Surgery Outline Common causes Goals Surgical approach Surgical techniques Drains Postop Common Causes Gastrointestinal tract Intestinal RA Dehiscence Common Causes Gastrointestinal tract ID: 916618
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Slide1
Septic Abdomen Surgery
Jayce Lineberger, DVM, DACVS
Slide2Surgery Outline
Common causesGoals
Surgical approach
Surgical techniques
Drains
Post-op
Slide3Common Causes
Gastrointestinal tract
Slide4Intestinal R/A
Slide5Dehiscence
Slide6Common Causes
Gastrointestinal tractPenetrating wounds
Migrating foreign bodies
Hepatic abscess
Pancreatic abscess
Genitourinary tract
Slide7Goals
Eliminate the sourceRepair damageReduce bacterial load
Consider nutritional support
To drain or not to drain
Slide8Still closed?
Slide9Surgical Approach
Ventral midline celiotomyDirectly over wounds
Slide10Surgical 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
Slide11Surgical Techniques
Systematic evaluation of all intra-abdominal structuresThe source is usually at the site of the most adhesions
Lavage
Drain(s) vs. open peritoneal drainage
+/-
Feeding tube
Slide12Drains
Jackson-PrattSumpPenrose
Slide13Jackson-Pratt Abdominal Drain
Multiple fenestrations
7-10 mm
Slide14Jackson-Pratt Abdominal Drain
Slide15Jackson-Pratt Abdominal Drain
Multiple fenestrations
7-10 mm
100 or 400 ml reservoir
Slide16Jackson-Pratt Abdominal Drain
Multiple fenestrations
7-10 mm
100 or 400 ml reservoir
Do not require 2
nd
surgery
Slide17Drains
Jackson-PrattSump (double lumen, air in & fluid out)
Penrose
Slide18Open Peritoneal Drainage
Requires more intensive careRisk of ascending bacterial infection
Requires second anesthetic/surgical episode
Slide19Post-op
Intensive careIntensive treatment
Intensive monitoring