patients with severe peritoneal infection who were man aged by planned re-laparotomy. Methods: Retrospective analysis of pati ents presenting at the King Faisal Specialist Hospital and Research Ce ntre between 1992 and 1994 with severe peritoneal infection was undert aken. Results: A total of 52 patients underwent either single (n = 30) or multiple (n = 22) peritoneal lavage, and Acute Physiology and Chro nic Health Evaluation (APACHE II) scores and predicted mortality rates were calculated for these patients. The predicted mortality rate for patients undergoing a single washout was 42.4%, actual mortality: 23%. The predicted mortality for patients undergoing multiple washouts was 55.6%, actual mortality: 36.3%. No patient with a predicted mortality of <30% who underwent multiple washouts died. Of nine patients with a predicted mortality between 31 and 60%, one died (11.1%). For a predi cted mortality of 61-80%, five of six patients died (83.3%), and for p atients with a predicted mortality of >80%, two of three died (66.7%). Conclusions: The utilization of planned re-look laparotomy and perito neal lavage in patients with severe peritonitis may result in a signif icant decrease in mortality as predicted by APACHE II scoring.