Is repeat laparotomy of value in patients with suspected intra-abdominal sepsis in the intensive care unit?

The management of patients with suspected post laparotomy intra-abdominal sepsis poses a major therapeutic challenge to clinicians. The mortality is high and the optimal interventional modality remains ill-defined. We define the incidence, diagnostic methodology, pre- and postoperative findings and outcome of patients going from the intensive care unit for a repeat laparotomy in search of abdominal sepsis over a one year period. Fifteen patients were included with an overall mortality of 60 percent. In 6 cases more than one relaparotomy was performed with a mortality of 50 percent. Sepsis was found in 14 of the 15 cases with a mortality of 57 percent and the patient with a normal relaparotomy died. The primary surgery was elective in 26 percent of cases and the mortality was 50 percent. All the non-survivors required mechanical ventilation, inotropic support and continuous veno-veno haemodialysis while the survivors required less organ support. Radiological assessment (ultrasound scan and CT scan) were no better at predicting an abnormal relaparotomy than clinical assessment. Higher mortality rates were associated with increasing age and multi-system organ failure (p < 0.05).